ACCOUNTABLE HEALTHCARE IPA HIPAA PRIVACY AND SECURITY TRAINING. By: Jerry Jackson Compliance and Privacy Officer

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1 ACCOUNTABLE HEALTHCARE IPA HIPAA PRIVACY AND SECURITY TRAINING By: Jerry Jackson Compliance and Privacy Officer 1 1

2 Introduction Welcome to Privacy and Security Training course. This course will help you understand and apply AHCIPA s Privacy and Security policies and procedures. 2 2

3 HIPAA Law(s) Health Insurance Portability and Accountability Act of Public Law The law requires each person who maintains or transmits health information shall maintain reasonable and appropriate administrative, technical, and physical safeguards. The Privacy Rule regulates how certain entities, called covered entities, use and disclose certain individually identifiable health information, called protected health information (PHI). The Health Information Technology for Economic and Clinical Health Act, abbreviated HITECH Act, was enacted under Title XIII of the American Recovery and Reinvestment Act of 2009 (Pub.L ). 3 3

4 HIPAA Law(s) Continued The HITECH Act requires entities covered to report data breaches, which affect 500 or more persons, to US Dept. Health Human Services, The news media, and To the people affected by the data breaches. On November 30, 2009, the regulations associated with the enhancements to HIPAA enforcement took effect. 4 4

5 HIPAA Law(s) Continued Final Omnibus Rule Became effective on March 26, 2013 Enhanced a patient s privacy protections Provided individuals new rights to their health information, and Strengthened the government s ability to enforce the law. 5 5

6 Protected and Confidential Information Everyone is responsible to make sure: We use the Protected Information about the individuals appropriately Protect that information as required by HIPAA and St. of California laws and regulations applicable to the health care industry And by our contracts with our customers, such as health plans 6 6

7 Officers The Privacy Officer serves to oversee the integration of privacy compliance, data protection, and privacy incident management. The Security Officer serves to oversee the establishment, implementation and management of an Information Security Program. This includes creating, administering, and overseeing policies and procedures to ensure the prevention, detection, containment, and correction of security breaches. 7 7

8 Who Does HIPAA Apply to? Covered Entities A covered entity is a health plan, health care clearinghouse, and a health care provider who transmits any health information in electronic form in connection with a transaction. 8 8

9 Types of Information to Protect Protected Health Information (PHI) is individually identifiable and is subject to laws and regulations which place legal restrictions on what can or cannot be done with the information. PHI (including demographics) relates to: Health care/medical claim data An individual s health condition Health records, protected health information (PHI) Personally identifiable information (PII) Social Security Numbers Payment for such care Financial Information Health plan member enrollment and demographic information 9 9

10 Types of Information to Protect Personally Identifiable Information (PII) is a combination of one or more of the following data elements: First name or last name Social Security Number Driver s License Number or State Identification Card Number Account Number, Credit Card or Debit Card Number in combination with any required security code, access code, or password that would permit access to an individual s financial account. PHI & PII can be in any form: Oral/Written/Electronic 10 10

11 USES AND DISCLOSURES 11 11

12 When can PHI be shared without an Authorization? For PHI and ephi (electronic), many accesses, uses, and disclosures within AHCIPA may be permitted for purposes of Treatment, Payment, and Health Care Operations (TPO). The Privacy Rule permits a covered entity to use and disclose protected health information for TPO without restriction or the individuals consent (an authorized disclosure)

13 When can PHI be shared without an Authorization? Treatment means the provision, coordination, or management of health care and related services by one or more health care providers, including coordination of care by a provider with a third party, consultations between providers, and referrals to other providers. Payment means activities undertaken by a health care provider or a health plan to obtain or provide reimbursement for health care

14 When can PHI be shared without an Authorization? Health Care Operations refers to activities operationally undertaken by health plans, health care providers and clearinghouses, including: Quality assessment and improvement activities Case management and coordination of care Credentialing Conducting or arranging for medical review and auditing functions Business planning, business management and general administration 14 14

15 When can PHI be shared without an Authorization? Generally, if the access, use, and/or disclosure is not permitted under TPO, then PHI and PII can only be used or disclosed if the individual or authorized representative has given written authorization. Before accessing, using, or disclosing Protected Information, you must determine whether you are permitted to do so in that particular situation. If you have questions contact the IPA s Privacy Officer

