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HIPPA Privacy Rules, Part 3- Who Must Keep Quiet

As discussed in the previous posting, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), was enacted in 1996. It was created to assure that individuals’ health information is properly protected. The previous postings listed information that the Privacy Rule protects and information that can be disclosed. This posting will list the entities that must keep private health information private.

The Privacy Rule applies to health plans, health care providers, and health care clearinghouses.

Health plans include health, dental, vision, and prescription drug insurers, health maintenance organizations (“HMOs”), Medicare, Medicaid, Medicare+Choice and Medicare supplement insurers, and long-term care insurers. Health plans also include employer-sponsored group health plans, government and church-sponsored health plans, and multi-employer health plans.

Every health care provider, regardless of size, who electronically transmits health information in connection with certain transactions, is a covered entity. These transactions include claims, benefit eligibility inquiries, referral authorization requests, or other transactions. The Privacy Rule covers a health care provider whether it electronically transmits these transactions directly or uses a billing service or other third party to do so on its behalf. This includes hospitals, physicians, dentists, and other practitioners. It also includes any other person or organization that furnishes, bills, or is paid for health care.

Health care clearinghouses are entities that process information and include billing services, repricing companies, and community health management information systems.

Also included as “Business Associates” are people or organizations that perform certain functions or activities for a “covered entity” that involve the use or disclosure of individually identifiable health information. Examples are claims processing, data analysis, utilization review, billing, legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, or financial services.

To be continued ….
Aaron E. Futterman, CPA, Esq. is a partner in the law firm of Futterman & Lanza, LLP with offices in Smithtown, NY and clients throughout Suffolk, Nassau, Queens, Brooklyn, Bronx, Richmond, New York, Westchester and Rockland Counties. He concentrates his practice to Elder Law, Medicaid Planning, Medicaid Applications, Estate Planning, Probate, Estate Taxes, and Estate Administration.

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