Health Insurance Portability and Accountability Act

Karen Lee

Health Insurance Portability and Accountability Act (HIPAA)

In 1996 government passed the Health Insurance Portability and Accountability Act of 1996 (HIPAA). This law set The Secretary of the US Department of Health and Human services to develop regulations to protect the privacy and security of certain health information.

Prior to the HIPAA law there was no general regulation of patient information. The main efforts of the HIPAA law are to protect and safeguard “e-pHI.” e-PHI is defined as “electronic protected health information”. This protected health information can include, but is not limited to: demographic information, medical histories, tests and laboratory results, mental health conditions, insurance information, and other data a healthcare professional may gather to provide care.

HIPAA impacts a number of individuals and entities. These individuals and entities can include: health plans, healthcare clearing houses, and any healthcare professional who transmits data in an electronic form.

Failure to comply with HIPAA standards can result in fines for both the individual and covered entities. These fines are determined based on tired civil penalty structure.

In addition to civil penalties HIPAA law may also hold individual entities accountable and impose criminal penalties as well. Covered entities and specified individuals, who "knowingly" obtain or disclose individually identifiable health information, in violation of the Administrative Simplification Regulations, face a fine of up to $50,000, as well as imprisonment up to 1 year.

Offenses committed under false pretenses allow penalties to be increased to a $100,000 fine, with up to 5 years in prison.

Finally, offenses committed with the intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm permit fines of $250,000 and imprisonment up to 10 years.

Rest assured at Ponderosa Billing Services not only do we help to uphold the integrity and security of your personal business, but we also help to ensure you comply with all HIPAA standards. All our providers are given access to our secure online sharing site. In addition, all our provider's patient data is housed in an encrypted billing system that is user and password protected. All our staff are trained and certified in HIPAA compliance so you can rest assured we are looking out for you and your patient’s best interest.

Are you compliant? Contact Ponderosa today and see how we can help! Call 800-452-9282 or Contact us via e-mail.