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HIPPA REGULATION: Privacy Overview - ANSWER-There are three major areas
addressed in the Privacy Regulation: 1. Use and disclosure of PHI, 2. Patient
rights 3. Security administrative and physical
Business Associates - ANSWER-can be held directly accountable by federal or
state authority for failure to comply with HIPAA statutory or regulations. ex. IT
techs, Janitors, Cleaning Services, Vendors, Collection agencies, Consultants
and Billing Services.
Entities - ANSWER-ex. doctors, hospitals, pharmacy
Breach - ANSWER-unauthorized acquisition access, use or disclosure of
protected health information, ex. ALGH issue on breach where health info was
spread with no consents from patients.
What is NOT considered a breach? - ANSWER-1. Where an authorized person
who received the health info. cannot reasonably have been able to retain it.
2. If an unintentional acquisition, access, or use occurs within the scope of
employ. and info doesn't go any further.
,3. If it is an inadvertent disclosure that occurs within a facility, and the
information does not go any further.
Tiered Increase in Civil Monetary Penalties - ANSWER-HIPPA violation at
$50,000 per violation and an annual maximum of $1.5million.
What are examples that could not result in HIPPA violation by DHHS? -
ANSWER--Overheard phone or nursing station conversation
-Joint treatment areas
-Sign-in sheets
-Calling names in reception areas
-Hospital rounds
Solutions would be to speak quietly, cubicles, curtains, dividers, asking patients
to step back, or closing doors.
Health Information (PHI) - ANSWER-Any info. whether oral or recorded in any
form or medium that is created or received by a health care provider, health,
plan public health authority, employer, life insurer, school or university, or
health care clearinghouse, and related to the past, present or future physical or
mental health or condition.
Individual Identifiable Health Information (IIHI) - ANSWER-Information that is a
subset of health information, including demographic, information collected
from an individual.
Identifiers - ANSWER--Email address
-Social Security number
-Medical record number
-Vehicle identifier
, -Full face photograph
The Notice of Privacy Practices should be... - ANSWER-In a written language,
tape, or video that the patient understands, be clearly posted in the practice or
facility, and if applicable, on the practice website.
Fraud - ANSWER-the intentional deception or misrepresentation that an
individual knows to be false or does not believe to be true and makes,
knowingly that the deception could result in some unauthorized benefit to
himself/herself or some other person.
ex. Billing for services that were not furnished and or supplies that were not
provided
-Billing for services as if performed by a particular entity when they were, in
fact, performed by another entity not eligible to be paid by Medicare
-Using in incorrect or inappropriate provider number ni order to be paid (using
a deceased provider number to defraud Medicare).
Abuse - ANSWER-describes practices that either directly or indirectly result in
unnecessary costs to the Medicare Program. Acts committed knowingly,
willfully and intentionally.
ex. Charging in excess for services or supplies
Providing medical unnecessary services
Whistleblower - ANSWER-or the "qui tam" provision as it is formally called
allows a person that has knowledge of a false claim against the government to
bring an action against the suspected wrongdoer on behalf of the U.S.
government.
Relator - ANSWER-a person that files a qui tam suit on behalf of the
government and may share a percentage of the recovery realized from a