Take 5 PATIENT CARE Health care providers billing ‘impossible’ hours treating car crash victims TORONTO — Hundreds of health care providers in Ontario are billing insurance companies for an im-probable number of daily hours spent treating car crash victims, recent insider data suggest. However, no one appears to be leading a charge against the po-tentially fraudulent overbilling worth millions of dollars a year, leaving it to drivers to pick up the tab in the form of higher insurance premiums. “Right now, it’s a shared prob-lem between the industry, individ-ual insurers, the colleges that oversee these different types of practitioners...and then the gov-ernment,” says Ben Kosic, CEO of the Canatics insurance consorti-um. “It isn’t clear that any one party holds either the keys to the solution or the responsibility.” The closely held data obtained by The Canadian Press suggest some chiropractors, physiothera-pists, massage therapists or other providers are billing for an exces-sive number of hours – frequently averaging more than 24 hours per day. The so-called “impossible day” data are drawn from the mandato-ry clearing system known as Health Claims for Auto Insurance or HCAI. Health care providers are required to submit claims forms electroni-cally through HCAI to bill auto in-surance companies directly for treatment of patients and clients. Canadian Insurance Crime Services (Canatics), has been qui-etly using massaged HCAI data in an effort to identify individual high billers throughout the past year. Canatics, which comprises nine insurance companies owning about 75 per cent of the auto-in-surance market in Ontario, identi-fied at least 700 “suspicious” billers through the new process. The Financial Services Commission of Ontario, which regulates the insurance industry and has the power to fine or take other action against scoff-laws, has reported an “unacceptable” 70 per cent of providers were in violation of various rules in 2016-2017 – an improvement from the 85 per cent non-compliance re-ported a year earlier. Violations included submitting unsigned claims forms or failing to verify patient identities. Prosecutions, however, are rare. A spokeswoman said the com-mission will conduct a “thorough” investigation where it has evidence of non-compliance, and encourag-es the industry and those providing health services to report suspect-ed fraud. The Ontario government, which did not respond to questions, is in the process of setting up a Serious Fraud Office although it remains to be seen how much of its attention will be devoted to auto insurance. The Insurance Bureau of Canada, which speaks for most of the in-dustry, said the office should help – once it’s up and running. Colleges, which regulate the various health care professions, say members must adhere to rules and guidelines around billing. “If you are aware of any inappro-priate behaviour, I encourage you to bring it to the attention of the college,” says Jo-Ann Willson, registrar of the College of Chiropractors of Ontario. “If there is HCAI information about chiro-practors, please feel free to for-ward that to us for review.” – Colin Perkel, The Canadian Press For more health care news and research, visit us at canadianchiropractor.ca May 2018 Canadian Chiropractor 9 NUMBER CRUNCH Around the world The new series from The Lancet highlights a few facts on low back pain: Here’s what’s going wrong. 540 million Source: WFC press release; Illustration by Brian Fray The number of people, mostly of working age, who are experiencing low back pain at any given time Low back pain is the number one cause of disability worldwide #1 The return to work rate of people with chronic low back pain in Germany www.canadianchiropractor.ca 22% $12.8 billion (US) The amount spent on spinal fusion surgery in the U.S. in 2011
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