Lance's Corner

OCR Takes HIPAA Action Against Hospital Over Improper Disclosure of Patient Information to Employer

Dec 3, 2024

Per the notice below, the United States Office for Civil Rights (OCR) has taken action under the Health Insurance Portability and Accountability Act of 1996 (HIPAA) against a hospital for improper disclosure of patient information to the patient's employer.

HHS Office for Civil Rights Settles with Holy Redeemer Hospital Over Disclosure of Patient’s Protected Health Information, Including Reproductive Health Information

Settlement emphasizes the need to ensure the privacy of PHI, including reproductive health information

The U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR) announced a settlement with Holy Redeemer Family Medicine (Holy Redeemer), a Pennsylvania hospital, concerning an alleged violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Rule due to an impermissible disclosure of a female patient’s protected health information, including information related to reproductive health care.  OCR enforces the HIPAA Privacy, Security, and Breach Notification Rules, which set forth the requirements that covered entities (health plans, health care clearinghouses, and most health care providers) and business associates must follow relating to the privacy and security of protected health information.  The HIPAA Privacy Rule establishes national standards to protect individuals’ medical records, requires appropriate safeguards to protect the privacy of protected health information and sets limits and conditions on the uses and disclosures that may be made of such information without an individual’s authorization (such as disclosures for health oversight activities or for law enforcement purposes), and gives individuals rights such as the ability to access their own medical records.

“It is imperative that health care providers take their duty to protect patient privacy seriously and follow the law,” said OCR Director Melanie Fontes Rainer.  “Patients must be able to trust that sensitive, health information in their files is protected to preserve their trust in the patient-doctor relationship and ensure they get the care they need.  This is particularly true for reproductive health privacy.”

In September of 2023, OCR received a complaint alleging that Holy Redeemer impermissibly disclosed a female patient’s protected health information to the patient’s prospective employer, including her surgical history, gynecological history, obstetric history, and other sensitive health information concerning reproductive health care.  OCR’s investigation found that Holy Redeemer disclosed the patient’s full medical record, including protected health information concerning her reproductive health care, that it did not have the patient’s authorization for the broad disclosure of her protected health information, and that there otherwise was no applicable requirement or permission under the Privacy Rule for such a broad release of her medical records.  The complainant stated that she had requested that Holy Redeemer send one specific test result, unrelated to her reproductive health, to a prospective employer.  Under the terms of the resolution agreement, Holy Redeemer paid $35,581 and agreed to implement a corrective action plan that identifies specific steps it will take to comply with the HIPAA Rules and protect patient privacy to prevent this from happening again.  OCR will monitor the implementation of this corrective action plan for two years:

  • Submit a breach notification report to HHS regarding this incident;
  • Review, develop or revise its policies and procedures to ensure compliance with the Privacy Rule, and submit all such policies and procedures to HHS for approval;
  • Distribute all HHS-approved policies and procedures to its workforce and ensure that each member of the workforce certifies receipt and understanding of the policies and procedures;
  • Train all members of its workforce on its HHS-approved policies and procedures, including all workforce members of its affiliated entities;
  • Within 120 days after HHS approval of Holy Redeemers policies and procedures, Holy Redeemer must submit a written report to HHS detailing the status of its implementation of the corrective action plan;
  • Provide a report to OCR regarding any non-compliance with its policies and procedures by any members of its workforce;
  • Provide annual reports to OCR regarding Holy Redeemer’s compliance with the corrective action plan.

The resolution agreement and corrective action plan may be found at: https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/holy-redeemer-hospital-ra-cap/index.html.  OCR is committed to ensuring the privacy of lawful reproductive health care.  Please see OCR’s 2024 final rule on HIPAA Privacy Rule to Support Reproductive Health Care Privacy for more information.  OCR enforces the HIPAA Rules that protect the privacy and security of peoples’ health information.  Guidance about the Privacy Rule, Security Rule, and Breach Notification Rule can also be found on OCR’s website.  If you believe that your or another person’s health information privacy or civil rights have been violated, you can file a complaint with OCR at: https://www.hhs.gov/ocr/complaints/index.html.

USDOL Issues Comprehensive Employer Guidance on Long COVID

The United States Department of Labor (USDOL) has issued a comprehensive set of resources that can be accessed below for employers on dealing with Long COVID.

Supporting Employees with Long COVID: A Guide for Employers

The “Supporting Employees with Long COVID” guide from the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) and Job Accommodation Network (JAN) addresses the basics of Long COVID, including its intersection with mental health, and common workplace supports for different symptoms.  It also explores employers’ responsibilities to provide reasonable accommodations and answers frequently asked questions about Long COVID and employment, including inquiries related to telework and leave.

Download the guide

Accommodation and Compliance: Long COVID

The Long COVID Accommodation and Compliance webpage from the USDOL-funded Job Accommodation Network (JAN) helps employers and employees understand strategies for supporting workers with Long COVID.  Topics include Long COVID in the context of disability under the Americans with Disabilities Act (ADA), specific accommodation ideas based on limitations or work-related functions, common situations and solutions, and questions to consider when identifying effective accommodations for employees with Long COVID.  Find this and other Long COVID resources from JAN, below:

Long COVID, Disability and Underserved Communities: Recommendations for Employers

The research-to-practice brief “Long COVID, Disability and Underserved Communities” synthesizes an extensive review of documents, literature and data sources, conducted by the USDOL-funded Employer Assistance and Resource Network on Disability Inclusion (EARN) on the impact of Long COVID on employment, with a focus on demographic differences.  It also outlines recommended actions organizations can take to create a supportive and inclusive workplace culture for people with Long COVID, especially those with disabilities who belong to other historically underserved groups.

