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Financial Services Regulatory Authority of Ontario

IN THE MATTER OF the Insurance Act, R.S.O. 1990, c.I.8, as amended (the “Act”), in particular sections 288.6 and 288.7;

AND IN THE MATTER OF Andrew Shaul Psychology Professional Corporation.


NOTICE OF PROPOSAL TO REVOKE LICENCE

TO:

Andrew Shaul Psychology Professional Corporation
3 – 421 Eglinton Avenue West
Toronto, ON M5N 1A4

Dr. Andrew Shaul
Principal Representative

TAKE NOTICE THAT pursuant to sections 288.6 and 288.7 of the Act, and by delegated authority from the Chief Executive Officer of the Financial Services Regulatory Authority of Ontario (the “Chief Executive Officer”), the Director, Litigation and Enforcement (the “Director”) is proposing to revoke the service provider’s licence issued to Andrew Shaul Psychology Professional Corporation (licence # SP14825).

Details of these contraventions and reasons for this proposal are described below. This Notice of Proposal includes allegations that may be considered at a hearing.

SI VOUS DÉSIREZ RECEVOIR CET AVIS EN FRANÇAIS, veuillez nous envoyer votre demande par courriel immédiatement à: contactcentre@fsrao.ca.

YOU ARE ENTITLED TO A HEARING BY THE FINANCIAL SERVICES TRIBUNAL (THE “TRIBUNAL”) PURSUANT TO SECTIONS 288.7(2) AND 288.7(3) OF THE ACT. A hearing by the Tribunal about this Notice of Proposal may be requested by completing the enclosed Request for Hearing Form (Form 1) and delivering it to the Tribunal within fifteen (15) days after this Notice of Proposal is received by you. The Request for Hearing Form (Form 1) must be mailed, delivered, faxed or emailed to:

Address:
Financial Services Tribunal
25 Sheppard Avenue West, 7th Floor
Toronto, Ontario
M2N 6S6

Attention: Registrar

Fax: 416-226-7750

Email: contact@fstontario.ca

TAKE NOTICE THAT if you do not deliver a written request for a hearing to the Tribunal within fifteen (15) days after this Notice of Proposal is received by you, orders will be issued as described in this Notice of Proposal.

For additional copies of the Request for Hearing Form (Form 1), visit the Tribunal’s website at www.fstontario.ca

The hearing before the Tribunal will proceed in accordance with the Rules of Practice and Procedure for Proceedings before the Financial Services Tribunal (“Rules”) made under the authority of the Statutory Powers Procedure Act, R.S.O. 1990, c. S.22, as amended. The Rules are available at the website of the Tribunal: www.fstontario.ca. Alternatively, a copy can be obtained by telephoning the Registrar of the Tribunal at 416-590-7294, or toll free at 1-800-668-0128 extension 7294.

At a hearing, your character, conduct and/or competence may be in issue. You may be furnished with further and or other particulars, including further or other grounds, to support this proposal.

REASONS FOR PROPOSAL

    I. INTRODUCTION

  1. These are the reasons for the proposal by the Director to revoke the service provider licence issued to Andrew Shaul Psychology Professional Corporation (“ASPPC”).

    2. II. BACKGROUND

  2. ASPPC is licensed as a service provider (licence #SP14825) under the Act. ASPPC was first licensed on December 1, 2014.

  3. Dr. Andrew Shaul (“Dr. Shaul”) is the principal representative of ASPPC. Dr. Shaul is a psychologist licensed by the College of Psychologists of Ontario (“CPO”). Dr. Shaul provides psychological services to individuals injured in motor vehicle accidents through ASPPC and several other licensed service providers.

    4. 2020 Review of Health Service Providers

  4. On September 16, 2020, FSRA issued an inquiry to ASPPC under the Act in the form of a 2020 Health Service Provider Market Conduct Questionnaire (“2020 Questionnaire”) to ASPPC. The 2020 Questionnaire informed ASPPC that it was due by October 7, 2020. ASPPC failed to submit the 2020 Questionnaire by the due date.

  5. ASPPC filed its completed 2020 Questionnaire on October 18, 2020 after FSRA followed up regarding the outstanding 2020 Questionnaire.

  6. A licensed service provider is required to keep the original paper version or an electronic true copy of Auto Insurance Standard Invoices (“OCF-21”) submitted to insurers bearing original authorized signatures of the regulated health professional (“Health Professional”) providing treatment, in accordance with Superintendent Guideline No. 02/18 (“Guideline”).

  7. A service provider licence grants access to the Health Claims for Auto Insurance system (“HCAI”) which allows a service provider to directly bill insurance companies for services rendered to insureds injured in automobile accidents.

