Regulatory Paper The Health Insurance Portability and Accountability Act of 1996

When it comes to health care, there are some major laws that come into play. The Health Insurance Portability and Accountability Act of 1996, HIPAA, is one of the most important laws that health care providers have to abide by. This law in particular, is regulated by the federal government, but there are also some key factors to this law everyone should know. There are also consequences that a health care employee will have to face if they don’t abide by this law, and this law’s regulations also effect ever member of health care from management to patients.

We will now discuss how important HIPAA is to the health care industry. To begin with, many people ask what is the Health Insurance Portability and Accountability Act of 1996 (HIPAA). HIPAA is a federal law that mandates insurance portability and set up procedures for electronic data exchange. Not only does HIPAA allow for that, but it also protects the privacy of health records. There are five different parts, or titles to HIPAA. Insurance portability is provided by Title I. There are two main parts to Title II. The first part has to do with fraud and abuse, and the reform of medical liability.

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The second orders administrative simplification, this includes privacy and security provisions for health data and requires electronic data interchange (EDI). Title III has to do with taxes. Title IV is the requirements for group health plans. Finally, Title V is revenue offsets. Also under this law, a patient has the right to access and control their health records. In order to ensure that protected health information is safe, health care providers have to restrict access to patient information and have the patients’ permission to disclose it. Next, there are some key provisions that every health care employee should know about HIPAA.

These include access to medical records, notice of privacy practices, limits on use of personal medical information, prohibition on marketing, stronger state laws, confidential communications, and complaints. To start with, patients are allowed to have access to their medical records and making corrections if they are needed. All health care providers, physicians, and covered health plans have to provide a notice to their patients about how their medical information can be used and the patients’ rights under HIPAA. There are also limits that are set on the usage of personal medical information.

The rules don’t restrict the share of information between doctors, nurses, and other providers because they want to be able to provide the best care for the patient. However, personal health information can’t commonly be used for anything that isn’t related to health care, and covered entities can only use or share the minimum amount necessary for a specific purpose. It would also be required for a patient to sign a disclosure for their health information to be released to a life insurer, bank, marketing firm, or any other outside business that isn’t related to health care.

A patient must also give their writing consent before any patient information can be used for marketing purposes. The federal privacy standards have no effect on state laws that provide additional privacy protection. HIPAA just sets the national “floor” for privacy standards, but any state law that provides additional protection will still apply. For confidential communications, patients can make request that their doctors, health plans, and other covered entities take reasonable steps to make sure that their communications with patients are confidential.

Finally, consumers can file formal complains in regards to the privacy practices of their provider or cover health plans. There are consequences that health care providers and facilities have to face if they don’t abide by the rules and regulations of HIPAA. Failure to comply can lead to civil and criminal penalties. There is a tiered civil penalty structure for violations, but the Secretary of the Department of Health and Human Services still has the authority in determining the amount of the penalty based upon the nature and extent of the violation and the harm resulting from the violation.

Civil penalties can’t be imposed if the violation is corrected within 30 days. The civil penalties are structured from the individual not knowing that he or she violated HIPAA, the violation is due to reasonable cause and not willful negligence, the violation is due to willful neglect, but is corrected within the required time frame, and the violation is due to willful neglect and isn’t corrected. The minimum penalties begin at $100 per violation with an annual maximum of $25,000 for repeating violations all the way to $50,000 per violation, with an annual maximum of $1. million. The maximum penalties are $50,000 per violation, with an annual maximum of $1. 5 million. Criminal penalties are faced when covered entities and specified individuals knowingly obtain or disclose individually identifiable health information violating the Administrative Simplification Regulations. These can be fines of up to $50,000 and imprisonment up to a year. If offenses are made under false pretenses, these penalties can increase up to $100,000 and up to five years in prison.

Last, but not least, if health information is released with intent to sell, transfer, use for commercial advantage, personal gain, or malicious harm, fines can go up to $250,000 and imprisonment for up to ten years. Finally, HIPAA affects everyone in the health care industry. With HIPAA in place, health care managers need to ensure that their employees understand the rules and regulations, if not it could become costly. Employees need to make sure that they understand what is required of them while dealing with patients’ medical records and keeping them private.

Patients also have a say so in how their medical records are handled. They can ask to have a copy of their medical record, they are allowed to make changes, the can make request on how they are discussed within reason, and they also have the right to say who their information can and cannot be disclosed to. No medical information can be disclosed about a patient for any reason other than ensuring they have the proper treatment without written consent from the patient.

There may be a need for more resources that would including training employees in HIPAA guidelines, but the cost for the training will definitely be less than the costs of fines for not abiding by the guidelines. Health care will overall become more confidential and personal with information not being able to be spread as easily as before, and what used to be an embarrassing mistake if information was released will now result in civil and/or criminal penalties.

In conclusion, we can see that the Health Insurance Portability and Accountability Act of 1996 has played a major role in the health care industry. Although it is regulated by the federal government, state laws can still override this law if they provide more patient protection. We have learned about the key provisions within this act and also about the consequences of not abiding by this law. As long as all health care employees understand and abide by this law, we will continue to make a better way for health care and the privacy of our patients.

American Medical Association. (2013). HIPAA Violations and Enforcements. Retrieved from Austin, A., & Wetle, V. (2012). The United States Health Care System: Combining Business, Health, and Delivery (2nd ed.). Retrieved from The University of Phoenix eBook Collection. Salem, D. (2003). HIPAA’s Privacy Regulations: Increased Privacy Comes at a Cost. Retrieved from U.S. Department of Health and Human Services. (n.d.). Understanding Health Information Privacy. Retrieved from

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