Health and Human Services

Unless the Department of Health and Human Services (HHS) makes another last-minute, litigation-inspired decision to delay the September 23, 2013 compliance date, we’re on a 10-day countdown for compliance with most of the Omnibus Rule requirements.  In a motion filed jointly with the plaintiff in the U.S. District Court for the District of Columbia on September 11, 2013, defendant HHS stated that it decided not to enforce the Omnibus Rule’s restriction on “remunerated refill reminders” until November 7, 2013.  HHS expects to issue guidance by September 23, 2013 on the amount of financial remuneration that will be considered “reasonably related to the covered entity’s cost of making the communication” so as not to cause refill reminders or other communications about drugs or biologics to be treated as “marketing” communications that require an individual’s prior authorization. 

So while covered entities and business associates (and their counsel) have a short reprieve with respect to this one Omnibus Rule prohibition, there are plenty of other new provisions that cannot be ignored.  Between today and September 23, 2013, we will post 10 tips that will help our readers bring their HIPAA policies and procedures, forms, and contracts up-to-date before the upcoming compliance deadline.


Check to make sure you have adequate “red flags” in place to comply with patient-requested restrictions on disclosure.

Provider covered entities must agree to an individual’s request to restrict disclosures of the individual’s PHI to a health plan when the PHI relates solely to items or services for which the individual (or someone on behalf of the individual, other than the health plan) has paid the covered entity in full – as long as the disclosure is not “otherwise required by law.” 

The provider’s Notice of Privacy Practices should be amended so that patients know they have this right, and providers may want to consider creating a separate form that can be given to for patients who want to pay “out of pocket” so that their PHI is not sent or made available to their health plan. This form could clarify the provider’s obligation and set forth some of the exceptions that might apply (such as where the provider participates in a network and is not permitted, under the contract, to treat the patient as out-of-network, or where the patient wants to pay for just one service that is part of a bundle of services).  The form could also make it clear that the provider is not required to tell other providers about the restriction, even where subsequent items or services appear related to the requested restriction.

This blog series has been following breaches of Protected Health Information (“PHI”) that have been reported on the U.S. Department of Health and Human Services (“HHS”) ever-lengthening parade list (the “HHS List”) of breaches of unsecured PHI affecting 500 or more individuals (the “List Breaches”).  As reported in a previous blog post in this series, as of August 14, 2013 (and today), there were postings of 646 List Breaches.

Several prior posts in this series here and here addressed the extent to which such List Breaches are being reported by covered entities (“CEs”) as having been attributable to events involving business associates (“BAs”).

As of August 20, 2013, 146 of the total of 646 List Breaches (22.6%) reportedly involved BAs of the reporting CEs.  This is remarkably consistent with the percentage of 22.3% (83 of the total of 372 List Breaches) as of December 2, 2011, reportedly involving BAs of the reporting CEs.

Further analysis of the HHS List as of August 20, 2013, reveals the following:

• 3 of the 6 List Breaches (50%) that affected 1,000,000 or more individuals reportedly involved BAs of the reporting CEs.

• 16 of the 43 List Breaches (37.2%) that affected between 30,000 and 999,999 individuals reportedly involved BAs of the reporting CEs.

• 21 of the 80 List Breaches (26.3%) that affected between 10,000 and 29,999 individuals reportedly involved BAs of the reporting CEs.

• 106 of the 517 List Breaches (20.5%) that affected between 500 and 9,999 individuals reportedly involved BAs of the reporting CEs.

While the foregoing review is only a snapshot of the HHS List as of a given date, it would indicate that, as the size of a List Breach increases, it is more likely that involvement of a BA will be reported. However, the overwhelming proportion of List Breaches (79.5%) on the HHS List, which affected fewer than 10,000 individuals, have reported no involvement of a BA.

More data will be required before the impact of BA involvement in smaller and larger List Breaches becomes clearer. However, there are indications that the larger the List Breach that is reported by a CE, the greater the likelihood that it will involve an alleged BA.  It is therefore incumbent upon any CE at a minimum to

(i) choose its BAs with care,

(ii) enter into effective business associate agreements with terms appropriate for the specific risks that may be present, and

(iii) continue to monitor the total performance of BAs, including both delivery of services and HIPAA compliance.

