Insurer De-Listing: The Hidden Penalty of a Health Professions' Discipline Committee Finding

Monday, December 12, 2022Lad KucisLitigation, Health LawDisciplinary Hearing

As a lawyer who regularly assists regulated health professionals (RHPs) in matters before their respective Discipline Committees, I wanted to alert RHPs about an increasing trend on the part of a number of extended health insurance companies.

Namely, in my experience, certain insurers are now actively reviewing the Discipline Committee decisions of various health professions colleges (which are posted online) and are proceeding to “de-list” RHPs who have been suspended in respect of “billing-related” conduct.

In such cases, the RHP will typically receive a short letter from the insurer advising that they have been de-listed as an approved provider due to administrative and/or billing practices, with no further information provided.

Speaking from experience, I know that it is extremely difficult to convince an insurer to set aside a de-listing decision – even after the passage of several years and the completion of restitution and/or remediation.

Needless to say, being de-listed by one or more insurance companies can have a crippling economic effect on an RHP, and in numerous instances, it has resulted in the RHP voluntary ceasing to practice their profession.

It is imperative that RHPs (and their counsel) are aware of this new reality and keep it in mind when responding to complaints and in considering resolutions before their respective Discipline Committees. It should also re-enforce the importance of ensuring that accounts are being submitted in accordance with all applicable college/insurer rules. A PDF version is available to download here.

About the Author

For more information please contact: Lad Kucis at 416.864.3114 or lkucis@grllp.com

Lad Kucis is certified by the Law Society of Ontario as a specialist in health law. As part of his practice, he provides advice and representation to chiropractors and other regulated health professionals regarding the full spectrum of college matters, including complaints, investigations, discipline and appeals/reviews.

This article has been prepared for information purposes only and is not intended to be construed as legal advice.