An important ingredient in ensuring compliance with the Privacy Rule is the Department of Health and Human Services’ (HHS) responsibility to investigate complaints that the Rule has been violated and to follow up on other information regarding noncompliance. At times, this responsibility entails seeing personal health information, such as when an individual indicates to the Department that they believe a covered entity has not properly handled their medical records.
What information would be needed depends on the circumstances and the alleged violations. The Privacy Rule limits HHS Office for Civil Rights’ (OCR) access to information that is “pertinent to ascertaining compliance.” In some cases, no personal health information may be needed. For instance, OCR would need to review only a business contract to determine whether a health plan included appropriate language to protect privacy when it hired an outside company to help process claims.
Examples of investigations that may require OCR to have access to protected health information include:
- Allegations that a covered entity refused to note a request for correction in a patient’s medical record, or did not provide complete access to a patient’s medical records to that patient.
- Allegations that a covered entity used health information for marketing purposes without first obtaining the individuals’ authorization when required by the Rule. OCR may need to review information in the marketing department that contains personal health information, to determine whether a violation has occurred.