Read the brief

Long COVID and Disability Accommodations in the Workplace

The policy brief “Long COVID and Disability Accommodations in the Workplace” explores Long COVID’s impact on the workforce and provides examples of policy actions different states are taking to help affected people remain at work or return when ready.  It was developed by the National Conference of State Legislatures (NCSL) as part of its involvement in USDOL’s State Exchange on Employment and Disability (SEED) initiative.

Download the policy brief

Understanding and Addressing the Workplace Challenges Related to Long COVID

The report “Understanding and Addressing the Workplace Challenges Related to Long COVID” summarizes key themes and takeaways from an ePolicyWorks national online dialogue through which members of the public were invited to share their experiences and insights regarding workplace challenges posed by Long COVID.  The dialogue took place during summer 2022 and was hosted by USDOL and its agencies in collaboration with the Centers for Disease Control and Prevention and the U.S. Surgeon General.

Download the report

Working with Long COVID

The USDOL-published “Working with Long COVID” fact sheet shares strategies for supporting workers with Long COVID, including accommodations for common symptoms and resources for further guidance and assistance with specific situations.

Download the fact sheet

COVID-19: Long-Term Symptoms

This USDOL motion graphic informs workers with Long COVID that they may be entitled to temporary or long-term supports to help them stay on the job or return to work when ready, and shares where they can find related assistance.

Watch the motion graphic

A Personal Story of Long COVID and Disability Disclosure

In the podcast “A Personal Story of Long COVID and Disability Disclosure,” Pam Bingham, senior program manager for Intuit’s Diversity, Equity and Inclusion in Tech team, shares her personal experience of navigating Long COVID symptoms at work.  The segment was produced by the USDOL-funded Partnership on Employment and Accessible Technology (PEAT) as part of its ongoing “Future of Work” podcast series.

Listen to the podcast

HHS OIG Issues Annual Report on State MFCUs

Per the notice below, the Office of the Inspector General (OIG) of the United States Department of Health and Human Services (HHS) has issued its annual report on the performance of state Medicaid Fraud Control Units (MFCUs).

Medicaid Fraud Control Units Fiscal Year 2023 Annual Report (OEI-09-24-00200) 

Medicaid Fraud Control Units (MFCUs) investigate and prosecute Medicaid provider fraud and patient abuse or neglect. OIG is the Federal agency that oversees and annually approves federal funding for MFCUs through a recertification process. This new report analyzed the statistical data on annual case outcomes—such as convictions, civil settlements and judgments, and recoveries—that the 53 MFCUs submitted for Fiscal Year 2023.  New York data is as follows:

Outcomes

  • Investigations1 - 556
  • Indicted/Charged - 9
  • Convictions - 8
  • Civil Settlements/Judgments - 28
  • Recoveries2 - $73,204,518

Resources

  • MFCU Expenditures3 - $55,964,293
  • Staff on Board4 - 257

1Investigations are defined as the total number of open investigations at the end of the fiscal year.

2Recoveries are defined as the amount of money that defendants are required to pay as a result of a settlement, judgment, or prefiling settlement in criminal and civil cases and may not reflect actual collections.  Recoveries may involve cases that include participation by other Federal and State agencies.

3MFCU and Medicaid Expenditures include both State and Federal expenditures.

4Staff on Board is defined as the total number of staff employed by the Unit at the end of the fiscal year.

Read the Full Report

View the Statistical Chart

Engage with the Interactive Map

GAO Issues Report on Medicaid Managed Care Service Denials and Appeal Outcomes

The United States Government Accountability Office (GAO) has issued a report on federal use of state data on Medicaid managed care service denials and appeal outcomes.  GAO found that federal oversight is limited because it doesn't require states to report on Medicaid managed care service denials or appeal outcomes and there has not been much progress on plans to analyze and make the data publicly available.  To read the GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the first link below.  To read GAO highlights of the report on federal use of state data on Medicaid managed care service denials and appeal outcomes, use the second link below.
https://www.gao.gov/assets/d24106627.pdf  (GAO report on federal use of state data on Medicaid managed care service denials and appeal outcomes)
https://www.gao.gov/assets/d24106627_high.pdf  (GAO highlights on federal use of state data on Medicaid managed care service denials and appeal outcomes)

CMS Issues Latest Medicare Regulatory Activities Update

The Centers for Medicare and Medicaid Services (CMS) has issued its latest update on its regulatory activities in the Medicare program.  While dentistry is only minimally connected to the Medicare program, Medicare drives the majority of health care policies and insurance reimbursement policies throughout the country.  Therefore, it always pays to keep a close eye on what CMS is doing in Medicare.  To read the latest CMS update on its regulatory activities in Medicare, use the link below.
https://www.cms.gov/training-education/medicare-learning-network/newsletter/2024-03-14-mlnc