The rampant healthcare fraud and abuse that existed in the American healthcare industry forced the federal government to enact the Health Insurance Portability and Accountability Act (HIPAA) in 1996.

1. Effective HR Compliance Programs for HIPAA Compliance
The rampant healthcare fraud and abuse that existed in the American healthcare industry forced the
federal government to enact the Health Insurance Portability and Accountability Act (HIPAA) in 1996.
HIPAA comprises of two titles with Title I protecting health insurance coverage for workers and their
families when they change or lose their jobs and Title II known as the Administrative Simplification (AS)
provisions, requiring the establishment of national standards for electronic health care transactions and
national identifiers for providers, health insurance plans and employers. The AS provisions also address
the privacy and security aspects of health information of patients.
As healthcare providers and practitioners need to use and disseminate the confidential health information
of the patients for various purposes, the health information has been subjected to wide scale abuse for
personal gains. In order to prevent such incidents, HIPAA creates tough standards for the use and
dissemination of health care information, which all the healthcare practitioners and providers must
comply with at all costs.
The federal government adopts a carrot and stick approach when it comes to ensuring HIPAA compliance.
The criminal penalties include:
i.
ii.
iii.
$50,000 and up to one-year imprisonment for willfully obtaining and disclosing health
information.
Up to $100,000 and up to five years imprisonment if the wrongful conduct involves false
pretenses.
Up to $250,000 and up to 10 years imprisonment if the information is gathered with the intent to
sell, transfer, or use it for commercial advantage, personal gain or malicious harm.
Therefore, ensuring HIPAA compliance is highly necessary for every organization. However, not every IT
staff can carry out HIPAA compliance effectively. Hence, having a human resource services partner who
takes care of HIPAA privacy compliance is beneficial. Their HR compliance programs with respect to HIPAA
help to:
Simplify the administration of health insurance claims and help manage the costs associated with
those claims using national standards.
Give patients more control over and access to their medical information.
Protect individual identifiable health information from any kind of threats of disclosure through
the setting and enforcing of standards.
Improve efficiency in health care delivery by standardizing electronic data interchange (EDI).
Recently, the federal government passed the HIPAA omnibus rule, which further strengthens the HIPAA privacy
and security rule. Therefore, considering the criticality of the situation, having a perfect HR partner to take care of
all the regulatory and compliance needs can allow companies to be on the right side of the law.