P2021-ND-103

Penguin Random House Canada

The Organization uses a third party provider to adjudicate and pay claims submitted by members under the Organization’s Extended Health Care Plan. In this case, an individual who was covered under their spouse?s plan submitted a receipt for psychological treatment. The receipt was forwarded to the third party for adjudication. When the claim was processed, a statement was mailed to the affected individual indicating there was no coverage for the service. However, the claim was also processed under another family member?s coverage, which resulted in a second statement being mailed to the other family member indicating there was no coverage for the service. The breach occurred on August 13, 2018 and was discovered on August 15, 2018, when the unintended recipient of the statement reported the error. The unintended recipient reported that the statement was disposed of in the garbage.

File Type: pdf
Categories: 2021
Tags: Loss