16 Other Authorized Disclosures Disclosures to Business Associates Disclosures to Brokers, Agents and Consultants Disclosures to Law Enforcement and Public Health Disclosure of abuse, neglect, and domestic violence to a state or local authority, as required or permitted by law Disclosure of PHI to law enforcement, but only if the request is accompanied by a court order Disclosure of PHI to health oversight agencies Disclosures related to legal actions, if the information has been requested in a court order or the information has been requested by means of a subpoena 16 16

17 Other Authorized Disclosures Continued Disclosure of PHI to coroners, medical examiners and funeral directors Disclosure of PHI to organ procurement agencies Disclosure of PHI for purposes of Research Disclosure of PHI needed to prevent or lessen a serious or imminent threat to the health or safety of a person or the public Disclosures to Family Members, Relatives and Close Personal Friends

18 Accounting of Disclosures Upon written request, an individual has the right to receive a written accounting of certain disclosures of PHI made by AHCIPA spanning a period of up to 6 years. The identity of a person making a request for an accounting of disclosures of PHI must be authenticated. AHCIPA tracks disclosure of PHI/PII other than for the purposes of TPO. Any request for PHI/PII, other than for the purpose of TPO, must be authorized by the Privacy Office

19 Authorization for Disclosure of PHI/PII An individual may provide a written authorization for the release of information. The authorization is a detailed document that gives covered entities permission to use protected health information for specified purposes, other than TPO, or to disclose protected health information to a third party specified by the individual. An individual can revoke their authorization at any time. 19

20 Marketing and Use of PHI/PII AHCIPA may generally use and disclose PHI for purposes of Marketing upon receipt of an authorization from any individual whose PHI may be used or disclosed for such purposes. In certain instances, however, AHCIPA may not be required to obtain an authorization from affected individuals

21 INDIVIDUAL RIGHTS 21 21

22 Members Right to Inspect and Copy PHI Individuals have the right to inspect and obtain a copy and request amendment of medical information used to make decisions about their care and billing information. Individuals have the right to access and request that AHCIPA amend PHI/PII in the Designated Record Set (DRS)

23 Members Right to Confidential Communications AHCIPA must permit individuals to request and must accommodate reasonable requests by individuals to receive communications of PHI by alternative means and/or at alternative locations. Also, AHCIPA accommodate an individual request concerning health care communications regarding certain sensitive services to be sent to an alternate address if the individual had, has, or will receive services that fall under the new law s definition of sensitive services. Sensitive Services - Types of services in which a member could feel are potentially embarrassing, if disclosed

24 ADMINISTRATIVE REQUIREMENTS 24 24

25 Privacy Safeguards AHCIPA must have appropriate administrative, technical, and physical safeguards in place to protect the privacy of PHI/PII. All employees and contractors are required to maintain physical, technical, and administrative safeguards of systems and tools to ensure the security and availability of confidential information or PHI

26 Improper Use or Disclosure The risk of organizational or member harm includes: Identity theft Embarrassment Loss of goodwill Payment of penalties and fines Negative impact to the company s business and reputation Personal liability of employees and contractors Criminal penalties A breach of contract 26 26

27 Rules To Protect Information It is critical to safeguard physical property and information technology systems

28 Physical Security Physical security means that we do not let unauthorized people into our facilities and that we keep our tools and documents containing PHI secure. Wear your photo identification badge at all times. Keep your desk clean! Make sure documents and other protected materials are securely stored. Paper documents containing PHI or confidential information should be discarded in a secure destruction container

29 Information Security Desktop and laptop security means that we do not let unauthorized people use our computers and that we secure our computers appropriately when we are away from our work station. Information security means that we protect systems containing data with strong passwords and only send data outside of our system using appropriate and secure (encrypted) processes

30 Computer Desktop/Laptop Security Rules You may not install or store unauthorized computer applications and material (games, music, data, etc.) on company-provided information technology systems. Always use Ctrl+Alt+Del and select Lock Computer when leaving your desk. Never leave your laptop in your car or somewhere unattended or unsecured. The use of removable storage media (e.g., external hard drives, CDs/DVDs, USB flash/thumb drives or memory cards) is prohibited without a security exception from Information Technology

31 Misdirected Information There are three common ways in which information can be misdirected: Paper Documents Faxing Information ing Information 31 31

32 Paper Documents Ways that misdirected or unattended paper documents might create a privacy incident: Incorrect mailing address Improper disposal of documents Leaving documents unattended 32 32

