Day: 12/24/2014

Brainyquotes – Holiday Edition

The main reason Santa is so jolly is because he knows where all the bad girls live.  George Carlin

I once wanted to become an atheist, but I gave up – they have no holidays.  Henny Youngman

I celebrate everyone’s religious holidays. if it’s good enough for the righteous, it’s good enough for the self-righteous, I always say.  Bette Midler

There’s nothing sadder in this world than to awake Christmas morning and not be a child.  Erma Bombeck

What I don’t like about office Christmas parties is looking for a job the next day.  Phyllis Diller

I used to think that the worst thing in life was to end up alone. It’s not. The worst thing in life is to end up with people who make you feel alone.  Robin Williams

Maybe Christmas, the Grinch thought, doesn’t come from a store.   Dr. Seuss

Let’s be naughty and save Santa the trip.  Gary Allan

Feds say data broker sold consumers’ identity to scammers

https://www.consumeraffairs.com/news/feds-say-data-broker-sold-consumers-identity-to-scammers-122414.html

The Federal Trade Commission charges that a data broker, LeapLab, sold the sensitive personal information of hundreds of thousands of consumers – including Social Security and bank account numbers – to scammers who allegedly debited millions from their accounts.

Additional post on Lindanee’s Blog

By Linda Nee on December 13, 2014 at 10:18 am

Another story is the claim I managed while still employed by Unum of a gentleman who was receiving treatment by a Mexican witch doctor. Each month, he would cross the border for a ceremony that was actually working for his cardiac condition. However, in some respect, although insurance companies cannot compel anyone to seek certain types of treatment most policies do include a provision, “treated by a qualified physician with a speciality suitable to the claimed disability.” With some encouragement (not threats) I was able to convince my claimant that he should seek treatment in the US by a qualified cardiologist. He did so, and his care was medically managed.

Patient notes should not be altered, written on, or changed in any way for disability claim purposes. It doesn’t matter that the changes made were benign, it shouldn’t be done.

There is a proper way to change medical notes by contacting the physician in writing, pointing out the errors, and requesting that the notes be changed or amended. Physicians do not like to “change” medical notes because it’s a time consuming nuisance. And, not everything that happens is a planned conspiracy since doctor’s offices are more chaotic than insurance companies are. If patient notes are consistently wrong, a letter to the physician citing the errors along with a request for more accurate reporting is appropriate.

The proper way to change medical notes doesn’t work.  Besides doctors not wanting to change anything, they have this problem of believing they’re always right.  And incorrect records are much more of a nuisance for the patient than for the doctor, especially since those medical records follow a patient wherever they go — for the rest of their lives.

Unum as a “Covered Entity” under HIPAA

Comments were closed by this blog before I was able to respond, so here’s my last post:

http://lindanee.wordpress.com/2014/12/05/daily-buzz-8/

There are many different kinds of car insurance — coverage for liability, flood, collision — but they all involve the use of a car.

There are different kinds of health care providers too, but they all provide a service that involves your health.

So, is a disability insurance company considered a “Covered Entity” under HIPAA? Here’s part of hhs.gov’s definition:

2. A Health Plan

This includes:

Health insurance companies
HMOs
Company health plans
Government programs that pay for health care, such as Medicare, Medicaid, and the military and veterans health care programs

3. A Health Care Clearinghouse

This includes entities that process nonstandard health information they receive from another entity into a standard (i.e., standard electronic format or data content), or vice versa.

Unum as a health insurance company: It can certainly be argued that disability insurance is a type of health care insurance. Disability insurance is for when your health declines to the point of disability. Do healthy people use disability insurance?

Unum as a company health plan: Unum’s policies are offered as additions to company health plans, including coverage for worker’s comp and short/long term disability.

Unum as a Health Care Clearinghouse: Doesn’t Unum fit this description? Maybe Unum doesn’t communicate with its insureds by electronic means, but I’m sure they use email and other digital technology with all their subsidiaries, vendors, etc. And doesn’t ERISA (which Unum has to follow) include HIPAA rules?

Unum as a government program that pays for health care: Can we consider ERISA as a type of government program? And I know that Unum provides disability insurance to government contractors, but I don’t now if it provides benefits directly to federal and other government employees.

“All matters relating to disability insurance are matters of contract and the contract always rules (including the provisions of discretionary authority).”

Contracts are just words, and words tend to have more than one meaning. It may not be easy to attack the contract itself, but as you say, the contract always rules. But the contract is not God, and neither is it the federal government.

I don’t expect my arguments to convince anyone at Unum — at this point, they are only made to save and protect them for the record.

“No regular medical treatment, no benefit.”

I’m still waiting for someone to define “regular medical treatment.” Especially for a 25-year intractable pain condition. As an expert on pain management, I can tell you that there is no such thing as “regular medical treatment” for a chronic pain patient. Since the medical industry gave up on me as a chronic pain patient, what will I be seeking treatment for?

The HIPAA Rules apply to covered entities and business associates

http://www.hhs.gov/ocr/privacy/hipaa/understanding/coveredentities/

The HIPAA Rules apply to covered entities and business associates. A Covered Entity is one of the following:

1. A Health Care Provider

This includes providers such as:

Doctors
Clinics
Psychologists
Dentists
Chiropractors
Nursing Homes
Pharmacies

…but only if they transmit any information in an electronic form in connection with a transaction for which HHS has adopted a standard.

2. A Health Plan

This includes:

Health insurance companies
HMOs
Company health plans
Government programs that pay for health care, such as Medicare, Medicaid, and the military and veterans health care programs

3. A Health Care Clearinghouse

This includes entities that process nonstandard health information they receive from another entity into a standard (i.e., standard electronic format or data content), or vice versa.

4/8/2014, More information on the Experian identity theft

https://www.consumeraffairs.com/news/more-information-on-the-experian-identity-theft-040814.html

Federal authorities say [identity thief Hieu Minh Ngo] obtained Social Security numbers through a U.S. firm known as Court Ventures, which provides customers with access to court records. It also offered them access to a database of Social Security numbers of some 200 million Americans through a data-share arrangement with another firm, known as U.S. Info Search.

How HIPAA works

HIPAA works in concert with the Health Information Technology for Economic and Clinical Health, or HITECH Act (2009).

“Under the HITECH Act, the United States Department of Health and Human Services is spending $25.9 billion to promote and expand the adoption of health information technology.” Wikipedia

Enforcement of this Act has been slow to materialize, but a list of the cases can be found here:

http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/

An article about the $144 million jury verdict in 2013 can be found here:

http://www.mondaq.com/unitedstates/

On July 26, a jury in Marion County, Indiana awarded $1.44 million to a Walgreens customer based on allegations that the customer’s pharmacist accessed, reviewed, and shared the customer’s prescription history with others who then used the information to intimidate and harass the customer.