jswizzle3737/ontario_laws_and_regs huggingface dataset:
Definitions
1. In this Act, “Board” means the Health Services Appeal and Review Board under the Ministry of Health Appeal and Review Boards Act, 1998; (“Commission”) “dentist” means a member of the Royal College of Dental Surgeons of Ontario; (“dentiste”) “General Manager” means the General Manager appointed under the Health Insurance Act; (“directeur général”) “insured person” means a person who is entitled to insured services under the Health Insurance Act and the regulations made under it; (“assuré”) “insured service” means a service that is an insured service under the Health Insurance Act and the regulations made under it; (“service assuré”) “optometrist” means a member of the College of Optometrists of Ontario; (“optométriste”) “physician” means a legally qualified medical practitioner who is lawfully entitled to practise medicine in Ontario; (“médecin”) “Plan” means the Ontario Health Insurance Plan; (“Régime”) “practitioner” means a physician, an optometrist or a dentist; (“praticien”) “unauthorized payment” means the amount of money by which the amount a practitioner has charged and been paid for rendering an insured service to an insured person exceeds the amount payable under the Plan for rendering that service to that insured person. (“paiement non autorisé”) R.S.O. 1990, c. H.3, s. 1; 1998, c. 18, Sched. G, s. 52 (1, 2).
Persons not to charge more than OHIP
2. (1) A physician or an optometrist who does not submit his or her accounts directly to the Plan under section 15 or 16 of the Health Insurance Act or a dentist shall not charge more or accept payment for more than the amount payable under the Plan for rendering an insured service to an insured person. R.S.O. 1990, c. H.3, s. 2 (1). Account due (2) A practitioner referred to in subsection (1) shall not accept payment in respect of an insured service rendered to an insured person until after the practitioner receives notice that the patient has been reimbursed by the Plan unless the insured person consents to make the payment on an earlier date. R.S.O. 1990, c. H.3, s. 2 (2). Hospitals (3) A hospital shall not accept payment with respect to the provision of an insured service to an insured person unless permitted to do so by the regulations in the circumstances and on the conditions prescribed in the regulations. 2000, c. 42, Sched., s. 14. Prescribed entities, etc. (3.1) Such entities and persons or classes of persons as may be prescribed shall not accept payment with respect to the provision of an insured service to an insured person unless permitted to do so by the regulations in the circumstances and on the conditions prescribed in the regulations. 2000, c. 42, Sched., s. 14.
Agreement for determining amount
3. (1) The Minister of Health may enter into agreements with the associations mentioned in subsection (2), as representatives of physicians, dentists and optometrists, to provide for methods of negotiating and determining the amounts payable under the Plan in respect of the rendering of insured services to insured persons. R.S.O. 1990, c. H.3, s. 3 (1). Associations (2) The associations representing physicians, dentists and optometrists are, (a) the Ontario Medical Association, in respect of physicians; (b) the Ontario Dental Association, in respect of dentists; and (c) the Ontario Association of Optometrists, in respect of optometrists. R.S.O. 1990, c. H.3, s. 3 (2). Idem (3) The Lieutenant Governor in Council may make a regulation providing that the Minister may enter into an agreement under subsection (1) with a specified person or organization other than an association mentioned in subsection (2). R.S.O. 1990, c. H.3, s. 3 (3).
