Question

You have graduated from the WCU and are now an administrator in a large orthopedic practice for Mainline Health. There is strong demand for the orthopedic services and most of the patients that receive services are privately insured. You are aware that the senior physician’s wife is an excellent physical therapist at the local hospital. The senior physician has stated that his wife is opening her own physical therapy practice just a few blocks away from the orthopedic practice. The physician states that it will be very convenient for the patients of the orthopedic practice to see his wife at her new practice given its proximity and quality care.                                                     

Although he has not asked you to consider the matter, you feel that this arrangement and potential referrals deserve a closer look. You take it upon yourself to do some independent research. After all, the physical therapist is a close friend and was a classmate in undergraduate school. You are aware she is the best in the business.

In your research, you also discover that the senior physician will be investing in his wife’s new physical therapy practice and will share in the financial profits as well as the losses. The physical therapy office will also use the same organization as the orthopedic practice to generate bills and submit claims to payers. The services provided at the physical therapy office will serve a critical need of the orthopedic practice as it will allow patients to recover from their surgeries as well as possibly avoid procedures that could be best treated by therapeutic services.

Both the senior physician and his wife have no intention of breaking any laws and are unaware of any health care regulations that they may be breaking.

What advice do you give to the senior physician and his wife? This answer has two parts. Please write out the name of the rule and the rule language (from the text) that guides your advice. Next provide your advice in full with support from the rule that you have written.

Answer 1

HIPAA privacy rule restricts the use or disclosure of PHI(protected health information) by covered entities. Covered entities with PHI for other uses it needs individual written permission. rule an authorization has a specific meaningful description of the information that to be disclosed. the authorization should be written plain language that should have core elements that signature of the individual, purpose, and disclosure and statement for individual rights for revoking authorization. authorization rule states for the reason of PHI disclosure. informed consent language protects confidentiality with specific details that respect the uses of information. this language important for the HIPAA authorization requirement. because patients from orthopedic service to physiotherapy service for their own practice need patient permission and authorization.
signing on authorization rule will permit covered entities to treat conditions. privacy rule permits the senior physician to continue an authorization form with the type of written permission. HIPAA privacy rule will not provide authorization for a private right of action by the patient or physician.