How HIPAA Violations Can Surprise You

How HIPAA Violations Can Surprise You

EDITOR’S NOTE: This is a fictional story that could become much too real.

In the bustling corridors of General Hospital USA, the heart of the administrative operations pulsed with urgency. The hospital’s CFO, Jennifer Morgan, was wrapping up a conference call when a soft knock on her door interrupted her train of thought.

“Come in,” Jennifer called out, her voice steady and authoritative.

The door opened to reveal the hospital’s Compliance Officer, Mark Davis. His usually calm demeanor was clouded with concern, a sight that made Jennifer’s own sense of unease grow.

“Mark, good to see you. What’s on your mind?” she asked, gesturing for him to take a seat.

“Jennifer, we have a serious issue that needs immediate attention,” Mark began, his tone grave. “It’s about our accounting system. I’ve discovered some invoices attached to it that contain patient information. This is a clear HIPAA violation.”

Jennifer’s face paled slightly as she absorbed the news. “How did this happen?” she asked, leaning forward, her eyes locked onto Mark’s.

Mark sighed, running a hand through his graying hair. “It seems that some of the invoices were uploaded by mistake. These invoices include patient names, treatment details, and other protected health information. Our accounting system isn’t HIPAA compliant, which means we’re in breach of the regulations.”

Jennifer took a deep breath, trying to process the implications. “How many invoices are we talking about?”

“From what I’ve seen so far, it’s about a hundred,” Mark replied. “But we need to conduct a thorough audit to identify the full scope of the issue.”

Jennifer nodded, her mind racing. “We need to act fast. The first step is to remove those invoices from the system immediately. Can you coordinate with IT to get that done?”

“Already on it,” Mark said, a hint of relief in his voice. “But we also need to inform the affected patients and report this breach to the Department of Health and Human Services. It’s crucial that we handle this by the book to mitigate any potential penalties.”

“Agreed,” Jennifer said, her tone resolute. “Let’s also ensure we have a team to review our current procedures and prevent this from happening again. We’ll need to provide additional training to our staff on handling patient information.”

Mark nodded. “I’ll get started on the breach notification and coordinate with our legal team to draft the communications for the affected patients. We need to be transparent about this mistake and reassure them that we’re taking all necessary steps to protect their information.”

While this is just a work of fiction, I want to demonstrate how easily hospitals and other healthcare providers can get caught in HIPAA violations when you assume that all of the systems in the organizations are HIPAA compliant.  Now is always a good time to talk to your compliance officer about which hospital systems are HIPAA compliant.  Even if certain software is compliant, you also need to make sure your organization has a “Business Associates” agreement with the vendor. 

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn

Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

Related Stories

What the End of Chevron Deference May Mean to Us

What the End of Chevron Deference May Mean to Us

During the last week of June, the U.S. Supreme Court unraveled the 1984 decision Chevron v. Natural Resources Defense Council. Chevron has been one of

Read More

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Preventing Sepsis Denials: From Recognition to Clinical Validation

Preventing Sepsis Denials: From Recognition to Clinical Validation

ICD10monitor has teamed up with renowned CDI expert Dr. Erica Remer to bring you an exclusive webcast on how to recognize sepsis, how to get providers to give documentation that will support sepsis, and how to educate to avert sepsis denials. Register now and become a crucial piece of the solution to standardizing sepsis clinical practice, documentation, and coding at your facility.

August 22, 2024
Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Comprehensive Inpatient Clinical Documentation Integrity: From Foundations to Advanced Strategies

Optimize your inpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. Participants will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.

June 26, 2024
Advanced Inpatient Clinical Documentation Integrity: Harnessing Technology, Analytics, and Compliance

Advanced Inpatient Clinical Documentation Integrity: Harnessing Technology, Analytics, and Compliance

Join expert Angela Comfort, MBA, RHIA, CDIP, CCS, CCS-P., as she helps you navigate advanced inpatient CDI technologies, regulatory changes, and system interoperability. Angela will provide actionable strategies for integrating AI and predictive analytics into CDI practices, ensuring seamless system interoperability, and maintaining compliance with evolving regulations. Attendees will learn to select and implement advanced EHR systems and CDI software, leverage data analytics to enhance documentation accuracy, and stay audit-ready with the latest compliance updates. Real-world case studies and practical tools will empower you to drive continuous improvement in CDI, improve patient outcomes, and enhance organizational efficiency. Don’t miss this opportunity to advance your CDI practices and stay ahead in this dynamic field.

July 11, 2024
Foundations of Inpatient Clinical Documentation Integrity: Enhancing Accuracy and Compliance

Foundations of Inpatient Clinical Documentation Integrity: Enhancing Accuracy and Compliance

Join expert Angela Comfort, MBA, RHIA, CDIP, CCS, CCS-P, for an insightful webcast on improving inpatient clinical documentation integrity (CDI). Inaccurate documentation can lead to misdiagnosis, improper treatment, and compromised patient safety. High workloads, lack of standardized practices, and outdated EHR systems contribute to these issues, affecting care quality and financial outcomes. Angela will offer practical strategies and tools to enhance accuracy, consistency, and timeliness in documentation. Attendees will learn to use standardized templates, checklists, and advanced EHR systems, while staying compliant with regulations. Improve patient care, ensure accurate billing, and reduce audit risks with actionable insights from this essential webcast.

June 26, 2024

Trending News

Featured Webcasts

Pediatric SDoH: An Essential Guide to Accurate Coding and Reporting

Pediatric SDoH: An Essential Guide to Accurate Coding and Reporting

This webcast, presented by Tiffany Ferguson, LMSW, CMAC, ACM, addresses the critical gap in Social Determinants of Health (SDoH) reporting for pediatric populations. While SDoH efforts often focus on adults, this session emphasizes the unique needs of children. Attendees will gain insights into the current state of SDoH, new pediatric Z-codes, and the importance of interdisciplinary collaboration. By understanding and applying pediatric-specific SDoH factors, healthcare professionals can improve data capture, compliance, and care outcomes. This webcast is essential for those looking to enhance their approach to pediatric SDoH reporting and coding.

August 8, 2024
Oncology and E/M Services: Compliance, Medical Necessity, and Reimbursement

Oncology and E/M Services: Compliance, Medical Necessity, and Reimbursement

Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, VP of CDM, for a webcast addressing oncology service coding challenges. Learn to navigate coding for infusions and injections alongside Evaluation and Management (E/M) services, ensuring compliance and accurate reimbursement. Gain insights into documenting E/M services for oncology patients and determining medical necessity. This webcast is essential to optimize coding practices, maintain compliance, and maximize revenue in oncology care.

July 30, 2024
The Inpatient Admission Order: Master the Who, When, and How

The Inpatient Admission Order: Master the Who, When, and How

During this webcast Dr. Ronald Hirsch delves into the inpatient admission order process including when to get it, when it becomes effective, its impact on billing and payment, who can write it, how to cancel it, the effects on the beneficiary, and more. You’ll leave with a clear understanding of inpatient orders and guidelines for handling improper orders that you can implement immediately.

June 20, 2024
Navigating AI in Healthcare Revenue Cycle: Maximizing Efficiency, Minimizing Risks

Navigating AI in Healthcare Revenue Cycle: Maximizing Efficiency, Minimizing Risks

Michelle Wieczorek explores challenges, strategies, and best practices to AI implementation and ongoing monitoring in the middle revenue cycle through real-world use cases. She addresses critical issues such as the validation of AI algorithms, the importance of human validation in machine learning, and the delineation of responsibilities between buyers and vendors.

May 21, 2024

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →