Health-care providers are overbilling insurers for auto collision patients using impossible hours

Published: March 31, 2018

Updated: July 24, 2018

Author: Luke Jones

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Health-care providers in Ontario are inexplicably billing insurance companies for a number of daily hours for treating auto collision victims that data suggests is improbable. The clear takeaway from the information is there is potential fraudulent activity and it is rife. Despite this, no company or authority is attempting to deal with a situation that could be costing the industry millions of dollar each year.

“Right now, it’s a shared problem between the industry, individual insurers, the colleges that oversee these different types of practitioners…and then the government,” said Ben Kosic, CEO of the Canatics insurance consortium. “It isn’t clear that any one party holds either the keys to the solution or the responsibility.”

The data, received by The Canadian Press, points to medical practitioners overbilling for the number of hours they work. Interestingly, the data suggests some physiotherapists, psychologists, massage therapists, and chiropractors are billing on average more than 24 hours per day.

Amazingly, insurers are not easily picking up on this obvious flaw billing. Called “impossible day” data, the information is from the mandatory clearing system known as Health Claims for Auto Insurance or HCAI. Under Ontario law, health-care providers must submit claims forms using HCAI to bill auto insurance companies for treatment of clients.

“Clearly, when there are multiple days across a year where a provider appears to be overbilling, that is a good trigger to do a more thorough investigation,” Kosic said. “These are not in and of itself proof that anybody is doing anything fraudulent but it’s certainly a good trigger to launch a more formal investigation, where the forms can be pulled and the details of those forms can be investigated.”