What is HIPAA?
The Health Insurance Portability and Accountability Act (HIPAA) was passed and signed into law in 1996. Its purpose is to provide a better health care system for the American people by integrating and centralizing their health care benefits, programs, contributions, and medical information. Through this system, the American people can retain their health insurance coverage despite losing a job or transferring to another job. HIPAA ensures a portable health coverage that does not depend on a person’s occupation.
The downside, however, is that the person’s medical and personal information are recorded in a central database. This sensitive information may be used for various criminal objectives. Thus, to ensure the privacy of information, HIPAA provides a stiff penalty for the unauthorized disclosure of protected health information. The penalty includes a fine anywhere from $100 to as high $250,000 and may even include imprisonment.
HIPAA Exemption for Whistleblowers
Whistleblowers may have access to, or need to disclose, health information protected under HIPAA while reporting fraudulent healthcare practices under the False Claims Act. Fortunately, the law provides for an exemption for whistleblowers. Under 45 CFR 164.502(j)(1), whistleblowers do not violate HIPAA if they disclose protected health information with the good-faith belief that the covered entity has engaged in conduct that is unlawful or otherwise violates professional or clinical standards or that the care, services, or conditions provided by the covered entity potentially endangers one or more patients, workers, or the public. In addition, the disclosure must be made before a health oversight agency, or by an attorney retained for the purpose of determining the whistleblower’s legal options.
This exemption is designed to protect whistleblowers and encourage the reporting of fraudulent healthcare practices.
Behn & Wyetzner attorneys are qualified to handle and determine a whistleblower’s legal options. Should you possess information regarding healthcare fraud but are hesitant to come forward because of concerns about HIPAA, our law office can aid you in this matter and provide you the proper legal advice.