In January 2011 this blog series discussed here and here that the University of Rochester Medical Center (“URMC” or the “Medical Center”) became a marcher twice in 2010 in the parade of large Protected Health Information (“PHI”) security breaches.  The U.S. Department of Health and Human Services (“HHS”) publishes a list (the “HHS List”), which posts large breaches of unsecured PHI incidents affecting 500 or more individuals.  The HHS List now reveals that URMC reported a third large security breach that occurred on February 15, 2013 (the “2013 Breach”). The HHS List reveals that 537 individuals were affected by a URMC loss of an “other portable electronic device.”  There are several interesting aspects about the 2013 Breach.

First, this blog series earlier observed that URMC apparently determined that it was not necessary or appropriate to publish its PHI breaches in 2010 in the URMC Newsroom or elsewhere on the URMC website.  Our later post reported a reader’s comment that the second breach of URMC in 2010 could be located with some effort on the general University of Rochester website.  In contrast, however, the 2013 Breach was prominently published by URMC on May 3, 2013 in the URMC Newsroom and can be found in the 2013 archives.

Apparently a URMC resident physician misplaced a USB computer flash drive that carried PHI and which was used to transport information used to study and continuously improve surgical results. The information was copied from other files and, therefore, the Medical Center believes its loss will not affect follow-up care for any patients.  Additionally, the URMC posting observed that “after an exhaustive but unproductive search, hospital leaders believe that the drive likely was destroyed in the laundry.”

According to the URMC posting,

The flash drive included the patients’ names, gender, age, date of birth, weight, telephone number, medical record    number (a number internal to URMC), orthopaedic physician’s name, date of service, diagnosis, diagnostic study, procedure, and complications, if any. No address, social security number or insurance information of any patient was included.

It is refreshing that URMC has given the public notice of the 2013 Breach on its website.  Significantly, URMC also disclosed its development of new policies for the use of smart phones, iPads and other mobile devices to safeguard protected health information. In addition, URMC is retraining users of its PHI and encouraging its physicians and staff to access sensitive patient information using its secure network rather than via portable devices.

One puzzling aspect of URMC’s actions is that its notifications to affected individuals and the posting by the Medical Center did not occur until the week of April 28, 2013. This is clearly past the date required by HHS.  HHS requires that notifications be made “without unreasonable delay and in no case later than 60 days following the discovery of a breach.”  Sixty days after the breach discovery on February 15, 2013 would have been April 16, 2013.

It is clear that the proliferation of mobile devices has geometrically expanded the potential for lost or improperly accessed PHI.  Even the most carefully planned and communicated policies cannot assure the protection of PHI from inappropriate compromise, whether intentional or accidental.  Moreover, the continual advancement of technology in this area at lightning speed often renders policies obsolete almost as soon as they are finalized and disseminated.  In the long run, it may make the question of the potential for a PHI breach for a covered entity, business associate or subcontractor more of a matter of “when” and “how” rather than “if.”

On February 7, 2013, our partner Keith McMurdy, Esq., posted an excellent entry on the Employee Benefits Blog of Fox Rothschild LLP that merits republishing for our readers as well. The post outlines some direct effects of the new HIPAA Omnibus Rule on employers and their health plans. 

Keith McMurdy writes as follows:


On January 25, the new (final?) rules about HIPAA Privacy under the HITECH Act were issued in the Federal Register.  While the effect of the new rules may not be to substantially change the way HIPAA privacy is viewed, there are a number of action items for employers as plan sponsors that have to be accomplished when these rules go into effect.


There are two pieces of good news.  The first is that the general purpose of compliance remains the same.  Plan sponsors have to ensure PHI is properly protected, refrain from impermissible disclosures and provide notices of security breaches.  The second is that the earliest possible deadline for compliance with the new rules is September 23, 2013, so there is some time to prepare.  But it is not a bad idea to start preparing now.  So let’s consider the key changes.


1. Tougher Security Breach Notification Standard


Under the old rule, the standard for notification to participants of a security breach was only necessary if the release of information "posed a significant risk of financial, reputational or other harm" to a covered person.  Now, that standard is tightened to apply to ANY security breach unless the plan sponsor can prove "a low probability that the [PHI] has been compromised based on a risk assessment."  This should encourage plan sponsors to tighten their security breach protections because any release, even things like accidental e-mails, can potentially become reportable events.  So the first step in compliance would be to review security standards and document steps taken to avoid security breaches.


