Psychologist fined over accident benefits statements
An Ontario registered psychologist has been fined $15,000 and suspended from practice for a total of 24 months after a regulator found he made misleading accident benefits statements to insurers.
The Financial Services Regulatory Authority of Ontario (FSRA) has imposed a compliance order against Romeo Vitelli, which prohibits him from conducting examinations, assessments, or treatment plans under the Statutory Accident Benefits Schedule for a 24-month period.
“Vitelli, a registered psychologist, made misleading statements or representations to insurers to obtain payment for services provided to an insured. Vitelli submitted 13 reports to insurers that contained quotations about symptoms that were not said by the claimants,” a release by FSRA stated. “He also submitted a treatment plan to an insurer that indicated a claimant was employed prior to an accident when the claimant was retired.”
The agreed statement of facts outlined in the settlement show Vitelli completed assessments, examinations, reports and forms under the SABS on behalf of multiple health service providers, including Novo Medical Services Inc.
Novo Medical provides rehabilitation treatments to people who’ve suffered injuries from motor vehicle accidents. Novo Medical then bills insurers under motor vehicle insurance policies for these services.
With the assistance of Novo staff, Vitelli prepared Psychological Evaluation Reports and Catastrophic Evaluation Reports for clients. These reports would then be submitted to the insurer by Novo Medical staff, according to the settlement.
“As a psychologist, Vitelli was authorized to complete Part 4 and Part 5 of Treatment Plans. He completed Part 4 and Part 5 of Treatment Plans for Novo Medical clients, supported by Novo Medical staff,” the settlement reads.
Parts 4 and 5 of the Treatment and Assessment Plan OCF-18, among other things, ask health practitioners and regulated health professionals to certify the information provided is true and correct, and verify they understand it’s an offence under the Insurance Act to knowingly make a false or misleading statement or representation to an insurer under an insurance contract.
Vitelli admitted to the regulator that between November 2017 and October 2018, he’d submitted 12 Psychological Evaluation Reports and one Catastrophic Evaluation Report to two separate insurers that contained phrases not actually said by claimants.
He also admitted to submitting a treatment plan to an insurer that suggested the claimant had been employed prior to the accident, when the claimant was actually retired.
According to the settlement, Vitelli has not provided services through Novo Medical since 2019.
As part of the settlement, Vitelli has been ordered by FSRA, for a 24-month period between Apr. 25, 2023 to Apr. 25, 2025, to refrain from:
Conducting examinations for the purposes of assisting an insurer to determine if an insured person is or continues to be entitled to a benefit under the Statutory Accident Benefits Schedule (SABS).
Conducting assessments or examinations in connection with a determination of catastrophic impairment under the SABS.
Preparing, completing, and signing the Treatment and Assessment Plans (OCF- 18) as a regulated health professional or health practitioner under the SABS.
Directly or indirectly invoicing insurers for any of the above services, except for those services provided on or before the date the order is issued.
In a separate action, on Mar. 2019, the College of Psychologists took disciplinary action against Vitelli following allegations of professional misconduct, according to the notice of proposal.
“The undertaking addressed concerns regarding the adequacy of Dr. Vitelli’s supervision of individuals who provided psychological services under his professional responsibility,” the notice read.
The College of Psychologists of Ontario suspended Vitelli for nine months starting Apr. 25, 2023.
Feature image by iStock.com/Jacob Wackerhausen
