Health information regarding a person who has been deceased over 50 years d. De-identified data How does the U. When will HHS investigate a complaint? How does HHS determine a penalty for a violation? If there is a monetary penalty, will the individual who filed the complaint receive money? Resources 1. Introduction Nearly everyone recognizes the sensitive nature of health and medical information. All protections were based in state law.
Between and technology changed the medical privacy landscape. Electronic medical records started replacing paper files. Patients began to communicate with their doctors by email and through online portals. Pharmacies began to process prescriptions electronically.
The HITECH Act created financial incentives for healthcare providers and insurers to continue shifting to electronic medical records, and also addressed privacy and security concerns related to the electronic transmission of health information, including unauthorized access and data breaches.
It modified and finalized the Breach Notification Rule. Health care providers get paid to provide health care. Doctors, dentists, hospitals, nursing homes, pharmacies, urgent care clinics, and other entities that provide health care in exchange for payment are examples of providers. Health care providers must comply with HIPAA only if they transmit health information electronically in connection with covered transactions.
Most providers transmit information electronically to carry out functions such as processing claims and receiving payment. Health plans pay the cost of medical care. The following are examples of health plans covered under HIPAA: health insurance companies, health maintenance organizations HMOs , group health plans sponsored by an employer, government-funded health plans such as Medicare and Medicaid, and most other companies or arrangements that pay for health care.
Health care clearinghouses process information so that it can be transmitted in a standard format between covered entities.
Clearinghouses often act as a go between for health care providers and health plans which means that they rarely deal directly with patients. For example, a clearinghouse may take information from a doctor and put it into a standard coded format that can be used for insurance purposes. Business associates What is a business associate? Business associates can perform many different services for a covered entity, including but not limited to : legal actuarial accounting consulting data aggregation management administrative accreditation processing or administering claims data analysis data transmission utilization review quality assurance certain patient safety activities billing benefit management practice management repricing.
Subcontractors A subcontractor that creates, maintains, or transmits protected health information PHI on behalf of a business associate has the same legal responsibilities as a business associate under HIPAA. Under HIPAA, " health information " is any information including genetic information that is created or received by a health care provider, health plan, public health authority, employer, life insurance company, school or university, or health care clearinghouse and relates to a person's past, present, or future physical or mental health or condition; treatment provided to a person; or past, present, or future payment for healthcare an individual receives.
Health information can exist in any form or medium, including paper, electronic, or oral. Health information in employment records HIPAA does not apply to employment records, even when those records include medical information. Health information regarding a person who has been deceased for over 50 years Protected health information PHI does not include health information about a person who passed away more than 50 years ago.
De-identified data De-identified data is health information that has had 18 specific identifiers removed and therefore is considered to make the individual who is the subject of the information unidentifiable.
To be considered for investigation, a complaint must meet the following basic criteria : If the complaint concerns a potential Privacy Rule violation, the action must have occurred after April If the complaint concerns a potential Security Rule violation, the action must have occurred after April An individual must file a complaint against a person, organization or other entity that is subject to HIPAA.
Individuals must file complaints within days of the time they knew or should have known about the potential violation. There are many businesses that support covered entities, and so might be in a position to view, handle, or transmit some of their data.
In addition to these contractual obligations, business associates are directly liable for compliance with certain provisions of the HIPAA Rules.
Sure, a power company providing electricity to a hospital would not be affected, even though it does business with the hospital. Common sense tells us that a power company is not handling or transmitting protected health information PHI , so it would not be possible to be in violation of HIPAA.
Such data goes well beyond official health records. It includes:. The following list is not meant to be exhaustive. HIPAA protects any type of health information that can be used to individually identify a patient, whether that information is provided in oral or written format.
Identifying health information includes:. For anyone entering the health and human services field, an understanding of HIPAA is critical for success. No job exists within or parallel to the healthcare industry that doesn't require some knowledge of HIPAA, and anyone managing a healthcare office, working in healthcare human resources, or dealing with patients in any capacity must have more than a basic understanding of the law.
One occupation undertaken by health and human services grads involves the management of healthcare records. From coding to medical records oversight, jobs that require individuals to interact with healthcare data are HIPAA intensive. These jobs require workers to safeguard data, protect patient confidentiality, and keep up with changing HIPAA regulations regarding data security, storage, and transmission. Covered entities are any organization that may come into contact with patient data including software vendors, medical device companies, social work firms, insurance payers, and even cleaning services that contract with medical providers.
Anyone managing healthcare workers in any capacity — including administrative team supervision, human resources, or clinical oversight — must ensure that all employees are well-trained in HIPAA regulations and that HIPAA rules are followed in day-to-day operations. Failure to comply with HIPAA can result in a range of consequences, including civil fines and sanctions for both organizations and individuals.
In extreme cases where fraud occurred, criminal consequences may be levied — even when the person or organization was ignorant of the requirement.
Because HIPAA violations are taken so seriously and ignorance is not a defense, high-level healthcare workers must have a strong understanding of the law and maintain education about evolving requirements. Any degree in health and human services should include studies on industry regulations such as HIPAA.
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