What Is HIPAA?
HIPAA, or the Health Insurance Portability and Accountability Act, is a federal law that protects sensitive patient health information from being disclosed without the patient’s consent or knowledge. It ensures that medical information remains confidential unless a specific exemption applies.
Origins and Purpose of HIPAA
HIPAA was enacted in 1996 with several primary objectives:
- Portability: Originally, one of the main motivations behind HIPAA was to ensure that people could maintain their health insurance between jobs. This is the “Portability” part of the title.
- Accountability: The Act also aimed to combat fraud and abuse in health insurance and healthcare delivery.
- Privacy and Security: One of the most lasting and impactful parts of HIPAA is the set of standards it introduced to protect the privacy and security of patient health information.
Protected Health Information (PHI)
HIPAA specifically protects what’s known as “Protected Health Information” or PHI. This is any information about health status, healthcare provision, or healthcare payment that can be linked to a specific individual.
HIPAA Privacy Rule
One of the crucial components of HIPAA is the Privacy Rule, which:
- Sets national standards for when PHI can be shared.
- Gives patients rights over their health information, including obtaining a copy of their medical records or requesting corrections.
- Limits who can look at and receive health information, ensuring that only the minimum necessary amount of PHI is shared.
HIPAA Security Rule
Another vital component is the Security Rule, which:
- Sets national standards for securing electronic PHI.
- Requires entities covered by HIPAA to evaluate risks and vulnerabilities in their environments and implement security measures to mitigate them.
Covered Entities and Business Associates
HIPAA applies to “covered entities” and their “business associates.”
- Covered Entities: These include health plans, health care clearinghouses, and certain health care providers.
- Business Associates: These are organizations or people who work with or for covered entities and handle PHI.
Updates to HIPAA
The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 expanded upon HIPAA. It introduced new requirements for health information technology and further protected electronic health information. It also increased penalties for HIPAA violations.
Do Police Have Access to Hospital Records?
Generally, under the Constitution and HIPAA, police do not have automatic access to hospital records, including blood alcohol tests, without a search warrant, patient consent, or a specific statutory exception. They must demonstrate probable cause and obtain a warrant from a judge to access such records in investigations.
Demonstrating probable cause and obtaining a warrant involves law enforcement officers providing sufficient evidence to a judge or magistrate to justify the need for a search or seizure.
Here’s how they would do this when seeking medical records, such as blood alcohol levels in medical records:
Gather Initial Evidence
Before approaching the court, law enforcement officers gather preliminary evidence to indicate that a crime has been committed and that specific records may contain evidence.
Drafting the Affidavit
An officer or detective will draft an affidavit, a written statement under oath, detailing why they believe the sought-after evidence is in the place to be searched. In the context of medical records, they would specify why they believe those records contain evidence related to a crime (e.g., blood alcohol levels related to a DUI investigation).
The core element in the affidavit is establishing “probable cause.” Probable cause means a reasonable basis for believing a crime may have been committed and that evidence of the crime exists in the place they want to search. The information must be factual, current, and relevant to the investigation.
The request must be specific. If seeking medical records, the warrant should specify what records are sought (e.g., blood tests) and from what period. An overly broad warrant can be challenged and possibly deemed invalid.
Review by a Judge or Magistrate
The officer or detective will then present the affidavit to a judge or magistrate. The judge or magistrate reviews the affidavit to ensure sufficient evidence to support the claim of probable cause.
Issuance of the Warrant
If the judge or magistrate believes the affidavit demonstrates probable cause, they will issue a search warrant, granting law enforcement the authority to access the specified records.
Execution of the Warrant
Once issued, law enforcement officers will serve the warrant to the entity holding the records (e.g., a hospital or medical facility). This gives them the legal authority to obtain the specified medical records.
Warrants typically have to be executed within a certain time frame. If the warrant isn’t executed within this period, it may expire, and law enforcement would need to obtain a new warrant.
The Fourth Amendment of the U.S. Constitution protects citizens from unreasonable searches and seizures. This is why the warrant process is crucial, ensuring that individual privacy rights are balanced against the needs of law enforcement.
Who Is Allowed to View a Patient’s Medical Information under HIPAA?
Under HIPAA, only individuals with a direct need-to-know basis, such as healthcare providers involved in the patient’s care, insurance entities processing healthcare claims, or individuals the patient has explicitly permitted to, can view a patient’s medical information. Unauthorized disclosures can lead to significant penalties.
Depending on the governing law and severity of the violation, fines can range from hundreds to millions of dollars. For instance, under HIPAA, fines can range from $100 to $50,000 per violation, with a maximum annual penalty of $1.5 million per type of violation.
Certain unauthorized disclosures can be treated as criminal offenses, leading to imprisonment for months to several years.
Affected individuals or entities may sue for damages resulting from unauthorized disclosures. Such lawsuits can lead to monetary settlements, judgments, compensation for harm suffered, and emotional distress.
Loss of Licensing or Certification
Some professional bodies or licensing agencies may revoke or suspend licenses if a member discloses unauthorized information. This can significantly impact professions such as doctors, lawyers, or accountants.
Exclusion from Participation
In some sectors, especially healthcare, entities that violate privacy regulations might be excluded from federal programs like Medicare and Medicaid, which can significantly affect their revenue.
If the unauthorized disclosure breaches a contract’s terms (e.g., between a business and its vendors or clients), the offending party may face contractual penalties, including termination of the contract or damages.
Can Law Enforcement Violate HIPAA?
Law enforcement can’t typically override HIPAA protections without a valid reason. However, there are specific situations, like obtaining evidence under a valid search warrant or responding to a health emergency, where they might access medical records without violating HIPAA. Still, these exceptions are limited and subject to strict scrutiny.
Do I Need an Attorney?
If you believe your privacy rights have been infringed upon or face DUI/DWI charges, seek legal guidance. A knowledgeable attorney can navigate the complexities of the law and ensure your rights are upheld. Consult a DUI/DWI lawyer through LegalMatch to find the right representation for your case.