HIPAA Concerns for Physician Whistleblowers

Washington DC Qui Tam Lawyers

In 2003, new rules governing patient privacy contained in the Health Insurance Portability and Accountability Act passed in 1996 (HIPAA) became effective. These rules imposed criminal and civil liability on physicians and medical care providers who fail to follow its guidelines on the confidentiality of patients’ health information. HIPAA’s Privacy Rule has been quite effective in its goal of protecting the privacy of patients, even though it has been costly for healthcare providers to implement and maintain compliance. However, one unforeseen side effect of the Privacy Rule has been concerns among physicians and other healthcare providers that bringing a qui tam lawsuit to report healthcare fraud might violate HIPAA.

What many physicians may not know is that HIPAA actually provides a statutory exemption for whistleblowers in certain situations. The Permitted Use/Disclosure portion of the Privacy Rule permits whistleblowers to disclose patients’ health information to their qui tam attorney, a “health oversight agency,” or “public health authority.” However, this exemption only applies when a whistleblower believes that a “covered entity” has broken the law, breached clinical or professional standards, or is endangering patients.

Physicians make excellent whistleblowers because they have access to important documentation of illegal activities, such as:

Medicare/Medicaid Fraud
Pharmaceutical Fraud
Medicare Upcoding
Stark Statute Violations
Anti-Kickback Statute Violations.

Thus, the statutory exemption contained in HIPAA has been crucial in healthcare fraud qui tam cases as this type of evidence might otherwise have been restricted by the Privacy Rule.

Becoming a Healthcare Fraud Whistleblower without Violating HIPAA

If you have knowledge of fraud or false claims against the government, but worry that providing evidence of that fraud may violate HIPAA, the qui tam attorneys of Chaikin, Sherman, Cammarata & Siegel, P.C. can help you better understand HIPAA’s whistleblower exemptions. We will help you determine which evidence is exempt from HIPAA privacy regulations, and will help you put together your qui tam lawsuit with the full protection of attorney-client privilege and the False Claims Act.

Becoming a whistleblower to report healthcare fraud is a courageous and patriotic service to your fellow taxpayers, and whistleblowers can maintain compliance with HIPAA and protect the privacy of their patients. Reporting fraud can help the government recover millions of dollars needed to provide healthcare for Medicare, Medicaid, and TRICARE patients.

While you may become a whistleblower as a public service, the False Claims Act also provides generous whistleblower rewards for physicians and other professionals who report fraud in the healthcare industry.

If you have knowledge of fraudulent schemes resulting in false claims paid by the government, please contact the qui tam lawyers of Chaikin, Sherman, Cammarata & Siegel, P.C. today to assess the potential for a qui tam claim in a private consultation protected by attorney-client privilege.

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