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.
| Large Provider Revises Patient Contact Process to Reflect Requests for Confidential Communications Covered Entity: General Hospital Issue: Impermissible Disclosure; Confidential Communications A patient alleged that a general hospital disclosed protected health information when a hospital staff person left a message on the patient’s home phone answering machine, thereby failing to accommodate the patient’s request that communications of PHI be made only through her mobile or work phones. In response, the hospital instituted a number of actions to achieve compliance with the Privacy Rule. To resolve this matter to the satisfaction of OCR, the hospital: retrained an entire Department with ...read more |
| Private Practice Revises Policies and Procedures Addressing Activities Preparatory to Research Covered Entity: Private Practice Issue: Impermissible Disclosure-Research A private practice physician who was the principal investigator of a clinical research study disclosed a list of patients and diagnostic codes to a contract research organization to telephone patients for recruitment purposes. The disclosure was not consistent with documents approved by the Institutional Review Board (IRB). The private practice maintained that the disclosure to the contract research organization was permissible as a review preparatory to research. Activities considered “preparatory to research” include: preparing a research protocol; developing a research hypothesis; ...read more |
| Mental Health Center Provides Access and Revises Policies and Procedures Covered Entity: Mental Health Center Issue: Access, Restrictions The complainant alleged that a mental health center (the "Center") refused to provide her with a copy of her medical record, including psychotherapy notes. OCR’s investigation revealed that the Center provided the complainant with an opportunity to review her medical record, including the psychotherapy notes, with her therapist, but the Center did not provide her with a copy of her records. The Privacy Rule requires covered entities to provide individuals with access to their medical records; however, the Privacy Rule exempts ...read more |
| When does the Privacy Rule allow covered entities to disclose protected health information to law enforcement officials? Answer: The Privacy Rule is balanced to protect an individual’s privacy while allowing important law enforcement functions to continue. The Rule permits covered entities to disclose protected health information (PHI) to law enforcement officials, without the individual’s written authorization, under specific circumstances summarized below. For a complete understanding of the conditions and requirements for these disclosures, please review the exact regulatory text at the citations provided. Disclosures for law enforcement purposes are permitted as follows: To comply with a court order or ...read more |
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Blog Home
Newest Blog Entries
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?
11/12/22 Must a covered entity inform individuals in advance of any fees that may be charged when the individuals request a copy of their PHI?
Blog Archives
November 2022 (54)
Blog Labels
HIPAA Enforcement (3)
ePHI (2)
BAA (3)
Covered Entity (40)
Data Breach (1)
EHR Fraud (1)
HIPAA (2)
PPP Fraud (1)
Telehealth (1)
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