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Christopher B, Esq
Christopher B, Esq, Attorney
Category: Personal Injury Law
Satisfied Customers: 2677
Experience:  personal injury and medical malpractice attorney
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I took my son to an emergency clinic because he complained

Customer Question

I took my son to an emergency clinic because he complained of chest pains. The ER physician gave him an EKG and checked him out fully and said his heart looks fine. She concluded that since he had attended a church camp earlier the same week for 4 days at which he did some kayaking, he likely strained chest muscles around his rib cage. To my surprise the following week, I got a call from his Psychiatrist who prescribes Focalin for his ADHD who explained Express Scripts, my prescription medication insurance administrator, had called them asking if the knew my some has a heart condition and asking whether they should be prescribing Focalin. Why would my prescription insurance company know that I took him to an emergency clinic complaining of chest pains and why would they be contacting his psychiatrist? This would seem to be in violation of ADA or HIPAA law?
Submitted: 1 year ago.
Category: Personal Injury Law
Expert:  Christopher B, Esq replied 1 year ago.

My name is***** and I will be helping you with your question today. This is for informational purposes only and does not establish an attorney client relationship.

HIPAA, which stands for the Health Insurance Portability and Accountability Act of 1996, is a federal law created to, among other things, standardize electronic healthcare transactions and to protect a patient’s medical and health information. In 2009, Health Information Technology for Economic and Clinical Health, or HITECH Act modified some parts of HIPAA and added the requirement that patients receive notification if their privacy is breached. A patient’s privacy is violated when pharmacy staff or other health care workers improperly use, disclose or allow unauthorized access to confidential health information. Sometimes this even includes sharing information with a patient’s family.

A pharmacist has a duty to investigate prescriptions and various harmful affects associated with the prescriptions they fill, often times this includes contacting certain physicians. HIPAA establishes a complex set of regulations specifying who can use or disclose patient PHI to whom and for what purpose. Pharmacists and pharmacies are only allowed to use PHI in a manner that is permitted or required by HIPAA. Providers must take reasonable steps to limit the use or disclosure of PHI to the minimum necessary to accomplish the intended purpose of the use or disclosure. In other words, PHI should only be released on a need-to-know basis. However, the minimum necessary requirement does not apply to treatment activities. Therefore, if a pharmacist called a prescriber to verify the intended use of a medication, the prescriber would be allowed to provide this information. A few other exceptions to the minimum necessary requirement also exist. These include disclosures of patient health information that are required by law (e.g., reporting for public health surveillance programs and reporting suspected victims of abuse or neglect). Therefore since this was a treatment activity, the pharmacist has a duty (for the protection of the patient) to follow up on the medications they are filling.

Please let me know if you have any further questions and please positively rate my answer as it is the only way I will be compensated for my time. (There should be smiley faces or numbers from 1-5 next to my answer, an excellent or good rating would be fantastic.)

Customer: replied 1 year ago.
I am concerned that the prescription insurance company has access to my medical records, or in this case my son's, in matters not associated with any prescription medication. It was the prescription insurance company that contacted my son's ADHD doctor letting them know, falsely, that he has a heart condition. My question and concern is not related to a pharmacist or health care provider, but whether a pharmaceutical insurance company can access medical records unrelated to anything for which they are providing prescription medications for and share that information with another physician. That just doesn't seem right from a logical perspective.
Expert:  Christopher B, Esq replied 1 year ago.

From my previous answer, "Providers must take reasonable steps to limit the use or disclosure of PHI to the minimum necessary to accomplish the intended purpose of the use or disclosure. In other words, PHI should only be released on a need-to-know basis." Pharmacists cannot access unrelated information to the prescriptions they are filling. My guess is the ADHD medicine was a red flag and there were some types of medications that were prescribed in the ER that might have counteracted with this prescription so they double checked with the physician. If this is not the case then there could definitely be a HIPAA violation here as the inquiries must be related to the "treatment activity".

Please let me know if you have any further questions and please positively rate my answer if satisfied.

Expert:  Christopher B, Esq replied 1 year ago.
I see you have reviewed my answer, do you have any further questions? If not, please positively rate my answer as it is the only way I will be compensated for my time by the site.
Expert:  Christopher B, Esq replied 1 year ago.

Any chance for a positive rating?

Expert:  Christopher B, Esq replied 1 year ago.

Any chance for a positive rating?