  8. There are no electronic signatures on HCAI. Instead, by submitting an OCF-21 through HCAI the principal representative is attesting to the fact that an original copy of the OCF-21 signed by, or on behalf of, the Health Professional who provided treatment is on file at the service provider. This requirement ensures that there is evidence that the invoiced services were provided by the Health Professional.

  9. In response to the 2020 Questionnaire, Dr. Shaul stated that ASPPC did not follow the Guideline and did not maintain the original paper or an electronic true copy of the OCF-21 invoices submitted through HCAI. Dr. Shaul acknowledged the requirement and attested that he would “ensure that this standard is met going forward.”

    10. Failure to Respond

  10. On August 21, 2020, Aviva Insurance Company of Canada (“Aviva”) submitted a complaint regarding certain billing practices of ASPPC and Dr. Shaul.

  11. FSRA sought information from Dr. Shaul relevant to the complaint. FSRA accommodated numerous extension requests from Dr. Shaul, but he ultimately did not provide the complete requested information. As a result, FSRA issued a letter of warning to Dr. Shaul and ASPPC on November 16, 2021 regarding the failure to provide information and ASPPC’s failure to update its email address on record with FSRA.

    12. College of Psychologists of Ontario Regulatory Proceeding

  12. While reviewing the complaint, FSRA became aware of a CPO decision dated April 22, 2021 regarding Dr. Shaul’s supervision practices at ASPPC.

  13. In the decision, the CPO found that Dr. Shaul’s “supervisory arrangements do not appear to sufficiently and properly document the monitoring, planning and delivery of psychological services provided to his clients”. As a result of the decision, the CPO “decided it would be appropriate and in the public interest to ask Dr. Shaul to enter into an ACKNOWLEDGEMENT AND UNDERTAKING (“Undertaking”)” with the CPO regarding the “adequacy of his supervision of individuals who are under his professional responsibility and providing a psychological service.”

  14. The Undertaking was signed on January 28, 2021 and came into effect on June 22, 2021. Pursuant to the Undertaking, Dr. Shaul agreed to not supervise individuals who are under his professional responsibility and providing psychological services, and to have met with a Coach to transition his files to another supervisor. The Undertaking will be in effect for a minimum of two years. After two years, Dr. Shaul can request the Undertaking be removed by agreeing to be re-evaluated by a Coach prior to being able to supervise.

  15. The Undertaking also states that should the Coach not provide a final report acknowledging the CPO’s concerns were appropriately remediated in the public interest, Dr. Shaul would not be considered to have successfully complied with the Undertaking, constituting professional misconduct allowing the Registrar to proceed with an investigation in accordance with the Health Professionals Procedural Code.

    16. 2021 Review of Health Service Providers

  16. In 2021, FSRA undertook a further inquiry of ASPPC under the Act. On September 22, 2021, FSRA sent a 2021 Health Service Provider Market Conduct Questionnaire (“2021 Questionnaire”) to ASPPC, which was due by October 13, 2021. ASPPC failed to file the 2021 Questionnaire by the due date.

  17. On November 1, 2021, after numerous follow-up communications by FSRA, ASPPC filed its answers to the 2021 Questionnaire. However, the answers provided were incomplete.

  18. In the 2021 Questionnaire, Dr. Shaul stated that ASPPC now kept the original paper version or an electronic true copy of OCF-21s submitted to insurers bearing original signatures, in accordance with the Guideline. Further, Dr. Shaul wrote “N/A” with respect to a question regarding whether ASPPC has an “Authorized Signatory” designated by Health Professionals at the facility. An “Authorized Signatory” is an individual designated by other Health Professionals to sign forms on their behalf using the Health Professionals’ digital signature.

  19. FSRA requested more information with respect to the Authorized Signatory question. In doing so, FSRA determined that ASPPC did not in fact keep an original paper version or an electronic true copy of OCF-21s submitted to insurers bearing original authorized signatures, contrary to the Guideline, contrary to Dr. Shaul’s attestation that he would do so in response to the 2020 Questionnaire, and contrary to Dr. Shaul’s initial responses to the 2021 Questionnaire.

  20. Dr. Shaul responded to FSRA that he did not print signed copies of OCF-21s to save paper but had access to the HCAI versions to print and sign when necessary. The printed version of an OCF-21 from HCAI does not conform to the Guideline and a separate document bearing Dr. Shaul’s or the Heath Professional’s signature is required to be kept by ASPPC. ASPPC did not have these separate documents.

  21. Additionally, as ASPPC did not have Authorized Signatory documents for its’ Health Professionals, ASPPC could not and did not have signed or electronic true copies of OCF-21s for those Health Professionals.

