Uncategorized
Jul 07

HIPAA privacy rule enforcement highlights

The HIPAA Privacy Rule is a set of federal standards to protect the privacy of patients' medical records and other health information maintained by covered entities: health plans, which include many governmental health programs, such as the Veterans Health Administration, Medicare and Medicaid; most doctors, hospitals and many other health care providers; and health care clearinghouses. These standards provide patients with access to their medical records and with significant control over how their personal health information is used and disclosed. Compliance with the standards was required as of April 14, 2003 for most entities covered by HIPAA. On that date, OCR began accepting complaints involving the privacy of personal health information in the health care system.

Privacy Rule Enforcement Results as of the Date of This Summary as of April 2011

  • HHS / OCR has investigated and resolved over 13,503 cases by requiring changes in privacy practices and other corrective actions by the covered entities. Corrective actions obtained by HHS from these entities have resulted in change that is systemic and that affects all the individuals they serve. HHS has successfully enforced the Privacy Rule by applying corrective measures in all cases where an investigation indicates noncompliance by the covered entity. OCR has investigated complaints against many different types of entities including: national pharmacy chains, major medical centers, group health plans, hospital chains, and small provider offices.
  • In another 7,022 cases, their investigations found no violation had occurred.
  • In the rest of our completed cases (40,025), HHS determined that the complaint did not present an eligible case for enforcement of the Privacy Rule. These include cases in which:

OCR lacks jurisdiction under HIPAA – such as a complaint alleging a violation prior to the compliance date or alleging a violation by an entity not covered by the Privacy Rule;

the complaint is untimely, or withdrawn or not pursued by the filer;

the activity described does not violate the Rule – such as when the covered entity has disclosed protected health information in circumstances in which the Rule permits such a disclosure.

In summary, since the compliance date in April 2003, HHS has received over 60,550 HIPAA Privacy complaints. We have resolved over ninety-one percent of complaints received (over 55,141): through investigation and enforcement (over 13,503); through investigation and finding no violation (7,022); and through closure of cases that were not eligible for enforcement (40,025).

From the compliance date to the present, the compliance issues investigated most are, compiled cumulatively, in order of frequency:

  1. Impermissible uses and disclosures of protected health information;
  2. Lack of safeguards of protected health information;
  3. Lack of patient access to their protected health information;
  4. Uses or disclosures of more than the Minimum Necessary protected health information; and
  5. Complaints to the covered entity.

The most common types of covered entities that have been required to take corrective action to achieve voluntary compliance are, in order of frequency:

  1. Private Practices;
  2. General Hospitals;
  3. Outpatient Facilities;
  4. Health Plans (group health plans and health insurance issuers); and,
  5. Pharmacies.
About Reed Tinsley, CPA

As a top advisor to physicians, I help increase practice profits by delivering hands-on, expert medical accounting/tax support, practice counsel, and revenue-building strategies. Read more →