Ontario clinic loses service provider license over insurance fraud scheme
Ontario clinic loses service provider license over insurance fraud scheme | Insurance Business Canada
Insurance News
Ontario clinic loses service provider license over insurance fraud scheme
It billed insurers for treatments that were never performed, says regulator
Insurance News
By
Mika Pangilinan
A rehabilitation clinic in Ontario has had its service provider license revoked by the province’s financial services regulator after it was found to have submitted falsified invoices to insurers.
The Financial Services Regulatory Authority of Ontario (FSRA) investigation found that Gibson Wellness Centre billed several insurance companies throughout 2020 for services that were never provided.
Certas, Allstate, and Intact received invoices from the clinic through the Health Claims for Auto Insurance system. They were billed for $205,564, with Gibson Centre being paid $183,033.
According to FSRA, the invoices were submitted on behalf of two health practitioners employed by Gibson Centre at the time.
These two practitioners later told investigators that they did not provide treatments to the claimants, stating that the clinic had been closed on the dates indicated in the invoices due to the COVID-19 pandemic.
FSRA has fined Gibson Centre an administrative penalty of $200,000 and revoked its service provider license. It also issued a $50,000 penalty to Thavendrarajah Krishna, who went by the name Krish Thavem and was the clinic’s former director.
Both Gibson Centre and Krish Thavem were found to have provided false and misleading statements to insurers. They also engaged in unfair or deceptive acts, according to FSRA.
Another $10,000 fine was issued to Sellamma Navaratnam, designated as the principal representative on Gibson Centre’s license application in 2020. Her penalty stems from failing to ensure clinic operations comply with the law.
FSRA said it initiated its investigation after receiving a complaint from Équité Association, a non-profit organization dedicated to helping P&C insurers combat insurance fraud.
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