In this post, we will be focusing on the Health Insurance Portability and Accountability Act of 1996 (HIPAA). We will look at what the HIPAA violation is, talk about HIPAA law, and which employers it applies to. Show
Also, we will also focus on what constitutes a HIPAA violation, what the consequences of a violation are. What’s more important, we will cover information on what HIPAA compliance
solutions covered entities can implement to prevent a
breach.
What is HIPAA Compliance?HIPAA is the acronym for the Health Insurance Portability and Accountability Act passed by Congress in 1996. The federal law protects the privacy rights of individuals in the US. They establish a set of standards to protect against the unauthorized disclosure of sensitive and individually identifiable Protected Health Information (PHI). Aside from protecting privacy rights, the act has also helped to modernize the flow of PHI in the U.S. and reduce national healthcare fraud and abuse. One can find HIPAA guidelines (as well as explore them) in the U.S. Department of Health & Human Services’ Office for Civil Rights (OCR). Any company or individual that comes into contact with PHI must implement appropriate policies and procedures. They should safeguard to protect data and ensure compliance with HIPAA law. HIPAA regulations do not apply to workplace health records held by an employer that relate to employee benefits such as life insurance, disability, workers compensation, or long-term care insurance. What Information Is Protected?HIPAA provides federal protection for the following information:
Individuals have the right to view all data held by a covered entity and receive notice when personal information is used and
shared. Who Must Follow HIPAA Regulations?As we mentioned above, only those companies deemed a “covered entity” must comply with HIPAA regulations. HIPAA covered entities include:
Aside from the HIPAA privacy rule, covered entities are also governed by The Privacy Rule. They set standards for protecting PHI, and The Security Rule, which specifies safeguards for protecting the confidentiality, integrity, and availability of electronic Protected Health Information (ePHI). Any breach of personal health data must be notified to the U.S. Department of Health & Human Services (HHS). Which Companies are Safe or Excluded from HIPAA Violation-Related Matters?Most employers are considered “non-covered” entities and they are therefore not subject to HIPAA rules and regulations. Even if an employer provides healthcare coverage to its staff, it is the responsibility of the insurance company to ensure data security and HIPAA compliance. Examples of organizations that do not have to comply with the HIPAA privacy act include:
Although HIPAA doesn’t apply to non-covered entities, these companies still have a legal obligation to protect the confidentiality of employee health information in their possession under the US Privacy Act of 1974 and the Americans with Disabilities Act (ADA) as well as state-level regulations relating to data protection. The California Consumer Privacy Act, for example, provides individuals with the right to view, access, and opt-out of the processing of their personal data by businesses at any time. And in Massachusetts, the PATCH Act enforces additional measures to protect access to confidential healthcare information. HIPAA for EmployersHIPAA can be a confusing regulation for employers. It’s important to establish whether or not your company is a covered entity so that you can implement the necessary measures to protect your data. Most employers that offer health insurance benefits for medical and/or dental care, for example, fall into the “Health Plans” category. And that not counting that the requirements depend on how PHI is maintained, transmitted, and received. Although the exchange of employee medical information with a company covered by HIPAA (such as an insurer) doesn’t necessarily mean that the regulation must be enforced. Why? Simply because the law does apply to any company that receives, processes, handles, or stores employee medical records for the purpose of employee compensation claims or relating to sick leave or health insurance. This is especially relevant during public health emergencies such as the current COVID-19 pandemic. Human resources managers must, therefore, be familiar with the restrictions and controls implemented by the HIPAA to ensure the necessary policies and procedures are put in place to safeguard employee data. HIPAA does not:
Although HIPAA may not apply to your company, it is still important to safeguard employee records. The responsible person should hold periodic training sessions to create a culture of privacy and data security in your organization. What is a Violation?A HIPAA infringement is a failure to comply with any aspect of the standards and provisions of the HIPAA security rule. This can include the unauthorized use and disclosure of an individual’s PHI. The failure to implement administrative, technical, and physical safeguards to ensure the confidentiality of electronic PHI. Also, it can cause delayed breach notifications; and failure to conduct regular risk analyses. Also, it can include a failure to provide individuals with access to their PHI or to ensure HIPAA-compliant agreements are made with business associates. HIPAA infringements are usually discovered in one of three ways:
It is important for covered entities to conduct a regular internal HIPAA audit? Why? Because it’s crucially important to detect and correct any potential violations according to the regulators and before any penalties occur. The longer an issue exists, the higher the penalty. What are the Consequences of a HIPAA Violation?U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) are the ones who enforce the HIPAA regulations. At the same time, covered entities are the ones that detect many violations during routine internal audits or reported internally by employees. Note that the OCR investigates any external complaints reported by healthcare workers, patients, and health plan members. By law, the OCR can only act if:
Investigations include conducting compliance reviews and performing education and outreach programs. In the event a non-compliance issue ocurrs, the OCR will attempt to obtain voluntary compliance, corrective actions, and/or a resolution agreement. Also, remember that violations can also result in civil and criminal penalties if the complaint is referred to the Department of Justice. Breach FinesDepartment of Justice is the authority that handles all the breach fines and charges for violating HIPAA regulations. They split the fines and charges into two categories: reasonable cause and willful neglect.