2. Tougher Standards for Business Associates Agreements


Because the new rule provides for penalties to a covered entity for breaches by business associates, the default position is that plan sponsors should be much more concerned about how compliant their business associates really are.  Where in the past, plan sponsors may have felt comfortable simply handing off certain protection functions to service providers, the new rule makes it pretty clear that plan sponsors have to actually know that their business associates are HIPAA compliant and diligently seek to confirm that compliance.


3.  New Privacy Notices for 2013 Open Enrollment


The new rule also requires that plan sponsors add or amend their privacy notices:

  1. The notice must specifically state that the covered health plans are required to obtain plan participants’ authorization to use or disclose psychotherapy notes, to use PHI for marketing purposes, to sell PHI, or to use or disclose PHI for any purpose not described in the notice as well as a statement explaining how plan participants may revoke an authorization.
  2. The notices must state that the plans (other than a long-term care plan) are prohibited from using PHI that is genetic information for underwriting purposes
  3. The notice must inform plan participants of their right to receive a notice when there is a breach of their unsecured PHI.

The new rules makes it clear that since this new language is a "material change," plan sponsors are required to distribute this revised notice, even if they had just recently sent the old notice. 


4. Genetic Information and the GINA Notice


The Genetic Information Non-Discrimination Act of 2008 (GINA) prohibits discrimination based on genetic information.  The HIPAA Privacy Rule now similarly prohibits HIPAA-covered plans from taking genetic information into consideration when offering incentives or discounts through a health risk assessment.  Because this modification of the Privacy Rule materially affects how a plan may use PHI, the HIPAA Privacy Rule requires that plan participants be informed in the plan’s privacy notice of the prohibition on the use of PHI for underwriting purposes.  See the second item under Part 3, above.


So in the midst of our struggles to comply with PPACA, plan sponsors should not forget about HIPAA medical privacy concerns.  Start pulling together privacy notices, business associates agreements and plan documents for review and amendment.  Review your security practices to avoid even accidental breaches.  And be prepared to issue new notices as necessary for your next open enrollment.  For more detailed information about HIPAA and HITECH Compliance, please make sure to check out our HIPAA Blog as well.  More information means better compliance, which is always a good thing.

In the wake of the post-Omnibus Rule (the “Rule”) frenzy, it is necessary to consider some collateral effects that the Rule may have brought about with respect to compliance with HIPAA/HITECH.  The Office of Civil Rights (“OCR”) summaries of closed investigations (the “Summaries”) posted on the U.S. Department of Health and Human Services (“HHS”) list (the “HHS List”) of breaches of unsecured PHI affecting 500 or more individuals (“List Breaches”) has been a source of meaningful guidance as discussed in previous posts on this blog.  For example, the summary (the “Tennessee Summary”) for a State of Tennessee Sponsored Group Health Plan breach (the “Tennessee Breach”) continues to provide an excellent road map of pre-Omnibus Rule actions for covered entities (“CEs”) or business associates (“BAs”)  that suffer List Breaches or PHI breaches of any size.  


While the Tennessee Breach itself dealt with mishandling of paper PHI and not electronic health records, the Tennessee Summary does give direction for early intervention by affected CEs or BAs before HHS knocks on their door.  However, while there was excellent compliance in the aftermath of the Tennessee Breach, advice from pre-Rule Summaries cannot be used without carefully taking into account the new requirements respecting PHI breaches under the Rule.  As will be further discussed below, the most important new requirement in this regard is the necessity for a CE, BA or subcontractor to analyze the level of risk of compromise of the affected PHI.


The Tennessee Summary


The Tennessee Breach occurred on October 6, 2011 and involved approximately 1,770 enrollees with respect to names, addresses, birth dates and social security numbers.  According to the Tennessee Summary, an equipment operator at the state’s postal facility set the machine to insert four (4) pages per envelope instead of one (1) page per envelope, which caused the PHI of four individuals to be sent to one address per envelope.


