Dear Health Professional,
In early 2014, the Health Claims for Auto Insurance (HCAI) Anti-Fraud Working Group
distributed two flyers related to professional identity misuse. The flyers highlighted the
Professional Credential Tracker (PCT) pilot project, its progress and preliminary results, and
how health professionals can prevent the misuse of their credentials. This third and final flyer
highlights the final results of the PCT pilot.
Between 2012 and 2014, six regulatory colleges participated in the pilot. The evidence suggests
the PCT is a valuable tool in identifying and preventing fraud in the auto insurance system.
The HCAI Anti-Fraud Working Group continues to identify ways to enhance the PCT tool and
how it can be marketed to a wider audience.
Sincerely,
Members of the Coalition of Health Professional Associations in Ontario Insurance Services on
behalf of the HCAI Anti-Fraud Working Group
____________________
_____________________
___________________
Dr. Moez Rajwani
Dr. Faith Kaplan
Ms. Karen Rucas
Ontario Chiropractic Association
Ontario Psychology Association
Ontario Society of Occupational Therapists
Overview
 The goal of the PCT “proof-of-
concept” (POC) initiative was to
determine whether an online
software tool could be used to
answer questions about the use
of health professional credentials
in HCAI.
 65% of participating health care
professionals did not have correct
information, prior to receiving
their PCT report, about how
many facilities maintained their
credentials in HCAI.
 11% of health care professionals
responding to the survey learned
via PCT that their credentials had
been added to at least one HCAI
facility that s/he had never been
affiliated with. Many of these
initiated IBC investigations.
 22% of participants found that at
least one facility had inaccurately
recorded their name, profession
or credentials in HCAI.
 Results were consistent across all
nine professions that piloted PCT:
audiologists, chiropractors, massage therapists, neuropsychologists, occupational therapists,
physiotherapists, psychological
associates, psychologists, and
speech-language pathologists.
Feedback from the participating
health care providers across all
these professions was very positive.
Professional Identity Misuse & the Auto Insurance System
The Health Claims for Auto Insurance (HCAI) Anti-Fraud Working Group was created by the Ontario Automobile Insurance Anti-Fraud Task Force Steering Committee to investigate how the HCAI system could be used to detect and prevent
fraud in Ontario’s auto insurance system. The Group is made up of representatives from the Ministry of Finance, the Financial Services Commission of Ontario
(FSCO), health care and insurance sectors.
The HCAI Anti-Fraud Working Group requested the development of a software
tool called the Professional Credential Tracker (PCT) as a possible solution to address health professional identity misuse in Ontario’s auto insurance system. As
endorsed by the Automobile Insurance Anti-Fraud Task Force, the PCT “proof-ofconcept” (POC) initiative was launched with six Health Regulatory Colleges and
ran from 2011 to 2014.
What is PCT?
PCT is a software application that provides information to help health professionals prevent their identities from being misused. Professionals who use the
PCT program receive a complete list of all HCAI enrolled facilities that have listed
the health professional as an Associated Provider and, therefore, have the ability
to invoice insurers with these credentials.
Evidence from the Health Regulatory Colleges that participated

In total, 1022 regulated health professionals received PCT reports, and 714
of these participants completed surveys about their findings.

65% of survey participants did not have accurate knowledge of the number
of facilities with which they are associated in the HCAI system.

The average survey participant believed s/he was included in only 2 HCAIenrolled facilities, but in fact, the average was 4 facilities.
What does the evidence suggest?
Results from the Health Regulatory Colleges that participated suggest:

PCT is easy to use and accurate: colleges can be confident about offering PCT to
their members;

The high error rate by facilities in entering health care providers’ credentials indicates a need to validate the professional registration information entered into
HCAI.

Health care facilities do not consistently manage their provider list to ensure it remains current and relevant. Participating health care providers requested an improved facility compliance process.

Health care providers underestimate the risk to their credentials. A behavioural
driver to advance use of the tool has yet to be identified.

Agreement on the full solution and the information it should provide to create the
necessary transparency must be established by all stakeholders prior to PCT becoming available to all regulated health professions in Ontario.
Who participated in the pilot
The HCAI Anti-Fraud Working Group wishes to thank the following colleges for the
time and resources they have invested into participating in the POC phase:

College of Audiologists and Speech-Language Pathologists of Ontario

College of Psychologists of Ontario

College of Occupational Therapists of Ontario

College of Physiotherapists of Ontario

College of Chiropractors of Ontario

College of Massage Therapists of Ontario
Learn More
For more information about reducing fraud and abuse in the Ontario auto insurance
system please visit:

FSCO



http://www.fsco.gov.on.ca/en/auto/brochures/Pages/auto-reducingabuse.aspx
Automobile Insurance Anti-Fraud Task Force, Final report of the Steering Committee
http://www.fin.gov.on.ca/en/autoinsurance/final-report.html