  22. FSRA also determined that ASPPC’s HCAI roster of Health Professionals was outdated. ASPPC failed to remove Health Professionals from the roster in accordance with the Guideline. An updated HCAI roster protects against fraudulent billings in the name of Health Professionals who no longer provide treatment for the service provider.

  23. On February 8, 2022, after further follow up communications by FSRA, Dr. Shaul filed an updated 2021 Questionnaire correcting the false answers he had given.

  24. In subsequent communications with FSRA, Dr. Shaul blamed a former employee for the mismanagement of the business both administratively and financially, including the completion of Authorized Signatory forms.

  25. Dr. Shaul informed FSRA that he commenced a lawsuit against this former employee. However, after FSRA requested a copy of the Statement of Claim, Dr. Shaul stated that in fact he was only contemplating a lawsuit.

  26. Dr. Shaul admitted to not signing, or arranging to have signed, hardcopies of OCF- 21s to save on paper. He noted the OCF-21s were completed and submitted via the HCAI using his electronic signature. Dr. Shaul stated that the OCF-21s were printed and signed on an as needed basis and that the remaining registered psychotherapists were aware of this process and consented to the use of Dr. Shaul’s electronic signature on the documents submitted to HCAI.

    27. III. CONTRAVENTIONS OR FAILURES TO COMPLY WITH THE ACT

    A. Failure to Take Reasonable Steps to Comply with Guidelines

  27. Section 288.4(2) of the Act states that it is a condition of a service provider’s licence that the licensee is required to comply with such standards as may be prescribed with respect to its business systems and practices, in connection with statutory accident benefits, and such standards as may be prescribed with respect to matters of integrity in the management of the licensee’s operations.

  28. Section 12(1) of Ontario Regulation 90/14 provides that a licensed service provider shall conduct periodic reviews of the forms, plans, invoices, documents and other information the service provider submits to insurers in connection with statutory accident benefits in order to ensure the service provider is in compliance with the requirements under the Act and all applicable guidelines and to ensure the reconciliation of its billings.

  29. Section 15 of Ontario Regulation 90/14 states that a licensed service provider shall take all reasonable steps to ensure that the service provider complies with all applicable guidelines.

  30. Section 2(1) of Ontario Regulation 349/13 states the principal representative of a licensed service provider shall take all reasonable steps to ensure that the licensee, and every person authorized by the licensee to provide on the licensee’s behalf, goods or services in connection with listed expense, complies with the Act.

  31. Section 2(2) of Ontario Regulation 349/13 states the principal representative shall take all reasonable steps to ensure that the licensee’s business systems and practices and the management of the licensee’s operations are carried on in accordance with the law and with integrity and honestly.

  32. The Director is satisfied that ASPPC has failed to comply with the Guideline, namely in failing to keep signed OCF-21s and failing to keep its HCAI roster up to date, and therefore has failed to comply with section 288.4(2) of the Act.

  33. ASPPC, and Dr. Shaul, are obliged to know and abide by regulatory requirements governing service providers. Although ASPPC was reminded of the requirement to maintain signed OCF-21s in the 2020 Questionnaire and stated it would follow it, it failed to do so and misrepresented the status of compliance to FSRA in its’ response to the 2021 Questionnaire.

  34. Based on the continued non-compliance and misleading information provided in the 2021 Questionnaire, it appears that neither ASPPC nor Dr. Shaul, as principal representative, took reasonable steps to ensure that ASPPC was in compliance with the applicable regulatory requirements, as required under sections 12(1) and 15 of Ontario Regulation 90/14 and sections 2(1) and (2) of Ontario Regulation 349/13, or any steps to rectify ASPPC’s identified non-compliance between the inquiries made in 2020 and 2021.

    35. B. False Information to FSRA and Failure to provide Information as required

  35. Section 447(2)(a) of the Act states that it is an offence to directly furnish false, misleading or inaccurate information to FSRA whether the information is required under the Act or is volunteered.

  36. The Director is satisfied that ASPPC and Dr. Shaul provided false, misleading or incomplete information to FSRA on the 2021 Questionnaire. Dr. Shaul, on behalf of ASPPC, attested that ASPPC was maintaining OCF-21s in accordance with the Guideline and Dr. Shaul’s previous acknowledgement in 2020 that this would be done. This was false.

  37. Section 442.1(5) of the Act states a person to whom an inquiry is directed shall answer promptly, explicitly, and completely and shall do so in a manner and within the period specified by the Chief Executive Officer or the designate.

  38. Section 442.3(3) of the Act states a person to whom a request is directed under section 442.1 shall answer promptly, explicitly, and completely and shall do so in the manner and within the period specified by the Chief Executive Officer or designate.

