05 Dec HEALTH INSURANCE 1 HEALTH INSURANCE 7

HEALTH INSURANCE 1

 

HEALTH INSURANCE 7

 

 

 

 

 

Health Insurance Portability and Accountability Act

 

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Introduction

Healthcare is an integral aspect of our daily lives. In the ever-growing world, healthcare is considered one of the top priorities in modern society. A health care system is an organization of people, resources, and institutions involved in delivering health care services to satisfy target populations’ health needs. Healthcare organizations have the responsibility of providing a wide range of well-being services at affordable prices. Healthcare organizations strive to achieve the delivery of quality healthcare services to target populations. The health providers may not handle the patients’ health data and information with high level of integrity and confidentiality thus leaving the patient vulnerable through exposure of the data and information. Over the years, governments have backed up efforts by the healthcare institutions by enacting healthcare legislation that would help improve the delivery of healthcare services to the people. The paper focuses on the Health Insurance Portability and Accountability Act (HIPAA), digging into the reasons that led to its creation and its application into the United States legal system.

The Health Insurance Portability and Accountability Act is a data privacy federal law that needed the creation of high national standards in protecting sensitive information about a patient’s health against disclosure without consent or knowledge of the patient. The law was signed in 1996 by President Bill Clinton. The department of Health and Human Services (HHS) in the U.S. issued the HIPAA Privacy Rule to implement the HIPAA requirements effectively. Data breaches can adversely affect individuals and organizations, such as litigation cases, huge fines, and even damage to the individual’s or organization’s reputation. Healthcare systems have been facing complex data and privacy challenges. The HIPAA seeks to address the challenges of patients’ health data and information privacy.

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The HIPAA legislation was necessitated by the numerous data breaches caused by ransomware and cyber-attacks on the health insurers and providers. The attacks highly exposed the patient’s data and important information to unauthorized and malicious people. The HIPAA Privacy Rule seeks to protect patient’s privacy by demanding health care providers to provide patients with a proper account of any entity to which the healthcare provider discloses protected health information (PHI)for administrative and billing purposes while allowing relevant healthcare information to flow through appropriate means. In fulfilling the legislation mandate assigned to HIPAA, it serves two main purposes. One is providing continuous health insurance cover to employees who lose or change their job. The second is reducing the healthcare delivery cost by standardizing the electronic transmission of financial and administrative transactions (Edemekong, Annamaraju & Haydel, 2020).

Several challenges arise from the ever-increasing data privacy concerns regarding data uses and the need to reconcile data with data for security in data applications such as health, food security, and homeland protection. These data security and privacy challenges pose a great risk to healthcare data and information for current and future use by healthcare providers. The HIPAA seeks to curb the exposure of patients’ health data and information privacy. HIPAA protects a number of patient’s information. Through the HIPAA Privacy Rule, all the patient’s identifiable health data and information that is stored or transmitted by a covered entity is highly protected. The data or information can be held in any form from paper, oral to digital. Personal Health information (PHI) includes a number of patient’s details. The first is the patient’s name, birth date, address, social security number or other identifiable personal information. The second information is the patient’s past, present or future mental and physical condition. Besides, the patient’s information on the past, present or future healthcare payment is protected by the HIPAA Privacy Rule.

Moreover, the Privacy Rule guarantees patients the right to get their PHI upon request from healthcare providers covered by HIPAA. The HIPAA stipulates three entities subject to the Privacy Rule: Health plans, Healthcare Providers, and Healthcare clearinghouses. These entities conduct particular health care transactions electronically, such as billing a health plan. The federal law states that a HIPAA covered entity may disclose PHI to law enforcement with a signed HIPAA authorization by the individual in question. However, a HIPAA entity may disclose PHI to law enforcement without signed HIPAA authorization in certain situations, such as when required by law to report gunshots or stab wounds. In such cases when the law demands for the patients’ health data and information, then it is not viewed as a violation of HIPAA but a provision of law. The information disclosed may be crucial in the proceedings and determination of the legal case (Rouse, 2017).

Many legal cases have involved HIPAA in their proceedings and determination. These cases have violated the HIPAA resulting in financial penalties, including civil monetary penalties. Violating HIPAA can attract hefty court fines. One of the HIPAA legal cases is Bayfront Health St.Peterburg of 2018, which was investigated upon receipt of a patient’s complaint. The patient herein has requested a copy of the fetal heart monitor record belonging to her child, but nine months later, the request had not been honored. In resolving the HIPAA violation, a settlement of $85,000 was agreed with the officer for civil rights (OCR). Another case of HIPAA violation is that of Elite Dental Associates. A patient of Elite Dental Associates reported a complaint to OCR lamenting that her protected health information (PHI) had been disclosed without her knowledge and consent as she had seen the information on a review on Yelp. The OCR investigated and discovered that Elite Dental Associates had violated the patient’s privacy. This impermissible disclosure of the patient’s PHI resulted in settlement of $10,000.These cases have clearly demonstrated the violation of HIPAA and the consequences of the offence in the court of law (Calhoun, Kiel & Morgan, 2018).

HIPAA is crucial in safeguarding a patient’s personal health information against exposure. HIPAA should be well enforced to guarantee the utmost protection of the PHI. Proper protection of PHI would create a high level of trust between patients and healthcare providers. A patient’s trust in the health care providers is a necessary element for establishing a good connection between the patient and the healthcare providers’ thus promoting high-quality healthcare delivery in the healthcare institutions. In improving the quality of healthcare, healthcare providers need to go beyond the superficial interaction with patients and act in a manner backed by academic significance. Strengthening of HIPAA is required to make it more effective in protecting patient’s health data and information. Data privacy and confidentiality is very crucial to both the healthcare organization and the patient as it prevents data from getting into the wrong hands. Health care providers should always uphold to their professionalism in executing their mandate by provide patients with a proper account of any entity to which the healthcare provider discloses PHI for administrative and billing purposes while allowing relevant healthcare information to flow through appropriate channels.

Conclusion

Therefore, there is a need to find ways of protecting patients’ data and information to prevent or solve healthcare provider-patient conflicts that may arise due to data breaches and violation of HIPAA. Health care providers need to always act with utmost integrity in handling patient’s data and information to establish close relationships with patients while building trust. Healthcare providers should always apply logos, pathos, and ethos in their practice to improve the quality of healthcare services they offer to patients. The legislators should find ways of strengthening the HIPAA to effectively protect a patient’s healthcare data and information for current and future use by the healthcare providers.

 

 

 

 

 

 

 

 

 

 

 

 

References

Calhoun, B. C., Kiel, J. M., & Morgan, A. A. (2018). Health Insurance Portability and Accountability Act Violations by Physician Assistant Students: Applying Laws to Clinical Vignettes. The Journal of Physician Assistant Education, 29(3), 154-157.

Edemekong, P., Annamaraju, P., & Haydel, M. (2020). Health Insurance Portability and Accountability Act. StatPearls.

Rouse, M. (2017). HIPAA (Health Insurance Portability and Accountability Act).