HMO Revises Process to Obtain Valid Authorizations
HMO Revises Process to Obtain Valid Authorizations
Covered Entity: Health Plans / HMOs
Issue: Impermissible Uses and Disclosures; Authorizations
A complaint alleged that an HMO impermissibly disclosed a member’s
PHI, when it sent her entire medical record to a disability insurance
company without her authorization. An OCR investigation indicated that
the form the HMO relied on to make the disclosure was not a valid
authorization under the Privacy Rule. Among other corrective actions to
resolve the specific issues in the case, the HMO created a new
HIPAA-compliant authorization form and implemented a new policy that
directs staff to obtain patient signatures on these forms before
responding to any disclosure requests, even if patients bring in their
own “authorization” form. The new authorization specifies what records
and/or portions of the files will be disclosed and the respective
authorization will be kept in the patient’s record, together with the
disclosed information.
| Tuesday, November 1, 2022 Modernizing Medicine Inc. (ModMed), an electronic health record (EHR) technology vendor located in Boca Raton, Florida, has agreed to pay $45 million to resolve allegations that it violated the False Claims Act (FCA) by accepting and providing unlawful remuneration in exchange for referrals and by causing its users to report inaccurate information in connection with claims for federal incentive payments. The Anti-Kickback Statute prohibits anyone from offering or paying, directly or indirectly, any remuneration — which includes money or any other thing of value — to induce referrals of items or services covered by Medicare, ...read more |
| Private Practice Implements Safeguards for Waiting Rooms Covered Entity: Private Practice Issue: Safeguards; Impermissible Uses and Disclosures A staff member of a medical practice discussed HIV testing procedures with a patient in the waiting room, thereby disclosing PHI to several other individuals. Also, computer screens displaying patient information were easily visible to patients. Among other corrective actions to resolve the specific issues in the case, OCR required the provider to develop and implement policies and procedures regarding appropriate administrative and physical safeguards related to the communication of PHI. The practice trained all staff on the newly developed policies and ...read more |
| Radiologist Revises Process for Workers Compensation Disclosures Covered Entity: Health Care Provider Issue: Impermissible Uses and Disclosures A radiology practice that interpreted a hospital patient’s imaging tests submitted a worker’s compensation claim to the patient’s employer. The claim included the patient’s test results. However, the patient was not covered by worker’s compensation and had not identified worker’s compensation as responsible for payment. OCR’s investigation revealed that the radiology practice had relied upon incorrect billing information from the treating hospital in submitting the claim. Among other corrective actions to resolve the specific issues in the case, the practice apologized to ...read more |
| Wednesday, November 9, 2022 A federal grand jury in Newark, New Jersey, returned an indictment today charging an Indian national for fraudulently obtaining millions of dollars in Paycheck Protection Program (PPP) loans guaranteed by the Small Business Administration (SBA) under the Coronavirus Aid, Relief, and Economic Security (CARES) Act. According to court documents, Abhishek Krishnan, 40, previously resided in Wake County, North Carolina, before returning to his home country of India. After returning to India, Krishnan allegedly submitted numerous fraudulent PPP loan applications to federally insured banks, including on behalf of purported companies that were not registered business entities. ...read more |
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1/21/25 Understanding Business Associate Agreements
11/12/22 Modernizing Medicine Agrees to Pay $45 Million to Resolve Allegations of Accepting and Paying Illegal Kickbacks and Causing False Claims
11/12/22 Indian National Charged in $8 Million COVID-19 Relief Fraud Scheme
11/12/22 Former Hospital Employee Pleads Guilty To Criminal HIPPA Charges
11/12/22 Covered entities and those persons rendered accountable by general principles of corporate criminal liability may be prosecuted directly under 42 U.S.C. § 1320d-6
11/12/22 The Delaware Division of Developmental Disabilities Services Data Breach
11/12/22 OCR Settles Three Cases with Dental Practices for Patient Right of Access under HIPAA
11/12/22 HHS Issues Guidance on HIPAA and Audio-Only Telehealth
11/12/22 Five Former Methodist Hospital Employees Charged with HIPAA Violations
11/12/22 May a covered entity use or disclose protected health information for litigation?
11/12/22 When does the Privacy Rule allow covered entities to disclose protected health information to law enforcement officials?
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