You are working in a physician’s office as an insurance billing specialist. You receive a call from the director of nurses of one of the local nursing homes. She needs to verify that Barbara Smith, a registered nurse who has applied for a position in her facility, is no longer receiving treatment for substance abuse.

You are working in a physician’s office as an insurance billing specialist. You receive a call from the director of nurses of one of the local nursing homes. She needs to verify that Barbara Smith, a registered nurse who has applied for a position in her facility, is no longer receiving treatment for substance abuse. You remember your conversation with Barbara Smith the last time she came to the office, particularly how desperate she was to find work. You want to help Barbara get a job so you pull her medical record and tell the caller that Barbara did receive treatment at one time but is no longer under treatment for drug addiction.

• After evaluating this situation, determine if the situation was handled correctly or incorrectly.
• Support your answer by including information regarding HIPAA standards that apply to this situation and what possible consequences might happen if they were violated.
• Also discuss how this situation could have been handled differently

QUESTION

Handling Confidential Medical Information in Accordance with HIPAA Standards

Introduction

The situation described above involves an insurance billing specialist receiving a call from the director of nurses at a local nursing home regarding the employment application of Barbara Smith, a registered nurse. The specialist, in an attempt to assist Barbara, accesses her medical record and discloses information regarding her past substance abuse treatment (National Academies Press (US), 2011). This essay will evaluate the handling of this situation, discuss the relevant HIPAA standards, and propose alternative approaches to ensure compliance with privacy regulations.

Handling of the Situation

The handling of the situation, where the insurance billing specialist disclosed Barbara Smith’s medical information without her explicit consent, was incorrect from a HIPAA perspective (Nass, 2009). The Health Insurance Portability and Accountability Act (HIPAA) sets standards for the protection of individuals’ health information and provides guidelines for the appropriate use and disclosure of such information by healthcare providers, including their staff.

HIPAA Standards and Consequences of Violation

Privacy Rule: The Privacy Rule under HIPAA mandates that individually identifiable health information must be protected from unauthorized use or disclosure. In this case, the insurance billing specialist violated the privacy rule by disclosing Barbara’s past substance abuse treatment without her permission.

Minimum Necessary Rule: The Minimum Necessary Rule requires healthcare providers to limit the use or disclosure of protected health information (PHI) to the minimum necessary to accomplish the intended purpose. By providing information beyond what was requested, the insurance billing specialist failed to adhere to this principle.

Consequences of violating HIPAA regulations

It can be severe and may include the following:

Legal repercussions: Violations of HIPAA can result in civil and criminal penalties, including fines and imprisonment, depending on the severity of the violation.

Damage to reputation: Healthcare providers found in violation of HIPAA may face significant damage to their professional reputation, which can lead to a loss of trust from patients and the community.

Loss of patients and business: If patients become aware of a breach of their medical privacy, they may seek alternative healthcare providers, resulting in a loss of patient base and potential revenue.

Alternative Approaches

To handle the situation in compliance with HIPAA standards and protect Barbara’s privacy, the insurance billing specialist could have taken the following steps:

Request written consent: Instead of accessing Barbara’s medical records without her consent, the insurance billing specialist should have requested written authorization from Barbara to disclose her medical information to the director of nurses. This would ensure compliance with HIPAA requirements and respect Barbara’s right to control the disclosure of her own health information.

Provide limited information: If Barbara had provided written consent, the insurance billing specialist should have disclosed only the information explicitly authorized by Barbara and limited the disclosure to what was necessary for the employment verification process.

Educate staff on HIPAA compliance: It is crucial to provide comprehensive training and education to all staff members involved in handling patient information to ensure they understand the importance of HIPAA compliance and the potential consequences of non-compliance.

Conclusion

The situation described, where the insurance billing specialist disclosed Barbara Smith’s past substance abuse treatment without her explicit consent, was handled incorrectly and violated HIPAA privacy regulations (Clayton et al., 2019). To avoid such violations and protect patient privacy, it is essential for healthcare providers and their staff to adhere to HIPAA standards by obtaining appropriate consent, limiting the disclosure of information, and providing comprehensive training on privacy regulations. By following these guidelines, healthcare organizations can maintain the trust of their patients and safeguard sensitive medical information appropriately.

References

Clayton, E. W., Evans, B. R., Hazel, J. J. G., & Rothstein, M. A. (2019). The law of genetic privacy: applications, implications, and limitations. Journal of Law and the Biosciences, 6(1), 1–36. https://doi.org/10.1093/jlb/lsz007 

Nass, S. J. (2009). Introduction. Beyond the HIPAA Privacy Rule – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK9576/ 

National Academies Press (US). (2011). Transforming Practice. The Future of Nursing – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK209871/