Unauthorized payment
4. (1) If the General Manager is satisfied that a person has paid an unauthorized payment to a practitioner, the General Manager shall pay to the person the amount of the unauthorized payment. 2002, c. 18, Sched. I, s. 6 (1). Practitioner indebted (2) Where a person has paid an unauthorized payment to a practitioner and the General Manager has paid the person under subsection (1), the practitioner is indebted to the Plan for an amount equal to the sum of the amount of the unauthorized payment and the administrative charge prescribed by the regulations. R.S.O. 1990, c. H.3, s. 4 (2). General Manager to recover money (3) The General Manager may recover from a practitioner part or all of any money the practitioner owes the Plan under subsection (2) by set off against any money payable to the practitioner by the Plan. R.S.O. 1990, c. H.3, s. 4 (3). Notice of recovery (4) If the General Manager recovers money from a practitioner under subsection (3), the General Manager shall forthwith serve on the practitioner notice of the amount recovered, the account in respect of which it was recovered and the practitioner’s right under section 5 to request a review of the issue of whether the practitioner has received the unauthorized payment. R.S.O. 1990, c. H.3, s. 4 (4). Service of notice (5) The notice under subsection (4) shall be served by registered mail addressed to the person to whom the notice is being given at the person’s latest known address and the service shall be considered to have been made on the seventh day after the day of mailing unless the person to whom notice is given establishes that he or she, acting in good faith, did not receive the notice until a later date. R.S.O. 1990, c. H.3, s. 4 (5).
Practitioner entitled to review
5. (1) A practitioner is entitled to a review of the issue of whether the practitioner has received an unauthorized payment if within fifteen days after receiving the notice under subsection 4 (4) the practitioner mails or delivers to the General Manager written notice requesting a review. R.S.O. 1990, c. H.3, s. 5 (1). Referral for review (2) The General Manager, upon receiving a request for a review in accordance with subsection (1), shall refer the matter to the Board’s chair. R.S.O. 1990, c. H.3, s. 5 (2). Persons to review (3) The Board’s chair may from time to time appoint a member of the Board to conduct a review under this Act. R.S.O. 1990, c. H.3, s. 5 (3). Terms of reference (4) A member of the Board conducting a review shall inquire into whether the practitioner has received an unauthorized payment. R.S.O. 1990, c. H.3, s. 5 (4). Right to representations (5) The General Manager, the practitioner and the insured person have the right to make written representations to the member of the Board conducting the review. R.S.O. 1990, c. H.3, s. 5 (5). Advise General Manager (6) The member of the Board conducting a review shall advise the General Manager and the practitioner in writing as to whether, in the person’s opinion, the practitioner has received an unauthorized payment and, if so, the amount of that payment. R.S.O. 1990, c. H.3, s. 5 (6). General Manager to pay (7) If the member of the Board conducting a review advises the General Manager that the General Manager recovered more from the practitioner than the sum of the unauthorized payment, if any, and the administrative charge, the General Manager shall pay the practitioner, (a) if the member finds there was no unauthorized payment, the total amount recovered; or (b) if the member finds there was an unauthorized payment, the difference between the amount recovered and the amount that should have been recovered. R.S.O. 1990, c. H.3, s. 5 (7). 6. Repealed: 1998, c. 18, Sched. G, s. 52 (3).
General Manager to pay
6. Repealed: 1998, c. 18, Sched. G, s. 52 (3).
Collection of personal information
6.1 (1) The Minister may directly or indirectly collect personal information, subject to such conditions as may be prescribed, for purposes related to the administration of this Act, the Health Insurance Act or the Independent Health Facilities Act or for such other purposes as may be prescribed. 1996, c. 1, Sched. H, s. 37. Use of personal information (2) The Minister may use personal information, subject to such conditions as may be prescribed, for purposes related to the administration of this Act, the Health Insurance Act or the Independent Health Facilities Act or for such other purposes as may be prescribed. 1996, c. 1, Sched. H, s. 37. Disclosure (3) The Minister shall disclose personal information if all prescribed conditions have been met and if the disclosure is necessary for purposes related to the administration of this Act, the Health Insurance Act or the Independent Health Facilities Act or for such other purposes as may be prescribed. However, the Minister shall not disclose the information if, in his or her opinion, the disclosure is not necessary for those purposes. 1996, c. 1, Sched. H, s. 37. Obligation (4) Before disclosing personal information obtained under the Act, the person who obtained it shall delete from it all names and identifying numbers, symbols or other particulars assigned to individuals unless, (a) disclosure of the names or other identifying information is necessary for the purposes described in subsection (3); or (b) disclosure of the names or other identifying information is otherwise authorized under the Freedom of Information and Protection of Privacy Act. 1996, c. 1, Sched. H, s. 37. Note: Effective November 1, 2004, clause (b) is amended by the Statutes of Ontario, 2004, chapter 3, Schedule A, subsection 83 (2) by adding at the end “or the Personal Health Information Protection Act, 2004”. See: 2004, c. 3, Sched. A, ss. 83 (2), 99 (2). Note: This amendment applies only if, by November 1, 2004, Bill 8 (An Act to establish the Ontario Health Quality Council, to enact new legislation concerning health service accessibility and repeal the Health Care Accessibility Act, to provide for accountability in the health service sector, and to amend the Health Insurance Act) has not received Royal Assent and section 41 of Bill 8, as numbered in the first reading version of the Bill, has not come into force. See: 2004, c. 3, Sched. A, s. 83 (1).
