How to beat a HIPAA investigation

Forming physician-hospital agreements

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 established federal standards for the security of electronic protected health information (e-PHI). In instances where violations are deemed to have occurred, a HIPAA investigation is initiated. For this reason, health providers are advised to retain legal counsel with expert knowledge of healthcare laws, so that they can determine how to beat a HIPAA investigation.

Under HIPAA health care providers and other ‘covered entities’ are required to safeguard the integrity of healthcare information. This requires setting up a tailor made compliance plan. However, there are times when gaps in privacy practices exist, and these could become the basis of an investigation into HIPAA procedures by state and government regulators.

Dealing with HIPAA Investigations

Ensure that you are HIPAA Compliant: Organizations that have the necessary administrative and technical safeguards in place, as well as appropriately trained personnel, are better equipped to handle a random audit or HIPAA investigation (learn more).
Review Policies Periodically and Conduct an annual risk assessment: Regular review of privacy and security policies should be carried out, to ensure that they are adequate in light of the changing statues. Making the appropriate investment in HIPAA compliance will pay huge dividends should there ever be an investigation.
Retain experienced legal counsel: Attorneys can help covered entities substantiate that they are HIPAA compliant. They can also monitor the organization’s conduct during an HIPAA investigation, provide guidance in interpreting the regulations, and respond to HIPAA enforcers on your behalf.

At Nelson Hardiman, Los Angeles, CA, our attorneys are specialists in healthcare matters.  We know what it takes for you to be HIPAA compliant, as well as how to beat a HIPAA investigation into your business data and records. Call us today at 310-203-2800 for an appointment.

How to resolve peer review and credentialing conflicts with physicians:

Legal nuances private practice physicians should be aware of

Although doctors are usually protected in hospital peer reviews, the process can be a challenging and complex one, and may not have a positive outcome. For this reason, resolving peer review and credentialing conflicts with physicians, often requires the intervention of legal counsel.

Reasons for Conflict

Physicians, who believe that they are adequately credentialed and competent, often feel that they are unfairly treated by a peer review. As a result, some of them become frustrated by the process, and opt to resign in the midst of the investigations.

Resolving Conflict

When peer reviews are presented in an educational rather than a disciplinary context, less conflict is likely to arise. Physicians should therefore be advised of hospital policies and procedures, and their expectations in this regard.

The hospital should also have a clear peer review policy that outlines the role of peer reviews in maintaining standards, and quality of care. Peer review committee members should be adequately trained, and have the specialized knowledge to carry out their task in a timely manner. In addition, the findings should consist of objective evaluations that are clear and consistent.

This approach can help to quickly diffuse potential conflict. However, there are times when the process is not properly executed, and the physician decides to seek legal representation to resolve conflict. The physician should choose a law firm that specializes in health care matters, and has the expertise to handle peer review and credentialing issues.

The attorneys at Nelson Hardiman, LLP have represented physicians in a number of peer review actions in California. Our success in gaining landmark decisions in relation to physician rights is evidence of our expertise in these matters.  Call 310-203-2800 today for an appointment.