Chiropractic Review Committee Activity

This is the second Bulletin of a bi-annual publication on Directions issued by the Chiropractic Review Committee (CRC). Bulletin #6082, published May 31, 2002, was the first release of information on such Directions.

Under the Health Insurance Act (HIA), the General Manager may refer claims that raise a concern about incorrect billing practices to the CRC. Usually this type of situation requires a detailed review of patient records that the CRC has the legal authority to undertake. A practitioner may also request that the CRC review a decision of the General Manager under the HIA to require the repayment of improper claims.

The CRC is an independent committee administered by the College of Chiropractors of Ontario. The CRC operates at arm's length from both the College of Chiropractors of Ontario and the ministry. The CRC consists of three practitioner members nominated by the College of Chiropractors of Ontario and two members of the public. The Minister of Health and Long-Term Care appoints all members.

The CRC may perform either a panel review or a single-member review. A panel review consists of two practitioner members and one member of the public. Single-member reviews, or ”expedited reviews”, are conducted by one practitioner.

The CRC may direct that :

• the General Manager pay the claims as submitted or at a lesser amount , or
• the practitioner repay all or part of the claims.

CRC directions are binding to the General Manager. Practitioners are the only parties who can appeal a CRC direction to the Health Services Review and Appeal Board (HSARB). HSARB directions can be appealed to Divisional Court.