Disclosure of information
7. Despite subsection 38 (1) of the Health Insurance Act, the General Manager, the Minister of Health and one other person engaged in the administration of this Act who is designated in writing by the Minister may furnish to, (a) a member of the Board; (b) the person to whom insured services were rendered or where a person other than the person to whom the insured services were rendered was charged for those services, the person who was so charged; and (c) any other person, with the consent of the person to whom the services were rendered, information pertaining to the nature of the insured services, the date or dates on which the insured services were provided and for whom, the name and address of the person who provided the services, the amounts paid or payable by the Plan for such services and the person to whom the money was paid or is payable, for the purpose of enforcing this Act. R.S.O. 1990, c. H.3, s. 7.
Offence
8. (1) A physician, a dentist or an optometrist who contravenes subsection 2 (1) is guilty of an offence. 1996, c. 1, Sched. H, s. 38. Same (1.1) A hospital that contravenes subsection 2 (3) is guilty of an offence. 1996, c. 1, Sched. H, s. 38. Same (1.1.1) An entity or person that contravenes subsection 2 (3.1) is guilty of an offence. 2000, c. 42, Sched., s. 15. Penalty, individual (1.2) An individual who is convicted of an offence under this section is liable, (a) for a first offence, to a fine of not more than $25,000 or to imprisonment for a term of not more than 12 months, or to both; (b) for a subsequent offence, to a fine of not more than $50,000 or to imprisonment for a term of not more than 12 months, or to both. 2002, c. 18, Sched. I, s. 6 (2). Penalty, corporation (1.3) A corporation that is convicted of an offence under this section is liable to a fine of not more than $50,000 for a first offence and to a fine of not more than $200,000 for a subsequent offence. 2002, c. 18, Sched. I, s. 6 (2). Compensation or restitution (1.4) The court that convicts a person of an offence under this section may, in addition to any other penalty, order that the person pay compensation or make restitution to any person who suffered a loss as a result of the offence. 2002, c. 18, Sched. I, s. 6 (2). No limitation (1.5) Section 76 of the Provincial Offences Act does not apply to a prosecution under this section. 2002, c. 18, Sched. I, s. 6 (2). Costs of prosecution (2) When a prosecution is conducted by a private prosecutor and the defendant is convicted, the court may determine the actual costs reasonably incurred in conducting the prosecution and, despite section 60 of the Provincial Offences Act, may order those costs to be paid by the defendant to the prosecutor. R.S.O. 1990, c. H.3, s. 8 (2).
Regulations
9. (1) The Lieutenant Governor in Council may make regulations, (a) prescribing an administrative charge not greater than $150 for the purpose of subsection 4 (2); (b) prescribing anything that must or may be prescribed under the Act or anything that is required or permitted to be done in accordance with the regulations or as provided in the regulations; (c) prescribing circumstances and conditions for the purposes of subsection 2 (3); (d) prescribing entities, persons, classes of persons, circumstances and conditions for the purposes of subsection 2 (3.1). 1996, c. 1, Sched. H, s. 39; 2000, c. 42, Sched., s. 16 (1). Retroactivity (2) A regulation under subsection (1) is effective with respect to a period before it was filed if the regulation so provides. 2000, c. 42, Sched., s. 16 (2). ______________ Français