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Document
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PO-1881-I
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File #
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PA-000286-1
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Institution/HIC
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Ministry of Health and Long-Term Care
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Summary
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NATURE OF THE APPEAL: The Ministry of Health and Long-Term Care (the Ministry) received correspondence from a requester who identified that he had been provided with a "decoded list of services" billed against his Ontario Health Insurance Plan (OHIP) account by an identified doctor (the doctor). The requester noted that the services listed in this record are false. His letter stated that the incorrect services listed in the record included treatment for malignant neoplasms-brain, alcoholism, anxiety neurosis, hysteria, neurasthenia and reactive depression. His letter also sets out that while the doctor had provided some services to him in the past, specifically flu shots and physical examinations, the doctor had not treated him for any of the conditions listed in the record. The requester also stated that he has never had any of these medical conditions, nor has he been treated for them. The requester asked the Ministry to remove these inaccurate claims from his record. The Ministry responded to the request, in part, as follows: At this time, amendments to your claim file have not yet been actioned due to technical constraints. We are aware of the sensitivity of the situation and are taking steps to ensure that in the future, the claims in question will be flagged to indicate that a statement of disagreement has been filed. Please be advised that the diagnostic codes recorded by the [Ministry] are used primarily for payment purposes. These codes frequently cover a broad range of diseases and disorders or are of a general character. They should not be confused with the more precise diagnosis appropriate to a clinical record. Under normal circumstances, you would be advised to request your medical information directly from the health care provider(s) involved. The transcript lists a history of claims submitted for payment against a health number and is not a reflection of services rendered. Please be advised that the information cannot be accessed by anyone without your written consent or in accordance with the Freedom of Information and Protection of Privacy Act . In the event that the information is requested and subjected to disclosure, the statement of disagreement will also be identified. The Ministry's response did not dispute any of the facts as stated by the requester. The requester (now the appellant), through his counsel, appealed the refusal of the Ministry to correct the information in his OHIP Claims Reference File (CREF). In his letter of appeal (a copy of which was provided to the Ministry), the appellant identified a number of grounds for appealing the Ministry's decision. They include: The doctor who fraudulently claimed for a series of psychiatric and neurological services to the appellant (which were never performed), pleaded guilty to criminal charges of fraud against him. These charges included the charges relating to the services which were billed for but not provided to the appellant. In addition to the appellant's records, numerous other individuals' records also included fraudulent billing information by the same doctor. The specific account records which contain the incorrect information are available to a broad range of health providers and Ministry officials, as well as other authorized agencies. Furthermore, insurers routinely seek consent from insured parties to disclose these records to the insurer as a pre-condition to offering coverage or claiming benefits. Once released to a private company, these records are out of the control of the Ministry. The existence of incorrect information about highly sensitive psychiatric treatments in the appellant's file may directly affect the appellant, particularly if the incorrect information came into the possession of health care providers or insurers. Furthermore, their existence could affect many other legal rights including his right to run for or hold elected office, to write a valid will, to travel to other jurisdictions, etc. Because of the nature of the incorrect information, attempts to explain it away or deny its validity, including attaching statements of disagreement to the record, are not acceptable options. In the current system of public medicine, the citizen's CREF is the single comprehensive summary of one's health, and is constantly sought by those seeking to confirm one's health status. The suggested attachment of a statement of disagreement is not sufficient to meet the appellant's concerns. Furthermore, the appellant does not believe that he should be responsible for having to explain inaccuracies in the Ministry's files, particularly if the Ministry is aware of them. Notwithstanding the Ministry's apparent position that the CREF is primarily a billing record, the Ministry is aware that these records are routinely accessed for a wide range of purposes. Furthermore, the appellant cannot withhold consent to the disclosure of the records without being denied a whole range of goods and services. The appellant also identified the remedies he was seeking, as follows: an order requiring the Ministry to remove the fraudulent records from the appellant's CREF; an order directing the Ministry to provide the appellant with a record of any exceptional uses to which the CREF has been put, pursuant to sections 46(1)(a) or (b) of the Act ; an order directing the Ministry to provide notification of the correction to anyone to whom the appellant's personal information has been sent pursuant to section 47(2)(c) of the Act ; an order directing the Ministry to notify each of the individuals who also have fraudulent information in their CREF files due to the actions of the doctor of the Commissioner's decision, and offering a process which would permit them to have their information corrected; an award of costs to compensate the appellant for bringing forward this public interest appeal. The appell
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Legislation
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Subject Index
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Signed by
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Ann Cavoukian
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Published
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Mar 20, 2001
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Type
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Order – Interim
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© Copyright
2013
Information and Privacy Commissioner of Ontario. All Rights Reserved.
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