April 15, 2021
By Suze Shaffer | Aris Medical Solutions
Recently a cosmetic practice was fined $30,000 to settle potential HIPAA Privacy Rule violations. In the past many practices believed if they did not accept insurance payments (considered as a “transaction” under HIPAA), they were immune from the privacy rule. This may not be the case. There is a section in the rule that states “Other transactions that the Secretary may prescribe by regulation”. HIPAA compliance is a balancing act, are you willing to lose $30K of your hard-earned money to test the system?
This investigation started with a compliant from a patient that had requested their medical record and did not receive them in a timely manner. Under the HIPAA Privacy Rule, the provider must respond to a patient’s request for access no later than 30 calendar days after the request. If the covered entity is not able to act within this timeframe, the entity may have up to an additional 30 calendar days if they provide the individual (within the initial 30-day period) with a written statement for the reason of the delay and include a date when the entity will have the information available. See 45 CFR §164.524(b)(2). Unfortunately for this practice, this was not handled in a timely manner. Therefore, an investigation was launched.
Let us review how this happens.
Once a complaint is filed to the Office for Civil Rights (OCR), the OCR will determine if the complaint falls within their duties to investigate. Once an investigation has been opened, the OCR will contact the practice for their documentation surrounding the incident. Depending on the documentation that is submitted will determine if a desk audit is warranted. Therefore, documentation is SO important, you may be able to avoid a desk audit if you supply the appropriate documents.
During a desk audit more than likely, you will be asked for documentation of what preventative measures you had in place before the incident and what you have implemented to prevent this from happening again. While you are being investigated the OCR may also review your compliance in other areas. If they find discrepancies, you could be fined for those as well. HIPAA encompasses a large range of requirements. Patient privacy, patient rights, and data security to name a few. I will not go into detail during this notification since we are sharing the security rule requirements in other messages.
Each resolution agreement that is issued by the HHS/OCR outlines the deficiencies they uncover. Most of them include the lack of a risk analysis, risk management, training, business associate agreements, and policies and procedures. During this investigation, other violations were uncovered and included the social security act was named in the resolution agreement: Section 1128A of the Social Security Act (42 U.S.C. § 1320a- 7a) a.
From this, I hope you can understand the importance of HIPAA compliance. Because one simple oversight can cause this much heartache. Patient privacy, patient rights, and data security is as important as caring for your patients. We have just learned that any entity that has patient data can be investigated and fined for violations under HIPAA.
Tell your friends and colleagues to ensure everyone understands no one is immune from HIPAA if you have patient data. Fines are fierce and not worth taking a chance by thinking “it won’t happen to me”.
If you need assistance with HIPAA Training, Risk Management, or guidance with your HIPAA Compliance contact us at 877.659.2467 or complete the contact us form.
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