Holzschu, Jordan, Schiff & Associates
Press Release
Health Insurance Portability Accountability Act (HIPAA) Compliance
Affects Virtually every Employer
On April 14, 2004 virtually every employer that sponsors a health care plan for its employees must become compliant with the HIPAA regulations. The requirements vary as to the amount of documentation that needs to be prepared based on your company’s involvement in the health care programs. If you only pay for the program and do not have any administration of claims or access to Protected Health Information (PHI), you only have to prepare a few documents. If you are self-insured and actively participate in the administration of the claims, your burden becomes much greater.
If you pay the premiums for or provide any of the following types of health care programs you must have your program in effect next April. 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 (excluding nursing home fixed-indemnity policies).
Penalties for Violators
Civil Penalties for Non-Compliance
$100 per person/violation to a maximum of $25,000 per person/ per single standard/per calendar year
Considering the proposed security rules contain more than 25 specific requirements, the maximum penalty can exceed $625,000 per year
Criminal Penalties for Wrongful Disclosure of Health Information
Simple disclosure - fines up to $50,000 and/or one year in prison
Disclosure under false pretenses - fines up to $100,000 and/or five years in prison
Disclosure with intent to sell or use or transfer individually identifiable health information for commercial advantage, personal gain or maliciousness - fines up to $250,000 and/or 10 years in prison
Complaints are initiated by the individual that had the Protected Health Information disclosed. There is an on-line complaint system that can be used as well as telephone access. Between April 2003 and October 2003 there were 600 complaints filed and action is proceeding on those complaints. These were regarding Health Plans such as medical care givers who had to be complaint April 14, 2003.
Will you be ready for HIPAA Compliance?
For additional information contact:
Michael Holzschu
Holzschu, Jordan, Schiff & Associates
248-476-6907
mholzschu@hjsa.com
Health and Human Services definitions:
Health Plans. Individual and group plans that provide or pay the cost of medical care are covered entities
. 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 (excluding nursing home fixed-indemnity policies). Health plans also include employer-sponsored group health plans, government and church-sponsored health plans, and multi-employer health plans. There are exceptions—a group health plan with less than 50 participants that is administered solely by the employer that established and maintains the plan is not a covered entity. Two types of government-funded programs are not health plans: (1) those whose principal purpose is not providing or paying the cost of health care, such as the food stamps program; and (2) those programs whose principal activity is directly providing health care, such as a community health center, or the making of grants to fund the direct provision of health care. Certain types of insurance entities are also not health plans, including entities providing only workers’ compensation, automobile insurance, and property and casualty insurance.
Fully-Insured Group Health Plan Exception. The only administrative obligations with which a fully-insured group health plan that has no more than enrollment data and summary health information is required to comply are the (1) ban on retaliatory acts and waiver of individual rights, and (2) documentation requirements with respect to plan documents if such documents are amended to provide for the disclosure of protected health information to the plan sponsor by a health insurance issuer or HMO that services the group health plan.
This document maintained by
mholzschu@hjsa.com.
Material
Copyright © 2003 Holzschu, Jordan, Schiff & Associates