Regulator revokes healthcare provider licence for insurance fraud

Ontario’s financial services regulator has revoked the healthcare service provider licence of a Markham clinic and imposed administrative penalties against the clinic and two individuals in connection with fraudulent billing practices.

The Financial Services Regulatory Authority of Ontario (FSRA) revoked the service provider licence and administered a $200,000 penalty against Gibson Wellness Centre Inc. (Gibson Centre). The regulator also revoked the service provider licence of Gibson Wellness Group Ltd. (Gibson Group) and imposed administrative penalties of $50,000 against Thavendrarajah Krishnan (Krish Thavem) and $10,000 against  Sellamma Navaratnam  (Navaratnam).

Gibson Centre and Krish Thavem submitted false invoices to insurers, charging them for services not rendered, FSRA said in a press release Thursday. The false invoices reflected services by two health practitioners who deny providing the services when the clinic was closed due to the COVID-19 lockdown.

Gibson Centre and Krish Thavem contravened the Insurance Act by providing false and misleading statements or representations to an insurer contrary to section 447(2)(a.3) of the Act and engaged in unfair or deceptive acts or practices contrary to section 439 of the Act.

“Gibson Centre and Gibson Group are not suitable to be licensed based on this conduct,” FSRA said in the release.

Both Gibson Centre and Gibson Group operated out of the same location.

Navaratnam, who was the principal representative for Gibson Centre, failed to take reasonable steps to ensure that its operations were carried out in accordance with the law and with integrity and honesty contrary to sections 2(1) and 2(2) of Ontario Regulation 349/13 (Service Providers – Principal Representatives) under the Insurance Act.

Enforcement action documentation from FSRA noted that the regulator received a complaint in December 2021 from Équité Association on behalf of eight insurers alleging that Gibson Centre billed for services not rendered and overbilled for services provided to patients.

FSRA investigated the complaint about statutory accident benefits forms through the Health Claims for Auto Insurance (HCAI) system related to treatment and assessment plans (OCF-18) and auto insurance standard invoices (OCF-21). Gibson Centre submitted treatment plans and invoices for services not provided by a psychologist (Dr. F) and registered massage therapist (WC), both of whom resigned in December 2021 and November 2020, respectively.

“Gibson Centre falsely billed a total of $205,564.53 to insurance companies by submitting invoices through HCAI for services that Dr. F did not provide,” FSRA said. “Of this amount, Gibson Centre was paid $183,033.83.”

During the investigation, Dr. F provided sworn statutory declarations stating that the services were falsely billed on invoices. The services were not provided because Gibson Centre was closed from March 28, 2020 until July 23, 2020 due to the COVID-19 pandemic. Gibson Centre also submitted $15,619.24 worth of invoices for services not rendered by WC because the services allegedly occurred on days WC was not at the clinic. “It is not clear how much of these invoices were paid out to Gibson Centre,” FSRA said.

Krish Thavem was previously a director of Gibson Centre and “Dr. F informed FRSA that Thavem was responsible for the completion and submission of treatment plans and invoices.”

Gibson Centre, Gibson Group, Navaratnam and Krish Thavem did not request a hearing or contest FSRA’s proposal.