  39. The 2020 Questionnaire and 2021 Questionnaire were inquiries under the Act directed to ASPPC and its principal representative. The 2020 Questionnaire and the 2021 Questionnaire both note on the first page that ASPPC is required to give the Chief Executive Officer full information and provide records about activities related to the business of insurance. They also note the requirement to provide the answers promptly, explicitly and completely, and in the manner and within the time period specified by the Chief Executive Officer or designate.

  40. Dr. Shaul’s responses to the 2021 Questionnaire, on behalf of ASPPC, were in the form of an Attestation which stated “I am aware that it is an offence to make a false statement to the Chief Executive Officer of FSRA under the [Act]. I confirm that the responses I am providing to this Questionnaire are true to the best of my knowledge.”

  41. Despite the notice provided in the 2021 Questionnaire and his attestation to be truthful, Dr. Shaul provided false information to FSRA indicating that he had complied with the Guideline and other regulatory requirements, when he had not done so. This false attestation was given one year after Dr. Shaul had acknowledged non-compliance with the same requirement and stated he would ensure it was met going forward.

  42. The Director is further satisfied that ASPPC and Dr. Shaul missed numerous deadlines and failed to provide FSRA with the requested completed 2020 Questionnaire and 2021 Questionnaire within the specified time periods. ASPPC and Dr. Shaul also failed to provide complete information with respect to the Aviva complaint.

    43. IV. GROUNDS FOR REVOCATION OF LICENCE

  43. Section 288.6(1) of the Act states that the Chief Executive Officer may, by order, revoke or suspend a service provider’s licence in any of the following circumstances:

    1. The licensee ceases to satisfy a prescribed requirement for issuance of the licence.

    2. The licensee has contravened or failed to comply with this Act, the regulations or a condition of the licence.

    3. The Chief Executive Officer believes, on reasonable grounds, that the licensee is no longer suitable to be licensed having regard to such circumstances as may be prescribed relating to the licensee’s business systems and practices and the management of its operations or having regard to such other matters as the Chief Executive Officer considers appropriate.

    4. Such other circumstances as may be prescribed.


  44. Pursuant to section 2(2) of Ontario Regulation 348/13, the Chief Executive Officer shall consider whether the previous conduct of the principal representative provides reasonable grounds for the belief that the service provider’s business systems and practices and the management of its operations will not be carried on in accordance with the law or with integrity and honesty.

  45. Firstly, the Director believes that ASPPC has demonstrated a consistent failure to comply with the Guideline. As such, ASPPC has not taken all reasonable steps to ensure compliance with all applicable guidelines, contrary to section 15 of Ontario Regulation 90/14. Pursuant to section 2.1(1) of Ontario Regulation 348/13 a prescribed circumstance in which the Chief Executive Officer may revoke a licence is when a licensee is not in compliance with the Guideline.

  46. Secondly, ASPPC has made repeated misrepresentations to FSRA in response to inquiries under the Act, contrary to section 447(2)(a) of the Act. Additionally, ASPPC and Dr. Shaul have not provided information in response to the requests for information related to the complaint from Aviva.

  47. Thirdly, the Director believes that the previous conduct of the principal representative, Dr. Shaul, with respect to the CPO proceeding provides reasonable grounds for the belief that ASPPC’s business systems and practices will not be carried on in accordance with the law or with integrity and honesty. Additionally, Dr. Shaul’s repeated misrepresentations to FSRA through email communication and through the questionnaires provide reasonable grounds for the Director’s belief that the management of the operations of ASPPC will not be carried on in accordance with the law or with integrity and honesty.

  48. Pursuant to paragraph 2 of section 288.6(1) of the Act, given the above issues it is clear that ASPPC has contravened or failed to comply with the Act and the Regulations with respect to signed OCF-21s and the HCAI roster of Health Professionals.

  49. ASPPC and its’ principal representative, Dr. Shaul, failed to provide prompt and complete responses in response to FSRA inquiries, contrary to sections 441.1(5) and 441.3(3), and provided false information to FSRA contrary to section 447(2)(a). The inquiries are vital to the oversight of the service provider licensing regime and false or incomplete information on the questionnaires significantly impacts FSRA’s supervisory function.

  50. The Director is satisfied that ASPPC is no longer suitable to be licensed as a service provider. For these reasons, the Director proposes to revoke the service provider licence issued to ASPPC (licence # SP14825).

  51. Such further and other reasons as may come to my attention.

DATED at Toronto, Ontario,  November 25, 2022

Elissa Sinha
Director, Litigation and Enforcement

By delegated authority from the Chief Executive Officer

Si vous désirez recevoir cet avis en français, veuillez nous envoyer votre demande par courriel immédiatement à : contactcentre@fsrao.ca.