Question

Explain at least four provisions within HIPAA that protect individuals and healthcare organizations from fraud and abuse.

Your response should be at least 200 words in length.c

Answer 1

HIPAA establishes policies and procedures for maintaining security and privacy of every individual about their health information and create civil and criminal penalties for violation.

It creates a program for controlling abuse and fraud. There are four provisions which are as follows:

• Privacy rule :
  • It regulates the use and disclosure of PHI ( protected health information) .
  • It include health insurance, employer sponsored health plan.
  • A concerned body may reveal PHI to facilitate treatment, payment or health care operation without written authorization by the patient.
• Security rule :
  • Complements the privacy rule
  • It is limited to electronic prohibited health information.
  • Three types are there - administrative, physical and technical.
  • Physical control physical abuse to protected data.
• Enforcement rule:
  • It sets financial penalties for violating HIPAA rule.
  • Corrective measures are applied if non compliance is determined as entity.
• Transaction and code sets rule :
  • In order to improve health care system efficacy of HIPAA created health care transaction.
  • It simplifies by health plans to standardise health care transaction.

HIPAA combined strict penalties for violation and may result in medical centers and practices.