State Medicaid Case Management Vs Private Hospital Billing

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Employees must also conform to their own moral and ideals knowing using one form of information for another is not ethical. This can put the employer at risk as well as the employee. If she chooses to use the confidential patient medical information at another facility, she also may be in violation of HIPAA.

HIPAA is Health Insurance Portability and Accountability Act. This was established during the Clinton Presidency and governs the protected health information of a patient and what can be disclosed. This law regulates the fine line between the sharing of health information and accessing medical care. Title II of HIPAA, under the control of Department of Health and Human Services, regulates fraud and abuse as used by those disseminating health-care information (HIPAA Violations & Enforcement (n.d.). The penalties for violating HIPAA are civil and/or criminal depending on the degree of violation. The business can be held for “corporate liability” for not training and educating the staff appropriately.

Summary: I believe these laws are good for the employers, employees and patients. For the health care employers the laws help maintain patient care as top priority not the financial means of the patient; employees are protected from sharing information they are exposed to others not involved in direct patient care, and the patients are protected knowing their private financial and health care information cannot be transmitted to anyone else without their approval. The strict violations that can be imposed for violating these laws keep employees and their employers in line while upholding the best practices for the patients.

References

Donica, K. (2013, September 5). Conflict Free Case Management Strategies for Integrated and Managed Care Long-Term Services and Supports Environments. Retrieved September 10, 2017, from http://www.nasuad.org/documentation/HCBS_2013/Presentations/9.10%202.30-3.45%20Potomac%201.pdf

Health Information Privacy. (2015, December 18). Retrieved September 10, 2017, from https://www.hhs.gov/hipaa/index.html/

HIPAA Violations & Enforcement. (n.d.). Retrieved September 10, 2017, from https://www.ama-assn.org/practice-management/hipaa-violations-enforcement

Kako, E., & Cooper, R. (2016, January). Conflict of Interest in Medicaid Authorities. Retrieved September 10, 2017, from https://www.medicaid.gov/medicaid/hcbs/downloads/conflict-of-interest-in-medicaid-authorities-january-2016.pdf