The Tennessee Summary states that the CE did the following (with some parenthetical observations from the blog author):


1.         Retrained the equipment operator (suggesting that suspension and/or termination are not the only actions in appropriate cases with respect to dealing with employees involved with a PHI breach where rehabilitation is possible).

2.         Submitted a breach report to HHS (resulting in the posting on the HHS List).

3.         Provided notice to affected individuals.

4.         Notified the media.

5.         Created a toll-free number for information regarding the incident.

6.         Posted notice on the CE’s website.

7.         Modified policies to remove the social security number on templates for future mailings (a good policy whether paper or electronic PHI is involved).

8.         Offered identity theft protection to the affected individuals (a common decision for CEs and BAs based on the type of information that may have been compromised).

9.         Following the OCR investigation, reviewed its policies and procedures to ensure adequate safeguards are in place (with this disclosure in the Tennessee Summary, there is a suggestion that OCR continued to exercise some oversight or received reports after the investigation was finished).


The Tennessee Breach in Retrospect after the Omnibus Rule


There was no discussion in the Tennessee Summary of any analysis by the CE of the probable “risk of harm” from the Tennessee Breach under the proposed rule standards that prevailed prior to the Rule.  However, it is clear that, in the post-Rule period, a risk analysis of the probability that the PHI “has been compromised” would be necessary for the CE; failure to do such an analysis may be a violation in itself.   Under the Rule, there is a presumption that a breach of PHI has taken place unless there is a low probability that the PHI has been compromised.  The four factor analysis that would have been required of the CE in the Tennessee Breach case had it happened after the effectiveness of the Rule encompasses the following (with parenthetical comments):


(i)         Identifying the nature and extent of the PHI involved, including types of identifiers and risk of re-identification (i.e., names, addresses, birth dates and social security numbers);


(ii)        Identifying the unauthorized person(s) who impermissibly used the PHI or to whom the disclosure was made (in the case of the Tennessee Breach, subscribers to the health plan who were not individuals that had an obligation of their own to comply with HIPAA/HITECH);


(iii)       Determining whether the PHI was actually acquired or viewed or, alternatively, if only the opportunity existed for the PHI to be acquired or viewed (in the case of the Tennessee Breach, there is a likelihood that numerous recipients of the PHI or others without the right to view such PHI did in fact view it); and


(iv)       The extent to which risk to the PHI was mitigated (items 3, 4, 5, 6 and 8 above appear to be potential mitigating factors).


As stated in an earlier postings here and here, no Summary has been posted by OCR for any List Breach that occurred later than October 6, 2011. Additionally, no Summary has been posted by OCR for any List Breach involving a BA that occurred later than February 1, 2011.  While the Summaries continue to provide highly useful information for CEs, BAs and subcontractors relative to confronting PHI breaches, large and small, they must be analyzed with appropriate care and attention paid to changes brought about by the Rule.  It may be that a concern of OCR about potential confusion which could be created by publishing pre-Rule Summaries has prevented OCR from making recent postings of Summaries on the HHS List.


This blog series has been following breaches of Protected Health Information (“PHI”) that have been reported on the U.S. Department of Health and Human Services (“HHS”) ever-lengthening parade list (the “HHS List”) of breaches of unsecured PHI affecting 500 or more individuals (the “List Breaches”). As of January 1, 2013 (and as of today), there were 525 postings of List Breaches.

A previous blog post reported that, on February 24, 2012, HHS listed the 400th List Breach. As the first postings on the HHS List occurred on March 4, 2010, an average of about 200 postings of List Breaches were recorded in each of its first two years. However, in the 10-plus months between February 24, 2012 and January 1, 2013, 125 additional List Breaches were posted, which on an annualized twelve month period basis would translate into 150 List Breaches. It is not yet clear whether the lower volume of List Breaches since February 2012 is attributable to increased caution and better practices in protecting PHI on the part of covered entities (“CEs”) and business associates (“BAs”), greater use of encryption and other practices to protect PHI, slower postings of List Breaches by HHS, other factors or a combination thereof.