33 Faxing Information Faxing might create a privacy incident by: Sending a fax to the wrong number Sending a fax without a cover page Sending a fax without verifying that the receiver is available 33 33

34 ing Information ing information might create a privacy or security incident by: Sending an to the wrong person(s), (avoid using Reply All if unnecessary). Sending an externally without using Secure Delivery (encryption) Sending to your home/personal web mail 34 34

35 Reporting Requirements and Incident Management You are required to report an actual or suspected privacy or security incident IMMEDIATELY regardless of how many members are involved. AHCIPA strictly enforces a non-retaliation policy for employees and contractors who, in good faith, report suspected incidents

36 36 Resources for Reporting A Supervisor/Manager The Privacy Officer at: , ext. 350 The Security Officer at: , ext

37 Data Security Risks There are several different types of attacks to manipulate people into performing actions or divulging confidential information. Phishing Whale Phishing Spear Phishing Pretexting Trojan Horse 37 37

38 Data Security Risks Continued Phishing is the activity of defrauding an online account holder of financial information by posing as a legitimate company. Typically, the messages appear to come from well-known Web sites. Whale Phishing (Whaling) describes a phishing attempt where the target is a wealthy individual or senior leadership of an organization. Spear Phishing describes a phishing attempt that targets a specific organization seeking unauthorized access to confidential data. These attempts are not typically initiated by random hackers, but are more likely to be conducted by perpetrators out for financial gain or trade secrets

39 Data Security Risks Continued Pretexting is when an individual lies or tells a phony story to obtain privileged data. Pretexting often involves a scam where the liar pretends to need information. After establishing trust with the targeted individual, the pretexter might ask a series of questions designed to confirm key individual identifiers such as the individual s Social Security Number, mother s maiden name, place or date of birth, or account number. Trojan Horse is a program in which malicious or harmful code is contained inside apparently harmless programming or data in such a way that it can get control and do its chosen form of damage, such as ruining the file allocation table on your hard disk. A Trojan Horse may be widely redistributed as part of a computer virus

40 40 Consequences of HIPAA Breaches The Department of Health and Human Services Officer of Civil Rights health information privacy rights of members who participate in Federal Healthcare Programs. Their duties include: investigations, voluntary dispute resolution, technical assistance, and enforcement. New York and Presbyterian Hospital and Columbia University- Data breach results in $4.8 million HIPAA settlements: disclosure of the ephi of 6,800 individuals, including patient status, vital signs, medications, and laboratory results. QCA Health Plan, Inc., of Arkansas- Stolen Laptops Lead to Important HIPAA Settlements in the amount of $1,725,220. Affinity Health Plan, Inc. settlement agreement resulted in a payment of $1,215,780 for impermissibly disclosing the PHI of up to 344,579 individuals when it returned multiple photocopiers to a leasing agent without erasing the data contained on the copier hard drives. 40

41 Consequences of HIPAA Breaches OCR compliance issues investigated most are, in order of frequency: 1. Impermissible uses and disclosures of protected health information; 2. Lack of safeguards of protected health information; 3. Lack of patient access to their protected health information; 4. Lack of administrative safeguards of electronic protected health information; and 5. Use or disclosure of more than the minimum necessary protected health information

42 Consequences of HIPAA Breaches The OCR may impose Civil Monetary Penalties for violations in the amount of: 1. Covered entity or individual did not know (and by exercising reasonable diligence would not have known) the act was a HIPAA violation. 2. The HIPAA violation had a reasonable cause and was not due to willful neglect. 3. The HIPAA violation was due to willful neglect but the violation was corrected within the required time period. 4. The HIPAA violation was due to willful neglect and was not corrected. $100-$50,000 for each violation, up to a maximum of $1.5 million for identical provisions during a calendar year. $1,000-$50,000 for each violation, up to a maximum of $1.5 million for identical provisions during a calendar year. $10,000-$50,000 for each violation, up to a maximum of $1.5 million for identical provisions during a calendar year. $50,000 or more for each violation, up to a maximum of $1.5 million for identical provisions during a calendar year

43 Consequences of HIPAA Breaches Criminal penalties: Tier Unknowingly or with reasonable cause Under false pretenses For personal gain or malicious reasons Potential jail sentence Up to one year Up to five years Up to ten years 43 43

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