Covered Entity Definition
A Covered Entity is:
A health plan. An individual or group plan that
provides, or pays the cost of, medical care. Health plans include
private entities (e.g., health insurers and managed care organizations)
and government organizations (e.g., Medicaid, Medicare, and the Veterans
Health Administration)
A health care provider. A provider of health care
services and any other person or organization that furnishes, bills, or
is paid for health care in the normal course of business. Health care
providers (e.g., physicians, hospitals, and clinics) are covered
entities if they transmit health information in electronic form in
connection with a transaction for which a HIPAA standard has been
adopted by HHS. (e.g., billing)
A health care clearinghouse. A public or private
entity, including a billing service, repricing company, or community
health information system, that processes non-standard data or
transactions received from another entity into standard transactions or
data elements, or vice versa.
| Can a covered entity refuse to disclose ePHI to an app chosen by an individual because of concerns about how the app will use or disclose the ePHI it receives? No. The HIPAA Privacy Rule generally prohibits a covered entity from refusing to disclose ePHI to a third-party app designated by the individual if the ePHI is readily producible in the form and format used by the app. See 45 CFR 164.524(a)(1), (c)(2)(ii), (c)(3)(ii). The HIPAA Rules do not impose any restrictions on how an individual or the individual’s designee, such as an app, may use the health information ...read more |
| Mental Health Center Provides Access after Denial Covered Entity: Mental Health Center Issue: Access, Authorization The complainant alleged that a mental health center (the "Center") improperly provided her records to her auto insurance company and refused to provide her with a copy of her medical records. The Center provided OCR with a valid authorization, signed by the complainant, permitting the release of information to the auto insurance company. OCR also determined that the Center denied the complainant's request for access because her therapists believed providing the records to her would likely cause her substantial harm. The Center did not, ...read more |
| If a CSP stores only encrypted ePHI and does not have a decryption key, is it a HIPAA business associate? Answer: Yes, because the CSP receives and maintains (e.g., to process and/or store) electronic protected health information (ePHI) for a covered entity or another business associate. Lacking an encryption key for the encrypted data it receives and maintains does not exempt a CSP from business associate status and associated obligations under the HIPAA Rules. An entity that maintains ePHI on behalf of a covered entity (or another business associate) is a business associate, even if the entity cannot actually ...read more |
| Radiologist Revises Process for Workers Compensation Disclosures Covered Entity: Health Care Provider Issue: Impermissible Uses and Disclosures A radiology practice that interpreted a hospital patient’s imaging tests submitted a worker’s compensation claim to the patient’s employer. The claim included the patient’s test results. However, the patient was not covered by worker’s compensation and had not identified worker’s compensation as responsible for payment. OCR’s investigation revealed that the radiology practice had relied upon incorrect billing information from the treating hospital in submitting the claim. Among other corrective actions to resolve the specific issues in the case, the practice apologized to ...read more |
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Blog Home
Newest Blog Entries
1/21/25 Understanding Business Associate Agreements
11/12/22 Modernizing Medicine Agrees to Pay $45 Million to Resolve Allegations of Accepting and Paying Illegal Kickbacks and Causing False Claims
11/12/22 Indian National Charged in $8 Million COVID-19 Relief Fraud Scheme
11/12/22 Former Hospital Employee Pleads Guilty To Criminal HIPPA Charges
11/12/22 Covered entities and those persons rendered accountable by general principles of corporate criminal liability may be prosecuted directly under 42 U.S.C. § 1320d-6
11/12/22 The Delaware Division of Developmental Disabilities Services Data Breach
11/12/22 OCR Settles Three Cases with Dental Practices for Patient Right of Access under HIPAA
11/12/22 HHS Issues Guidance on HIPAA and Audio-Only Telehealth
11/12/22 Five Former Methodist Hospital Employees Charged with HIPAA Violations
11/12/22 May a covered entity use or disclose protected health information for litigation?
11/12/22 When does the Privacy Rule allow covered entities to disclose protected health information to law enforcement officials?
Blog Archives
January 2025 (1)
November 2022 (54)
Blog Labels
PPP Fraud (1)
ePHI (2)
Data Breach (1)
HIPAA Enforcement (3)
Covered Entity (40)
Telehealth (1)
BAA (4)
HIPAA (2)
EHR Fraud (1)
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