Of the total of 525 List Breaches posted through January 1, 2013, there were approximately 274 (52.2%) events shat attributed the type of breach to involve “theft” of all kinds, including laptops, other portable electronic devices, desktop computers, network servers, paper records and others. If the 60 additional List Breaches listing the category of “loss” of all types is added to the 274 “theft” events, the total for the two categories swells to approximately 334 or 63.6% of the 525 posted List Breaches. Combining the two categories appears to make some sense since it is likely that a number of the List Breaches categorized as a “loss” event may have involved some theft aspects.


Even more revealing may be the fact that approximately 193 (36.8%) of the 525 List Breaches listed the cause or partial cause of the breach to be “theft” or “loss” respecting laptops or other portable electronic devices.  Theft or loss of laptops or other portable electronic devices thus constituted 51.6% of the 334 List Breaches that involved reported theft or loss. 


Over the last 10 months since the number of List Breaches passed 400, it appears that the relative percentage of List Breaches attributable to theft and loss is trending mildly upward. Of the 125 additional reported List Breaches, approximately 86 or 68.8% listed theft or loss as the source of the PHI breach. The number of such 125 List Breaches that reported theft or loss of laptops or other portable electronic devices was 37 or 29.6%, a lower percentage than the 36.8% for all 525 List Breaches.  The sample sizes are relatively small, so that further following of these numbers is warranted.


My partner, William Maruca, Esq., recently posted a blog entry highlighting the fact that the first breach settlement announcement by HHS in 2013 (the “2013 Settlement”) involved a $50,000 fine based on theft of a laptop containing 441 patients’ unencrypted data. It was the first fine by HHS for a PHI security breach that involved fewer than 500 individuals and, therefore, was below the threshold for a List Breach. 


While the parade of List Breaches continues to lengthen, the 2013 Settlement underscores the fact that there are many more PHI security breaches involving fewer than 500 individuals. The PHI security breaches that are not List Breaches are receiving increased scrutiny by HHS. As this blog series has emphasized in the past, it may become more a question of when a CE or BA will suffer a PHI security breach and how severe the breach will be, rather than if it will suffer a breach. All CEs and BAs must exercise vigilance and use recommended protection procedures to avoid all PHI security breaches, not just large List Breaches. The continuing proliferation of the use of portable electronic devices to receive, access and store PHI should be monitored, as it can be expected that this type of security breach will continue to expand.

Much has been written about the circumstances surrounding the agreement of Massachusetts Eye and Ear Infirmary (“MEEI”) to pay the U.S. Department of Health and Human Services (“HHS”) the sum of $1.5 million to settle potential violations involving an alleged security breach (the “2010 Breach”) of Protected Health Information (“PHI”) under HIPAA. However, relatively little has been written that the 2010 Breach was the second of what may be three significant PHI breaches experienced by MEEI within the last three years. 

This blog series has been following breaches of PHI that have been reported on the HHS list (the “HHS List”) of breaches of unsecured PHI affecting 500 or more individuals (the “List Breaches”). Currently HHS has posted 502 List Breaches. The first List Breach posted for MEEI on the HHS List (the “2009 Breach”) was reported to have occurred by reason of a theft on November 10, 2009 that was said to have affected 1,076 individuals. 


The 2010 Breach was reported to have occurred on February 19, 2010, only slightly more than three months after the 2009 Breach. According to the HHS List, it affected 3,621 individuals. A statement from MEEI on its Web site reports that HHS review of the 2010 Breach was “triggered by the hospital’s proactive self-reporting of a doctor’s unencrypted laptop being stolen while he was traveling abroad in 2010.”  MEEI further stated that it “has no indication that any patients were harmed by this isolated incident.” Query: How “isolated” was the incident in view of the fact that the 2010 Breach occurred soon after the 2009 Breach?


Potential entries in the PHI Breach Parade did not end for MEEI, however, with the 2010 Breach. On April 16, 2012, during a time that MEEI was likely to have been heavily negotiating with HHS about the $1.5 million payment, MEEI posted the following statement on its Web site (the “2012 Statement”), about which relatively little was reported in the media:


On March 5, 2012, the Quincy, Massachusetts, Police Department informed [MEEI] that they were investigating a [MEEI] employee for inappropriately using the names, Social Security numbers and dates of birth of certain individuals, some of whom were believed to be MEEI patients. . . .

