The Privacy Rule Aims To Balance Two Interests In Handling ✓ Solved

The Privacy Rule Aims To Balance Two Interests In The Handling Of

1. The Privacy Rule aims to balance two interests in the handling of “protected health information” (PHI). What are those two interests? 2. What are the situations in which a covered entity must disclose PHI? 3. What is the relationship of a “business associate” to a “covered entity”? 4. Breach of Information at Business Associate You received a call from a patient today whose identity has been stolen. He blames your facility for the breach. You researched his complaint and do not find any indication that there has been a breach of the patient’s data. You decide to call your business associates to see what they can find. When you call Coding Consulting, they admit that they had a security breach several months ago due to a hacker, and patient information was accessed. This patient information included Social Security numbers. Coding Consulting had not notified you of their breach as per the business associate agreement. a) Identify the privacy and security violations that have occurred b) Determine what your facility should do now.

Paper For Above Instructions

The Privacy Rule, integral to the Health Insurance Portability and Accountability Act (HIPAA), serves to balance two primary interests: the protection of individual privacy and the necessity for healthcare entities to share information for legitimate business purposes. The rule ensures that protected health information (PHI) remains confidential while enabling sufficient access to care providers for treatment, payment, and healthcare operations.

Interests in the Handling of PHI

The first interest is the right of individuals to control their own personal health information. This includes the right to have their PHI disclosed only with consent, thereby protecting their identity from unauthorized access. The second interest is the operational need for healthcare providers and related entities to utilize PHI to deliver quality healthcare services effectively. The Privacy Rule establishes a framework where these two interests can coexist; unauthorized disclosures are restricted, but necessary information flow for treatment and healthcare operations is permitted.

Situations Requiring Disclosure of PHI

Certain situations require covered entities to disclose PHI without individual consent. These situations include:

• For treatment purposes, where sharing information with another provider is necessary for effective patient care.
• For payment processes, where information needs to be shared with insurance companies or other payers for reimbursement.
• For healthcare operations, including quality assessments and case management.
• In response to legal requirements, such as subpoenas or court orders.
• To report certain types of injuries or abuse to appropriate authorities.
• For public health activities, which involve reporting disease outbreaks to prevent further transmission.

Business Associates and Covered Entities

A “business associate” is an individual or entity that performs certain functions or activities on behalf of, or provides certain services to, a covered entity that involve the use or disclosure of PHI. Business associates are typically not considered part of the healthcare entity but can access PHI when necessary for their services, such as billing, data analysis, or IT services. The relationship is formalized through a business associate agreement that outlines how PHI is to be handled, ensuring compliance with HIPAA standards.

Identifying Privacy and Security Violations

In the provided scenario, several privacy and security violations have occurred. Primarily, Coding Consulting’s delayed notification of the security breach constitutes a violation of the business associate agreement, as it failed to inform the covered entity of compromised patient information in a timely fashion. This lack of communication leaves the covered entity vulnerable to legal repercussions and places patient information at risk without adequate protective measures being taken.

Additionally, the unauthorized access to PHI through hacking indicates a breach of the security rule. According to HIPAA regulations, business associates must implement proper safeguards to protect PHI, which were evidently inadequate in this case. As a result, not only has the patient's information been exposed, but the trust between the patient and the healthcare provider could be significantly eroded.

Steps for the Facility

Your facility must take immediate and appropriate measures to address this breach. The following steps should be considered:

1. Notify Affected Individuals: First and foremost, the facility should inform the patients whose data may have been compromised, including the individual patient who reported the identity theft. This notification should include details about what information was accessed, the steps taken to mitigate the breach, and how they can protect themselves.
2. Coordinate with Business Associate: The facility should reach out to Coding Consulting to assess the breach's full scope, request a detailed report of the incident, and ensure they are implementing corrective actions. This can include improving their security measures to prevent future breaches.
3. Internal Investigation: Conduct an internal investigation to assess any potential vulnerabilities within the facility itself that could have contributed to the breach. This includes reviewing access controls, training for staff regarding PHI handling, and ensuring compliance with HIPAA regulations.
4. Consider Legal Counsel: Given the potential legal implications of a PHI breach, consulting with legal counsel who specializes in healthcare law is advisable. They can provide guidance on notification requirements, penalties, and how to mitigate legal risks.
5. Report to Authorities: Depending on the severity of the breach, reporting it to the Department of Health and Human Services (HHS) may be required. This department oversees HIPAA compliance, and failure to report can result in additional penalties.
6. Review Business Associate Agreements: Evaluate existing agreements with business associates to ensure that terms for safeguarding PHI are stringent and enforceable. It's also good practice to address compliance requirements and breach response protocols explicitly.

Conclusion

In conclusion, the Privacy Rule serves a vital function in balancing the dual interests of protecting patient privacy while allowing for necessary information flow in healthcare. Covered entities must remain vigilant about the actions of their business associates to prevent breaches that compromise patient information. Addressing such breaches comprehensively and promptly is critical to maintaining patient trust and ensuring compliance with legal obligations.

References

• Office for Civil Rights. (2013). Summary of the HIPAA Privacy Rule. U.S. Department of Health & Human Services.
• HealthIT.gov. (n.d.). What is PHI?
• Kelley, T. (2021). Understanding Business Associates under HIPAA. Compliance Guide.
• U.S. Department of Health & Human Services. (2020). Breach Notification Rule. HIPAA.
• Miller, J. (2018). HIPAA Compliance: Best Practices for Businesses. Journal of Health Care Compliance.
• Siegel, N. (2019). The Importance of Breach Response Plans: Protecting Patient Data in Healthcare. Healthcare IT News.
• Allen, M. (2022). Security Considerations for Healthcare Business Associates. Health Policy Journal.
• Harris, R. (2020). Patient Rights in the Digital Age: Balancing Privacy and Accessibility. Medical Ethics Today.
• Turner, L. (2019). Impact of Data Breaches on Healthcare Organizations: A Case Study. Journal of Healthcare Management.
• U.S. Department of Justice. (2019). Criminal Enforcement of HIPAA.