Dear Health Professional, In early 2014, the Health Claims for Auto Insurance (HCAI) Anti-Fraud Working Group distributed two flyers related to professional identity misuse. The flyers highlighted the Professional Credential Tracker (PCT) pilot project, its progress and preliminary results, and how health professionals can prevent the misuse of their credentials. This third and final flyer highlights the final results of the PCT pilot. Between 2012 and 2014, six regulatory colleges participated in the pilot. The evidence suggests the PCT is a valuable tool in identifying and preventing fraud in the auto insurance system. The HCAI Anti-Fraud Working Group continues to identify ways to enhance the PCT tool and how it can be marketed to a wider audience. Sincerely, Members of the Coalition of Health Professional Associations in Ontario Insurance Services on behalf of the HCAI Anti-Fraud Working Group ____________________ _____________________ ___________________ Dr. Moez Rajwani Dr. Faith Kaplan Ms. Karen Rucas Ontario Chiropractic Association Ontario Psychology Association Ontario Society of Occupational Therapists Overview The goal of the PCT “proof-of- concept” (POC) initiative was to determine whether an online software tool could be used to answer questions about the use of health professional credentials in HCAI. 65% of participating health care professionals did not have correct information, prior to receiving their PCT report, about how many facilities maintained their credentials in HCAI. 11% of health care professionals responding to the survey learned via PCT that their credentials had been added to at least one HCAI facility that s/he had never been affiliated with. Many of these initiated IBC investigations. 22% of participants found that at least one facility had inaccurately recorded their name, profession or credentials in HCAI. Results were consistent across all nine professions that piloted PCT: audiologists, chiropractors, massage therapists, neuropsychologists, occupational therapists, physiotherapists, psychological associates, psychologists, and speech-language pathologists. Feedback from the participating health care providers across all these professions was very positive. Professional Identity Misuse & the Auto Insurance System The Health Claims for Auto Insurance (HCAI) 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 Ministry of Finance, the Financial Services Commission of Ontario (FSCO), health care and insurance sectors. 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. As endorsed by the Automobile Insurance Anti-Fraud Task Force, the PCT “proof-ofconcept” (POC) initiative was launched with six Health Regulatory Colleges and ran from 2011 to 2014. What is PCT? PCT is a software application that provides information to help health professionals prevent their identities from being misused. Professionals who use the PCT program receive a complete list of all HCAI enrolled facilities that have listed the health professional as an Associated Provider and, therefore, have the ability to invoice insurers with these credentials. Evidence from the Health Regulatory Colleges that participated In total, 1022 regulated health professionals received PCT reports, and 714 of these participants completed surveys about their findings. 65% of survey participants did not have accurate knowledge of the number of facilities with which they are associated in the HCAI system. The average survey participant believed s/he was included in only 2 HCAIenrolled facilities, but in fact, the average was 4 facilities. What does the evidence suggest? Results from the Health Regulatory Colleges that participated suggest: PCT is easy to use and accurate: colleges can be confident about offering PCT to their members; The high error rate by facilities in entering health care providers’ credentials indicates a need to validate the professional registration information entered into HCAI. Health care facilities do not consistently manage their provider list to ensure it remains current and relevant. Participating health care providers requested an improved facility compliance process. Health care providers underestimate the risk to their credentials. A behavioural driver to advance use of the tool has yet to be identified. Agreement on the full solution and the information it should provide to create the necessary transparency must be established by all stakeholders prior to PCT becoming available to all regulated health professions in Ontario. Who participated in the pilot The HCAI Anti-Fraud Working Group wishes to thank the following colleges for the time and resources they have invested into participating 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 College of Chiropractors of Ontario College of Massage Therapists of Ontario Learn More For more information about reducing fraud and abuse in the Ontario auto insurance system please visit: FSCO http://www.fsco.gov.on.ca/en/auto/brochures/Pages/auto-reducingabuse.aspx Automobile Insurance Anti-Fraud Task Force, Final report of the Steering Committee http://www.fin.gov.on.ca/en/autoinsurance/final-report.html
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