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Hippa Violation


kakul
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under HIPPA RULES,can a hospital disclose to a collection agency the names of medicines given to a patient,under description of services. i got a letter from west asset management that shows name of hospital description of services which shows names of medicines,cost of each total amount. no where it shows amount owed or the reimbursement by insurance company. please let me know if its a violation of HIPPA.

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Let this sit for a couple days so LadynRed can see this, or send her a PM. She is very up on HIPAA.

As best as I can recall, all a provider is allowed to share with the CA, is the name of patient, responsible party, if different, dates involved, amount due, and reference numbers, which are the ones used by a provider for billing purposes. The law says that no personal information is to be shared with anyone, which, to me, makes it a big violation for sharing names of medicines. Now, if you dispute the debt with the DV, a CA's own computer generated accounting does not meet the minimum requirement of the law. Their response to a DV must be a copy of a letter/statement from the provider, on the provider's own letterhead. it must include all dates, reference numbers, all amounts paid by insurance, if applicable, and the balance owing. For your own protection, and you do not have a copy of the involved EOB from your insurance, you need to contact them to assure you were billed properly. Do note that you are never, to be billed for more than the allowable amount set by your insurance company, pay for noncovered treatments, unless exact procedure was followed prior to treatment, such as your signature acknowledging this, any item noted as "mutually exclusive", and any amount not shown as copay/cost share/patient's responsibility, unless as noted above. Lastly, many insurance companies have a special department to assist you in dealing with collectors. What I mean, for example, is that our insurance company forbids any provider from assigning a debt to a collector. They must contact the insurance and they will assist in the collection. Remember one very important thing. Anytime a provider agrees to accept assignment from a patient/beneficiary, they automatically agree to abide by all rules and regulations set by the insurance company. This is why you will sometimes find providers who won't accept assignment.

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Medical providers must have a Business Associate Agreement (BAA) with anyone they deal with. Collections is a necessary evil for medical providers and with a valid BAA in place there is no violation of HIPAA for providing the CA with the necessary information to collect a debt, and that includes an itemization of services rendered. I'd have to check on the medications piece, but I would think that would not be relevent just to collect a debt.

As already pointed out, there is no private right of action under HIPAA, the gov't is the only enforcer. If you feel there is a violation, you must contact the privacy official at the facility or medical provider, everyone must have at least one person designated for the role. If there is a violation, the fines START at 100,000K, so the penalties are by no means weak.

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Guest FloridaDebtor
under HIPPA RULES,can a hospital disclose to a collection agency the names of medicines given to a patient,under description of services. i got a letter from west asset management that shows name of hospital description of services which shows names of medicines,cost of each total amount. no where it shows amount owed or the reimbursement by insurance company. please let me know if its a violation of HIPPA.

I work in a hospital and might shed some light on this. Violation may be reported but the injured party may only file a HEALTH INFORMATION PRIVACY COMPLAINT. No monetary awards. HIPAA would then fine the hospital for violations, not the individual.

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That is my biggest complaint with HIPAA. Though the fines are heavy, the "patient" still gets the shaft. Plus, in many cases, the law is too broad and allows things they shouldn't. As I write below, you will see why.

To add, I was told in the beginning that a provider can only send the reference numbers, not the actual "problem". But, some people still complained as it was found some reps in the collection industry had a friend in the billing industry, or insurance industry, so would call to have the numbers "translated", for their own "entertainment". Therefore, I still stand that the collector receives no information other than location, name of OC, and amount due. Why is becuase the majority of the patients have an EOB from their carrier, so have seperate proof of claim to verify amount. Then, if they dispute, the CA would not be in violation as FDCPA 809 does state the proof must be mailed by them. The only stipulation would be that the OC would seal the info in a stamped envelope from them for the CA to forward on. This way no one can even begin to question if a violation took place.

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