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hippa violation by a private citizen?


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#1 darla44

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Posted 25 January 2013 - 09:16 PM

My husband's ex-wife recently visited a dental clinic where my husband has an account for his two children. She solicited insurance information from the billing clerk regarding payments made to him directly from the insurance company (amounts, dates and for whom) even though she doesn't pay for or isn't included on the policy. The billing clerk then called the insurance company, obtained the information and gave it to the ex-wife. Is this considered a HIPAA violation for all three parties involved? Since the ex-wife knew she wasn't on the account can she be held liable for soliciting the information?

#2 LegalwriterOne

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Posted 26 January 2013 - 09:24 AM

HIPAA does not allow for private causes of action. Your husband can file a complaint against the dental office for releasing the information with HHS but that's all that can be done.

#3 adjusterjack

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Posted 26 January 2013 - 10:52 AM

My husband's ex-wife recently visited a dental clinic where my husband has an account for his two children. She solicited insurance information from the billing clerk regarding payments made to him directly from the insurance company (amounts, dates and for whom) even though she doesn't pay for or isn't included on the policy. The billing clerk then called the insurance company, obtained the information and gave it to the ex-wife. Is this considered a HIPAA violation for all three parties involved? Since the ex-wife knew she wasn't on the account can she be held liable for soliciting the information?


I can't imagine why it would be a HIPAA violation for her to get the information.

It's her kids.

She's got a right to the information.

Warning: Legal issues are complicated. Explanations and comments here are simplified and might not fully explain the ramifications of your particular issue. I am not a lawyer. I do not give legal advice. I make comments based on my knowledge and experience. I guarantee nothing. If you act on my comments without the advice of an attorney, you do so at your own risk.


#4 Tax_Counsel

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Posted 26 January 2013 - 11:18 AM

Is this considered a HIPAA violation for all three parties involved? Since the ex-wife knew she wasn't on the account can she be held liable for soliciting the information?


First, understand that not all medical practices/professionals are covered by HIPAA in the first place. If the dental practice/professional is not one of those covered by HIPAA, then there is no HIPAA violation. Second, the HIPAA privacy rule only prohibits the medical practice/professional from making a disclosure in violation of the HIPAA rules. It does not prohibit anyone from asking the practice for the information nor does it prohibt anyone from receiving medical information. In short, if your goal is get the ex-wife in trouble over this, that won't work because the ex-wife is not prevented from receiving anything under HIPAA. Third, under the HIPAA privacy rule, parents generally have the right to access to their children’s medical records unless state law or a court order says otherwise. Thus, unless there is something in the divorce decree or custody order here that prevents the ex-wife from being authorized to get this information, there is probably no HIPAA violation. If she is the custodial parent for the kids, she certainly will be authorized to get that information on the kids since she is the primary caregiver. That should include the information on how the kids’ care is paid for, since she would have an obligation to pay for care not covered by the insurance.

Thus, I think it is likely that there is no HIPAA violation here. Your husband may, if he wants, make a complaint with the U.S. Department of Health and Human Services (HHS) for a possible HIPAA violation if he wants. That's his sole remedy here — it will be up to HHS to determine if there was any violation and, if so, what to do about it.




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