Health Fraud

Health Insurance Act

ONTARIO REGULATION 173/98

HEALTH FRAUD

Consolidation Period:  From January 1, 2026 to the e-Laws currency date.

Last amendment: 350/25.

Legislative History: 86/22, 209/23, 97/25, 350/25.

This is the English version of a bilingual regulation.

1. (1) The following persons are prescribed for the purposes of subsections 11.1 (6) and 43.1 (1) of the Act:

1. A physician, a registered nurse in the extended class, an aboriginal midwife, a midwife, a dentist, an optometrist, a member of the College of Chiropodists of Ontario who is a podiatrist or a member of the College of Chiropractors of Ontario.

2. An employee of a person named in paragraph 1 whose employment is related to the provision of insured services by that person.

3. A person who, under a contract with any person named in paragraph 1, performs services that are related to the provision of insured services.

4. A person who is employed in the provision of insured services in,

i. a hospital under the Public Hospitals Act or Private Hospitals Act,

ii. a facility whose primary function is the provision of insured services, or

iii. a laboratory or specimen collection centre licensed under the Laboratory and Specimen Collection Centre Licensing Act.

5. A person who, under a contract, performs services that are related to the provision of insured services and performed in a place described in paragraph 4.  O. Reg. 173/98, s. 1 (1); O. Reg. 86/22, s. 1 (1, 2); O. Reg. 97/25, s. 1 (1); O. Reg. 350/25, s. 1 (1).

(2) In paragraph 1 of subsection (1),

“aboriginal midwife” means an aboriginal person who provides traditional midwifery services to aboriginal persons or members of an aboriginal community; (“sage-femme autochtone”)

“dentist” means a member of the Royal College of Dental Surgeons of Ontario or a person who is exempted from subsections 9 (1) and (2) of the Dentistry Act, 1991 by a regulation made under that Act; (“dentiste”)

“midwife” means a member of the College of Midwives of Ontario or a person who is exempted from subsections 8 (1) and (2) of the Midwifery Act, 1991 by a regulation made under that Act; (“sage-femme”)

“optometrist” means a member of the College of Optometrists of Ontario or a person who is exempted from subsections 9 (1) and (2) of the Optometry Act, 1991 by a regulation made under that Act; (“optométriste”)

“registered nurse in the extended class” means a member of the College of Nurses of Ontario who is a registered nurse and who holds an extended certificate of registration under the Nursing Act, 1991 or a person who is exempted from subsections 11 (1) and (5) of the Nursing Act, 1991 by a regulation made under that Act and who holds the equivalent of a certificate of registration in the extended class for registered nurses in Ontario. (“infirmière autorisée ou infirmier autorisé de la catégorie supérieure”) O. Reg. 173/98, s. 1 (2); O. Reg. 86/22, s. 1 (3); O. Reg. 209/23, s. 1; O. Reg. 97/25, s. 1 (2, 3); O. Reg. 350/25, s. 1 (2, 3).

2. An insured person is a prescribed person for the purposes of subsection 43.1 (5) of the Act.  O. Reg. 173/98, s. 2.

3. Omitted (revokes other Regulations).  O. Reg. 173/98, s. 3.