TORONTO, May 12 /CNW/ - Pioneer Rehabilitation Clinic Inc. pleaded
guilty to knowingly making false or misleading statements to an insurer
in order to obtain payment for goods and services provided to an
insured in the Ontario Court of Justice in Toronto on May 12, 2011.
The court ordered a conviction and a $50,000 fine. Pioneer must also pay
a $12,500 surcharge to the Victims' Justice Fund.
In August 2010, the Financial Services Commission of Ontario (FSCO) laid
charges against Pioneer. Following an investigation, FSCO found that
Pioneer had submitted false treatment plans and false invoices, in some
cases to get paid for treatment that was never provided.
FSCO investigates allegations of misconduct, unfair practices and
non-compliance with legislation or regulations in its regulated
sectors. If warranted, FSCO takes enforcement action, such as
initiating a prosecution.
FSCO is an agency of the Ministry of Finance established under the
Financial Services Commission of Ontario Act, 1997. It regulates
insurance, pension plans, loan and trust companies, credit unions and
caisses populaires, co-operative corporations and mortgage brokerages
and administrators in Ontario.
"Abuses of the auto insurance system by unscrupulous participants will
not be tolerated. FSCO will continue to prosecute these abuses." -
Philip Howell, CEO and Superintendent of FSCO
Insurers have rights and responsibilities under the Statutory Accident
Benefits Schedule (SABS) to challenge questionable or abusive claims,
including verifying invoices and expenses.
Ontario is establishing an auto insurance anti-fraud taskforce to
determine the scope of auto insurance fraud in Ontario and make
recommendations on detection, investigation, enforcement and consumer
As of February 1, 2011, all Ontario health care facilities or providers
were required to transmit auto insurance claim forms to insurers
through Health Claims for Auto Insurance (HCAI). This database will
help to detect auto insurance abuses.
Ontario auto insurers will be required to annually attest that their
companies have established effective compliance controls to satisfy the
rules that protect the rights of policyholders and accident victims.
SOURCE Financial Services Commission of Ontario
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