HCAI Anti-Fraud Working Group

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The HCAI (Health Claims for Auto Insurance) Anti-Fraud Working Group was created by the Ontario Automobile Insurance Anti-Fraud Task Force Steering Committee to investigate how the HCAI system could be used to detect and prevent fraud in Ontario’s auto insurance system. The Group is made up of representatives from the government, health care and insurance sectors.

Professional Credential Tracker

The HCAI Anti-Fraud Working Group requested the development of a software tool called the Professional Credential Tracker (PCT) as a possible solution to address health professional identity misuse in Ontario's auto insurance system.

PCT provides information to help health professionals prevent their identities from being misused by Health Care Facilities. Health professionals who use PCT can see which Facilities have registered their credentials in their Associated Providers list to bill Insurers in the HCAI system, and, if concerned, health professionals may report any questionable activity to HCAI Processing’s Chief Privacy Officer.

PCT is by invitation only. If participating, your health regulatory college may be able to inform you of which health care facilities have registered your credentials as an associated Provider in HCAI.

To learn more about managing your professional credentials and how to request your professional information in HCAI, visit the Access and Security page in the Health Care Facility portal’s Privacy section.

For more information about reducing fraud and abuse in the Ontario auto insurance system, please visit Final report of the Steering Committee.

You can also click here to learn about FSCO’s Anti-Fraud Task Force.

Facility responsibilities in HCAI

Section 4.1 of the HCAI Terms and Conditions agreement signed by the Authorizing Officer upon your Facility’s registration in HCAI states that the “User agrees to maintain a current list of Affiliated Providers and Dependent Providers”. If you own or operate a Health Care Facility, you are responsible for

• Remaining in regular contact with the health professionals active on your Associated Provider list, even if they are not regular full-time employees
• Ensuring these individuals know they are, and consent to be, associated with your Facility
• Removing health professionals from your Facility’s Associated Provider list when your association with them has ended

What We Have Learned About Professional Credential Misuse

The goal of the PCT “proof-of-concept” (POC) initiative is to determine whether an online software tool could be used to answer questions about the use of health professional credentials in HCAI. In early 2012, at the request of the HCAI Anti-Fraud Working Group, the College of Audiologists and Speech-Language Pathologists volunteered as a pilot group for the initial phase of the PCT POC, and collaborated to advance the POC process.

The initial POC phase was highly successful, and the outcomes were applicable across other health professions. As a result, three additional POC phases were completed with the College of Psychologists of Ontario, the College of Occupational Therapists of Ontario, and the College of Physiotherapists of Ontario. Feedback from the participating health professionals remains very positive.

Evidence from the Health Regulatory Colleges that participated

• In total, 664 regulated health professionals received PCT reports, and more than 500 of these participants completed surveys about their findings
• 69% of survey participants did not have accurate knowledge of the number of Facilities with which they were associated in the HCAI system
• The average survey participant believed s/he was included in only 2.1 HCAI-enrolled Facilities. In fact, the average was 4.6 Facilities—more than double what participating health professionals expected.

What does the evidence suggest?

Results from the Health Regulatory Colleges that participated suggest:

• Communication between Facilities and health professionals requires more attention
• The PCT POC needs to be completed so usability of the tool can be accurated evaluated
• Agreement on the full solution and the information it should provide to create the necessary transparency must be established prior to PCT becoming available to all regulated health professions in Ontario.

Who has participated in POC?

During the POC phase, PCT access is by invitation only. The HCAI Anti-Fraud Working Group wishes to thank the following colleges for the time and resources they have invested as participants in the POC phase: College of Audiologists and Speech-Language Pathologists of Ontario, College of Psychologists of Ontario, College of Occupational Therapists of Ontario, College of Physiotherapists of Ontario, and College of Chiropractors of Ontario.