Whistleblower HIPAA Concerns
Serving Clients Nationwide
The Privacy Rule included in the 1996 Health Insurance Portability and Accountability Act, commonly known as HIPAA, came into effect in 2003. This portion of HIPAA protects the confidentiality of individual health information and imposes criminal and civil penalties for noncompliance. While HIPAA is recognized as relatively effective in protecting patient privacy despite the cost of implementation and compliance, the Privacy Rule has also had the unfortunate side effect of discouraging some potential whistleblowers from reporting healthcare fraud. These whistleblowers fear that they might incur some of the harsh penalties for noncompliance with HIPAA.
However, HIPAA actually addresses this problem by allowing an exemption for whistleblowers under specific circumstances. Under the Permitted Use/Disclosure section of the Privacy Rule, the law allows those who believe that a “covered entity” has behaved unlawfully, violated professional/clinical standards, or is endangering anyone to disclose protected health information to a “health oversight agency,” “public health authority,” or an attorney retained to determine the whistleblower’s legal options regarding the misconduct she wishes to report.
This is a very important exemption to HIPAA’s Privacy Rule because often the disclosure of key documents is necessary for proving illegal activities, such as Medicare fraud, pharmaceutical kickbacks, intentional upcoding, and Stark Statute violations, which would otherwise be restricted by HIPAA.
Becoming a Whistleblower without Violating HIPAA
If you have knowledge of healthcare fraud of any kind but are worried about violating HIPAA requirements, the qui tam attorneys at Kenney & McCafferty can explain the whistleblower exemption for you and discuss the merits of a potential qui tam lawsuit under the False Claims Act.
Blowing the whistle on healthcare fraud is an important public service that you as a physician or other healthcare professional can provide. Uncovering fraud saves millions in taxpayer dollars that can be used to provide healthcare for Medicare and Medicaid recipients, and it can be done while protecting patient privacy and maintaining HIPAA compliance. In addition, the federal government offers significant whistleblower rewards for those with the courage to report Medicare fraud and other forms of healthcare malfeasance.
If you have knowledge of a fraud or false claim against the government, please contact our qui tam lawyers today. Kenney & McCafferty attorneys will consult with you about your case, without obligation. All communications with Kenney & McCafferty attorneys during these consultation services are confidential and protected by the attorney-client privilege.