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How Far Does HIPAA Go?
Nov 29, 2005

With the recent release of a WAL-MART memo on corporate efforts to reduce healthcare costs, it seems that HIPAA does not prevent an insurance company, or third party billing company, from releasing fairly detailed statistics on a group of employees.

First, have you had a chance to read this memo? If not:

And here's another WAL-MART tactic that indicates and anti-worker stance:

My question is: Does HIPAA allow frequent and detailed employee health profiles to be sent that would allow, by the process of elimination, for HIV+ employees to be identified?

More specifically, does HIPAA allow the day (and or time) that a doctor visit took place to be provided to an employer (who would just check their timesheets to determine which employee(s) to fire)?

Regards, Tom

Response from Ms. Franzoi

HIPAA provides extensive requirements for group health plans regarding pre-exisiting condition exclusions, certification of coverage, discriminatory eligiblity and premiums, mandatory special enrollment and protection of health care information. Employers can only get access to detailed health information to the extent that it is needed in the administration of the plan. In an insured plan, this would be limited information, typically total claims incurred by disease, specific drug costs, etc. but this would be on a plan basis not by individual. If it is a self-insured plan (unless the plan is administered (claims adjudicated) in-house), the employer would only see information on claims incurred by disease, dollars spent by Rx, etc. The only time participant specific information would be disclosed would be if the participant asks for assistance with a claim (and then the employer would most likely have the participant sign a release acknowledging what information can be disclosed) or in the event of a large claim where a stop-loss carrier is involved and is requesting specific information in order to process the stop loss claim.

With respect to your timesheet question, that is outside the scope of HIPAA.

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HIPPA and Medicaid

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