While [MEEI] is only aware of four individuals whose personal information was actually misused, as a precaution we are notifying, by mail,  approximately 3,600 patients whose Social Security numbers were available to the former employee in the course of performing her assigned duties.

The 2012 Statement went on to say that MEEI will “provide one year of free credit monitoring to potentially affected individuals to protect them against possible harm resulting from this incident.”  [Emphasis supplied.]


It is perplexing that nothing about the 2012 Breach has been posted on the HHS List to this point, although


(i)         the MEEI Web site reported the event more than six months ago,

(ii)        the number of “potentially” affected individuals far exceeded the 500 minimum threshold for placement on the HHS List, and

(iii)       the period during which MEEI was dealing with HHS after the 2010 Breach overlapped with the occurrence and aftermath of the 2012 Breach.

Queries: Did MEEI not report the 2012 Breach to the HHS List because it ultimately concluded that the 2012 Breach did not involve more than 500 individuals even though it does offer credit monitoring to more than 3,600 individuals? (As a potential third time marcher in the Breach Parade, MEEI was certainly aware of its reporting obligations to HHS.) In other words, did MEEI determine by a reasonable risk assessment that the potential access by the former employee to PHI of 3,600 individuals was not sufficient to require a report for the HHS List, absent more substantial proof that the PHI of 500 or more individuals was actually accessed and/or that 500 or more individuals were actually harmed by such access?

Alternatively, is it simply possible that HHS has been slow in reporting additional List Breaches on the HHS List, similar to a suggestion in an earlier post in this blog series that HHS may be slow in posting Summaries of cases that it has investigated and closed?

This blog series will continue to monitor developments in this area.

This blog series has been following breaches of Protected Health Information (“PHI”) that have been reported on the U.S. Department of Health and Human Services (“HHS”) list (the “HHS List”) of breaches of unsecured PHI affecting 500 or more individuals (the “List Breaches”). Currently HHS has posted 498 List Breaches reported by covered entities (“CEs”), of which approximately 102 (20.5%) have been reported as also involving business associates (“BAs”).  

As stated in an earlier posting in this blog series, the HHS List includes valuable guidance for CEs and BAs in the form of “brief summaries of the breach cases that OCR [the federal Office of Civil Rights] has investigated and closed. . . .” To date, the HHS List has posted approximately 96 summaries (“Summaries”) respecting the 498 current postings for CE marchers in the Breach Parade (which include some multiple postings of List Breaches where a single alleged breach by a BA caused a number of CEs to have List Breaches). Of the 96 List Breaches for which Summaries have been posted by OCR, 19 (19.8%) were reported as involving BAs.  


Unfortunately, since May 10, 2012, it would appear that only one new Summary has been posted by OCR, which relates to List Breach number 337 reported by Indiana University School of Optometry as CE. According to the OCR Summary, that List Breach affected 757 individuals and resulted in accessibility over the Internet of patient names, birth dates, medical history, diagnoses and treatment plans for the period from August 8, 2011 through September 9, 2011.  


No Summary has been posted by OCR for any List Breach that occurred later than October 6, 2011, already a year ago. Additionally, no Summary has been posted by OCR for any List Breach involving a BA that occurred later than February 1, 2011, as discussed in an earlier posting in this blog series. 


Moreover, the substantial majority of Summaries posted by OCR relate to List Breaches affecting fewer than 10,000 persons. While this Summary history may be reflective of the population of List Breaches as discussed in an earlier post in this blog series, the largest number of affected individuals for which a Summary has been posted to date is 83,000. That List Breach, which occurred on November 12, 2009 and was number 21 on the HHS List, related to unauthorized access/disclosure of paper information and was reported by Universal American in New York as the CE with Democracy Data & Communications, LLC as an involved BA. In light of the existence of complex List Breaches that reportedly affect hundreds of thousands or even millions of individuals, Summaries respecting larger List Breaches may be helpful in providing new and different insights for CEs and BAs.


There is great value in the guidance provided by the posted Summaries for educating CEs and BAs as to what OCR may deem to be significant with respect to List Breaches. OCR Summaries may provide analysis not only of the List Breaches themselves but also subsequent actions taken by the affected CEs and BAs. However, because the paucity of recent postings of Summaries can dampen their overall educational benefit, OCR is encouraged to increase the frequency, number, currentness and diversity of the Summaries posted.  

