healthcarecompliance101

Healthcare Compliance 101

Archive for the month “January, 2016”

A Risk Assessment is a Necessary Requirement of a HIPPA Compliance Program

December 14, 2015

$750,000 HIPAA SETTLEMENT UNDERSCORES THE NEED FOR ORGANIZATION WIDE RISK ANALYSIS

 The University of Washington Medicine (UWM) has agreed to settle charges that it potentially violated the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Security Rule by failing to implement policies and procedures to prevent, detect, contain, and correct security violations.  UWM is an affiliated covered entity, which includes designated health care components and other entities under the control of the University of Washington, including University of Washington Medical Center, the primary teaching hospital of the University of Washington School of Medicine.  Affiliated covered entities must have in place appropriate policies and processes to assure HIPAA compliance with respect to each of the entities that are part of the affiliated group.   The settlement includes a monetary payment of $750,000, a corrective action plan, and annual reports on the organization’s compliance efforts.

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) initiated its investigation of the UWM following receipt of a breach report on November 27, 2013, which indicated that the electronic protected health information (e-PHI) of approximately 90,000 individuals was accessed after an employee downloaded an email attachment that contained malicious malware. The malware compromised the organization’s IT system, affecting the data of two different groups of patients:  1) approximately 76,000 patients involving a combination of patient names, medical record numbers, dates of service, and/or charges or bill balances; and 2) approximately 15,000 patients involving names, medical record numbers, other demographics such as address and phone number, dates of birth, charges or bill balances, social security numbers, insurance identification or Medicare numbers.

OCR’s investigation indicated UWM’s security policies required its affiliated entities to have up-to-date, documented system-level risk assessments and to implement safeguards in compliance with the Security Rule. However, UWM did not ensure that all of its affiliated entities were properly conducting risk assessments and appropriately responding to the potential risks and vulnerabilities in their respective environments.

The Resolution Agreement and Corrective Action Plan can be found on the OCR website at:http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/uwm/index.html

The HHS Press Release can be found at:  http://www.hhs.gov/about/news/2015/12/14/750000-hipaa-settlement-underscores-need-for-organization-wide-risk-analysis.html

HHS offers guidance on how your organization can conduct a HIPAA Risk Analysis:  http://www.healthit.gov/providers-professionals/security-risk-assessment

To learn more about non-discrimination and health information privacy laws, your civil rights, and privacy rights in health care and human service settings, and to find information on filing a complaint, visit us at http://www.hhs.gov/ocr/office

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Understanding Individuals Rights Under HIPPA

January 7, 2016

 

Understanding Individuals’ Right under HIPAA to Access their Health Information

The HIPAA Privacy Rule has always provided individuals with the right to access and receive a copy of their health information from their doctors, hospitals and health insurance plans.  This right is critical to enabling individuals to take ownership of their health and well-being.  Individuals with access to their health information are better able to monitor chronic conditions, adhere to treatment plans, find and request fixes to errors in their records, track progress in wellness or disease management programs, and directly contribute their information to research.  As the health care system evolves and transforms into one supported by rapid, secure exchange of electronic health information and more targeted treatments discovered through the new precision medicine model of patient-powered research, it is more important than ever for individuals to have ready access to their health information. Unfortunately, based on recent studies and our own enforcement experience, far too often individuals face obstacles to accessing their health information, even from entities required to comply with the HIPAA Privacy Rule.  This must change.

Today, we took an important step toward ensuring that individuals can take advantage of their HIPAA right of access. We released a fact sheet and the first in a series of topical Frequently Asked Questions (FAQs) to further clarify individuals’ core right under HIPAA to access and obtain a copy of their health information.  This set of FAQs addresses the scope of information covered by HIPAA’s access right, the very limited exceptions to this right, the form and format in which information is provided to individuals, the requirement to provide access to individuals in a timely manner, and the intersection of HIPAA’s right of access with the requirements for patient access under the HITECH Act’s Electronic Health Record (EHR) Incentive Program.

We will continue to develop additional guidance and other tools as necessary to ensure that individuals understand and can exercise their right to access their health information.  In addition, the Office for Civil Rights will work with the White House Social and Behavioral Sciences Team and the Department of Health and Human Services Office of the National Coordinator for Health Information Technology (ONC) to produce consumer-friendly resources, including sample communications tools to encourage patients to access their digital health information.

The first set of materials may be found on OCR’s website at: http://www.hhs.gov/hipaa/for-professionals/privacy/guidance/access/index.html

To learn more about non-discrimination and health information privacy laws, your civil rights, and privacy rights in health care and human service settings, and to find information on filing a complaint, visit us at http://www.hhs.gov/ocr/

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