FSRA is probing health service providers and the auto insurance sector after concerns arose about whether PPNs restrict a car accident victim’s ability to choose where they receive medical treatment or other health services after they file a claim with their car insurance company. A sign points visitors toward the financial services department at a hospital on Jan. 24, 2014.David Goldman/The Associated Press
Ontario’s financial services regulator has launched a review of health care professionals who sign preferential deals with auto insurers, responding to concerns that insurers are steering car accident victims toward certain health service providers, such as physiotherapists.
The Financial Services Regulatory Authority of Ontario (FSRA) announced that as part of a new supervision plan for health service providers, it will start to conduct examinations of health services that participate in preferred provider networks.
Also referred to as PPNs, these arrangements typically involve auto insurers providing a “recommended list” of health-care providers for individuals to use for medical treatment or rehabilitation.
PPNs came into the spotlight more than a year ago when Canada’s largest insurer, Manulife Financial Corp., and the country’s largest grocery and pharmacy retailer, Loblaw Cos. Ltd. L-PR-B-T, struck an exclusive PPN deal. The arrangement would have required people covered by Manulife’s group benefits to fill prescriptions for certain specialty medications at Loblaw-owned pharmacies, including Shoppers Drug Mart.
After public backlash, the two companies backtracked on the agreement.
But the increased scrutiny on the issue has led to calls for tighter regulation of PPNs across several sectors. Ontario’s Ministry of Finance is currently reviewing submissions for a consultation it launched on whether policy intervention is needed on PPN agreements between insurers and the pharmaceutical industry.
Now, FSRA is probing health service providers and the auto insurance sector after concerns arose about whether PPNs restrict a car accident victim’s ability to choose where they receive medical treatment or other health services after they file a claim with their car insurance company.
“If evidence of consumer harm is uncovered through our supervision programs or any other method, we will take appropriate action,” FSRA spokesperson Russ Courtney said in an e-mail to The Globe and Mail.
FSRA said its review will also address allegations that health service providers solicit referral fees from insurance companies in connection to the goods and services they provide to insurance claimants. (Regulatory rules prohibit a referral fee from being solicited, demanded, paid or accepted in connection with any goods and services by a health services provider.)
“The purpose of this initiative is to understand how insurers and health service providers are managing their PPN agreements to ensure fair treatment of claimants and compliance with regulatory requirements,” FSRA said in the supervision plan.
Individuals who suffer an injury from a motor vehicle accident may need to make an insurance claim to cover their health and rehabilitative costs. FSRA is the regulatory body that licenses health service providers that receive direct payments from insurance companies.
FSRA said it first began to gather information on PPNs in the spring of 2024 to better understand the potential for risks in these arrangements, particularly in relation to conflicts of interest and fair treatment of customers. At that time, the information gathered “verified” the potential for risks within PPN arrangements, FSRA said.
A spokesperson for the College of Physiotherapists of Ontario, Alison Sandstrom, said the college is aware of the review on auto PPNs, and that it will continue to monitor the “space for any potential impacts on the public interest.”
However, health care professionals are concerned that FSRA is not talking to all the stakeholders involved in PPN agreements – including the insurance companies that are on the other side of the deals.
“FSRA must avoid reinforcing a system that prioritizes insurers over ethical health care,” said Darryl Tempest, CEO of HRC Innovations Inc., a political advocacy firm specializing in public health policy.
“The review should incorporate input from patients, families and independent clinics, with oversight from the Ministry of Finance and health care associations.”
Anthony Grande, an Ontario-based physiotherapist, echoed the need for a more robust review process. In an e-mail to The Globe, Mr. Grande said that the “complex ethical and care concerns” involved may extend beyond the traditional scope of a financial regulator.
“To ensure a truly inclusive and transparent process, it is essential that the FSRA’s efforts be augmented by the active involvement of the Ministry of Finance, health-care professional associations, health-care colleges and, most importantly, the voices of independent clinics and patients – both within and beyond the PPN framework,” Mr. Grande said.
“Failing to take this comprehensive approach risks compromising patient recovery, undermining family well-being, and eroding public trust further.”