We have seen substantial delay in publication of the long-awaited HIPAA/HITECH Omnibus Final Rule, sometimes affectionately referred to as the “Mega Rule.” Health Data Management reported on June 6 of this year that Farzad Mostashari, national coordinator for health information technology, had said that the HIPAA Mega rule, which will include modifications to the privacy and security rule, breach notification and enforcement, “should’ be published by “the end of summer.” After previous disappointments and delays in regulations in other contexts from the U.S. Department of Health and Human Services, however, it may be noteworthy that Mr. Mostashari was said to have used the word “should,” and did not specify the summer of what year, e.g., 2012, 2013, 2014, etc.

Now there has been some scuttlebutt that the Mega Rule may not surface until after Election Day, November 6, 2012, perhaps because of concerns about potential political implications. Even as we wait, there is some justifiable trepidation as to the number of pages of regulations that will be published. The recently-issued CMS final requirements that hospitals and other providers must meet to receive funding under the second phase of the federal electronic health-record incentive program, which is a relatively narrow topic, constituted 672 pages.


What can we expect from HHS on the Mega Rule? Well, we can register our own speculations. Marla Durben Hirsch, Editor of Medical Practice Compliance Alert published by DecisionHealth, Inc., informed me of a clever contest that is being conducted on line by idexperts as to the Mega Rule. Any household can put in a single entry as to the month, day and year that the Mega Rule will be published in the Federal Register. In the event of a tie, the number of pages in the Mega Rule will serve as a first tie breaker. The prize for first place is a contribution of $2,500 in the name of the winner to the Wounded Warrior Project, a $200 Amazon gift card, a year’s subscription to RADAR published by idexperts and, of course, internet bragging rights.

So, with the approach of Labor Day and the waning days of summer, join the contest and make the Mega Rule wait more enjoyable!

A recent posting by our partner Christina Stoneburner, Esq., on the Fox Rothschild Employment Discrimination blog discussed the need by employers to limit protected health information (“PHI”) that they provide with respect to medical examinations of employees and job applicants to the least amount of medical information necessary for evaluation.  Interestingly, the focus of her posting was not disclosure under HIPAA/HITECH, or even state statutes regulating the use of PHI; it dealt with allegations that employees and job applicants had been sent for unnecessary medical examinations in violation of the Americans with Disabilities Act and the Genetic Information Nondisclosure Act. 

Christina summarizes her posting with the following:


In short, the least amount of medical information necessary to evaluate an employee is what should be provided to examiners.  For example, if you have an employee being evaluated to see if he can perform the essential functions of his job after a shoulder injury, the examining doctor should not be given the medical records relating to his planter’s wart being removed.

In her discussion, Christina noted our blog series respecting large breaches and a particular recent posting by Elizabeth Litten, Esq.  Christina also mentioned that the complaint on which her posting focused had alleged, "the employer often turned over Workers’ Compensation records . . . , even where those records were not relevant to the examination.”


Workers’ compensation is an area where Christina’s posting comes full circle to our blog’s focus on HIPAA;  as HIPAA directly confronts such area by making it clear that only the “minimum necessary” disclosure of PHI is permitted by covered entities without patient authorization pursuant to 45 CFR 164.512(l):


A covered entity may disclose protected health information as authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs, established by law, that provide benefits for work-related injuries or illness without regard to fault.


The Office of Civil Rights of the U.S. Department of Health and Human Services (“HHS”) has published further advice on how the workers’ compensation Regulation works:


Covered entities are required reasonably to limit the amount of protected health information disclosed . . . to the minimum necessary to accomplish the worker’s compensation purpose. Under this requirement, protected health information may be shared for such purposes to the full extent authorized by State or other law. 


In summary, to avoid needless and costly violations, employers and other covered entities must be constantly aware of the need to comply with multiple regulatory schemes that may govern PHI, beyond those of HIPAA and State laws governing PHI;  there is not unlimited flexibility to disclose PHI even within the context of State-governed workers’ compensation matters. When the long-anticipated “mega-regulation” regarding HIPAA/HITECH is finally published by HHS, special attention must be given to potential changes that may further tighten the “minimum necessary" standards.