Effective HR Compliance Programs for HIPAA Compliance

The rampant healthcare fraud and abuse that existed in the American healthcare industry forced the federal government to enact the Health Insurance Portability and Accountability Act (HIPAA) in 1996. HIPAA comprises of two titles with Title I protecting health insurance coverage for workers and their families when they change or lose their jobs and Title II known as the Administrative Simplification (AS) provisions, requiring the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans and employers. The AS provisions also address the privacy and security aspects of health information of patients. As healthcare providers and practitioners need to use and disseminate the confidential health information of the patients for various purposes, the health information has been subjected to wide scale abuse for personal gains. In order to prevent such incidents, HIPAA creates tough standards for the use and dissemination of health care information, which all the healthcare practitioners and providers must comply with at all costs. The federal government adopts a carrot and stick approach when it comes to ensuring HIPAA compliance. The criminal penalties include:

i. $50,000 and up to one-year imprisonment for willfully obtaining and disclosing health information.

ii. Up to $100,000 and up to five years imprisonment if the wrongful conduct involves false pretenses.

iii. Up to $250,000 and up to 10 years imprisonment if the information is gathered with the intent to sell, transfer, or use it for commercial advantage, personal gain or malicious harm.

Therefore, ensuring HIPAA compliance is highly necessary for every organization. However, not every IT staff can carry out HIPAA compliance effectively. Hence, having a human resource services partner who takes care of HIPAA privacy compliance is beneficial. Their HR compliance programs with respect to HIPAA help to:

Simplify the administration of health insurance claims and help manage the costs associated with those claims using national standards.

Give patients more control over and access to their medical information.

Protect individual identifiable health information from any kind of threats of disclosure through the setting and enforcing of standards.

Improve efficiency in health care delivery by standardizing electronic data interchange (EDI). Recently, the federal government passed the HIPAA omnibus rule, which further strengthens the HIPAA privacy and security rule. Therefore, considering the criticality of the situation, having a perfect HR partner to take care of all the regulatory and compliance needs can allow companies to be on the right side of the law.