 How to File a Complaint on HIPAA-Related Matters?In the event you personally witness (or it somehow affects you) a HIPAA violation breach, you should report to the Office for Civil Rights. One can file complaints against covered entities and their business associates. Above all, anyone can report a health information security breach with the OCR. In addition, one should file the complaints in writing by mail, fax, or via e-mail. They can also file a complaint via the OCR Complaint Portal within 180 days of a violation being observed and must specify the non-compliant action. If a breach appears during the investigation, the covered entity or business associate must voluntarily comply with HIPAA rules. They should immediately take corrective action, and/or agree to a settlement. However, if the breach problem doesn’t disappear the OCR may impose fines and penalties. HIPAA Security: Best PracticesIf you are a covered entity or the business associate of a covered entity you must be aware and comply with HIPAA standards. On the other hand, you should also introduce a series of best practices to ensure a corporate culture of security privacy and protection is at the proper level in your organization. It’s a good idea to include a HIPAA compliance checklist in your policies and procedures. Here are a few examples of common do’s and don’ts: Do’s
Dont’s
HIPAA Violations FAQTo end this post, we have put together a few additional Frequently Asked Questions. If you have any other questions that we haven’t included, please feel free to leave them in the comments section below and we’ll get back to you. What are Common Examples of HIPAA Infractions?Examples of common HIPAA violations include the following:
Famous cases of violations that you may have heard of:
Can you Sue for a HIPAA Violation?There is no private cause of action in HIPAA, so it is not possible for an individual to sue under the terms of the act. However, you may have a right to sue based on state law if harm has been caused as a direct result of negligence or a violation (although this can be expensive and there is no guarantee of success). Is Talking About a Patient a HIPAA Breach?Healthcare providers are permitted to discuss patients with other members of the care team but talking about specific patients and disclosing their health information to family, friends & colleagues would be classified as a HIPAA violation. All above, providers must also “reasonably protect” PHI to limit disclosure, such as not discussing a patient’s case in a public area. Manage your employee sick leaves & other documents safely & securely with Factorial. Written by Cat Symonds When scheduling a patient over the phone what information is important to obtain from them?The caller's telephone number. The reason for the visit. The caller's name. 1) Have another opportunity to bill the patient's insurance.
When answering a phone call in the medical office the medical assistant should?Answering the telephone in a professional manner involves answering within two to three rings, so the caller is not left waiting. If taking multiple calls, proper etiquette suggests that you give the first caller priority unless the second caller has an emergency.
When answering incoming calls what is the first thing the caller should hear group of answer choices?When answering incoming calls, what is the first thing the caller should hear? When answering incoming telephone calls, the medical assistant should identify the facility first, state his or her name, and then follow with an offer of help.
Why is it important to ask callers if you can place them on hold quizlet?Why is it important to ask callers if you can place them on hold? A caller may want to be given the option to choose not to be put on hold. It is a common courtesy. A caller may want to call back at a later date rather than hold.
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What type of violation is it to disclose patient information to an attorney who calls the office?
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