Clearinghouses And Patient Privacy Protection

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Summary
Patients are forced to give personal details when seeking treatment. However, the privacy of such information has been a topic of discussion owing to the sensitivity of this data. To enhance patient confidentiality and data privacy, legal regulations have been put in place to restrict entities that can access the medical records from the unlawful distribution of patient details (U.S Department of Health and Human Services 2). Grandison and Bhatti listed clearinghouses under ‘covered entities,’ meaning they are subject to the Privacy Rule (2).Clearinghouses link insurers to healthcare systems by processing medical claims, electronically forwarding them to the respective insurers, and sending the payments back to the healthcare providers. With such undertakings, clearinghouses have unlimited access to extensive data relating to different patients.
According to the Health Insurance Portability and Accountability Act (HIPAA), clearinghouses are allowed by the law to obtain and analyze patient data (Grandison and Bhatti 2). Nonetheless, distribution of similar data is only permitted under specific circumstances; if it is intended for research purposes to facilitate scientific innovations and when the information is to be used for public health purposes. Healthcare stakeholders may use the data to analyze healthcare costs, evaluate geographical disparities in the distribution of health services, and forecast and plan how to use the limited resources (Grandison and Bhatti 2).

Before the information is used in the outlined circumstances, patients have the right to be notified and willingly give written authorization to that effect. The privacy rule restrains dissemination of Protected Health Information (PHI) under any other circumstance (U.S Department of Health and Human Services 3). An exception to the rule is disclosing personal details to corresponding patients.
Analysis
Unauthorised access to patient’s personal information has been, partly, motivated by financial gains. Richard Gibson, a phlebotomist, had access to the health records of a cancer patient, Eric Drew, and used the information to secure four credit cards that would cost the patient a whopping $ 9,000 (Grandison and Bhatti 3). Richard worked with Seattle Cancer Care Alliance. Richard was imprisoned for one year and four months.
On the same note, Williams Linda, a representative of an insurance firm was convicted after he conspired to obtain billing details of over 400 clients illegally. Part of the data was sold out to Adjei Richard who used it to file tax returns and seek a refund from Internal Revenue Services (Grandison and Bhatti 3). The two examples are just a few legal cases that involve a breach of the Privacy Rule. Precautionary measures and harsh disciplinary actions will go a long way to enhance patient privacy and restore patient confidence in the health systems.
Despite the privacy threat posed by clearinghouses, healthcare systems and individual patients still prefer using them for several reasons. Filing claims electronically are simpler, faster, and lead to reduced wait-times when compared to BlueCross (Grandison and Bhatti 5). In most cases, the reimbursement period is significantly reduced to below eight days. The claim errors can also be fixed in minutes and there is higher claim success.
Works cited
Grandison, Tyrone, and Bhatti Rafae. “HIPAA compliance and patient privacy protection.” MedInfo. 14.4 (2010): 2-10.
U.S Department of Health and Human Services. “Covered Entities and Business Associates.” HHS.gov, 16 June 2017, www.hhs.gov/hipaa/for-professionals/covered-entities/index.html. Accessed 21 Apr. 2018.