Question

Evaluate the following case study utilizing the AHIMA Code of Ethics, the AHA Patient Care Partnership and HIPPA guidelines (sample HIPAA Privacy Notice is in Appendix C of textbook). What issues exist in this case study? What are the consequences of the situation? What resolutions are necessary?

Jenna Peterson, a 20 year old college student, made an appointment to be seen by Susan Grant, M.D., one of the partners at Mountainside Family Medicine Associates. Jenna had been seeing Dr. Grant for a few years. Dr. Grant was also the long time family practitioner for Jenna’s mom and older sister.On this visit, Jenna said she would like to get a prescription for birth control pills. They discussed other contraception options, as well as the risk and benefits of each and decided that “the pill” would be Jenna’s best option. After reviewing Jenna’s medical history and performing a brief physical examination, Dr. Grant gave Jenna a six month prescription for Ortho-Novum 10/11, along with educational materials on oral contraceptives. She told her to schedule a six month follow-up appointment over summer break. When Jenna checked out with the front office, shetold the billing office that she did NOT want this visit submitted to her mother’s insurance. Instead, she would pay for the visit herself because she didn’t want her mother to know the reason for the visit. The billing clerk said that she would send Jenna a bill because the practice’s billing system was undergoing a software upgrade. Jenna asked that the bill be sent to her college address. About two weeks later, Mrs. Peterson had a routine appointment with Dr. Grant. When she checked in, she stopped by the billing office and asked the insurance clerk to check a notice of claim statement she recently received from her insurance carrier about a visit by Jenna. Mrs. Peterson said, “I know Jenna hasn’t been here because she’s away at school.” The clerk said she’d check on the claim and should have information for Mrs. Peterson by the time she was done seeing Dr. Grant. Mrs. Peterson was then taken back to an exam room for her appointment. While seeing Mrs. Peterson, Dr. Grant inquired about the Peterson family and mentioned that “Jenna has really blossomed into a beautiful, intelligent young woman.” Mrs. Peterson thanked Dr. Grant and asked, “When did you see Jenna?” Dr. Grant unthinkingly said, “Oh, a couple weeks ago when she was in for her appointment.” When Mrs. Peterson questioned why Jenna had been seen, Dr. Grant realized she had said too much. She hemmed and hawed a bit, and finally suggested that Mrs. Peterson talk to Jenna. Despite Mrs. Peterson’s insistence that she had a right to know why Jenna was seen, Dr. Grant refused to provide additional details. Mrs. Peterson was clearly angry with that response and stormed out of the exam room. On her way out, she stopped at the billing office, and the insurance clerk confirmed that Jenna was in for an appointment on the day in question and that the claim was correct.

Answer 1

The issue that exist here is that the principle of consumer's right to privacy and confidentiality was not followed or the PHI was not protected. The billing clerk has disclosed the patient information even after the patient asked not to bill it under her mother's insurance instead to send it directly to the college. Secondly Dr.Grant unintentionally revealed Jenna's visit to her mother.

Consequences include penalty charges as per the HIPPA guidelines. Apart from the penalty there would have also been slight misunderstandings among the three.

Resolutions: Communication gap should be adressed. Jenna should have informed Dr.grant as well that she does not want her Mom to know about her visit and bill detals and the billing clerk should have been more careful and attentive so that she could have avoided the disclosure of the PHI of Jenna.