Overbilling ‘a problem’

Drivers to pick up the tab in insurance premiums

Hundreds of health-care providers in Ontario are billing insurance companies for an improbable number of daily hours spent treating car crash victims, recent insider data suggest.

However, no one appears to be leading a charge against the potentially 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 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 closely held data obtained by The Canadian Press suggest some chiropractors, physiotherapists, psychologists, massage therapists or other providers are billing for an excessive number of hours frequently averaging more than 24 hours per day.

The so-called “impossible day” data are drawn from the mandatory clearing system known as Health Claims for Auto Insurance or HCAI. Health-care providers are required to submit claims forms electronically through HCAI to bill auto insurance companies directly for treatment of patients and clients.

Canadian Insurance Crime Services, better known as Canatics and whose mandate is to fight insurance crime, has in the past year been quietly using massaged HCAI data in an effort to identify individual high billers, something not previously possible on a wide scale.

Canatics, which comprises nine insurance companies owning about 75 per cent of the auto-insurance market in Ontario, identified at least 700 “suspicious” billers through the new process.