What you learned about HIPAA to an actual situation in which a health care organization violated HIPAA regulations.

INTRODUCTION

This graded project is a research paper that you’ll complete

and submit to the school for grading. In your paper, you’ll

apply what you learned about HIPAA to an actual situation in

which a health care organization violated HIPAA regulations.

YOUR ASSIGNMENT

Health care organizations must know and follow the regulations

that are set forth by HIPAA, or be held accountable

for their failure to follow the rules. For this assignment,

you’ll need to find three real-life examples of HIPAA violations;

that is, violations of HIPAA’s privacy or security laws

that occurred in the United States since the passage of the

HIPAA law (after 1996). Each violation described should be

serious, and one that resulted in a fine or penalty for the

individual or company involved.

You can find real-life examples of HIPAA violations in

news reports, medical journals, professional health care

publications, and other similar reliable factual sources.

For each example violation, you should provide the following

information:

n A complete, descriptive summary of the case

n Important facts that relate to the case, such as the

names of the company or individual involved, the date

of the violation, and the city and state where the incident

occurred

n An explanation of the HIPAA rules that were violated

Be sure to answer these questions when writing your

summaries:

n How did the HIPAA violation occur?

n What policies (if any) did the organization have in place

to protect against the violation?

n What was the penalty for the violation (fine, prison term,

termination of employment, etc)?

Finally, describe three ways in which the organization could

have prevented the violation.

Organize your three case examples into a 750-word paper.

Research Instructions

To write your paper, you may use journal articles, textbook

material, case studies, and Web site information. The Web

site information must come from reputable and verifiable

sources, such as the United States Department of Health and

Human Services, the American Medical Association, professional

or business organizations, or articles published by

major news organizations.

To get started on finding a real-life case example that you’re

interested in, you can use an Internet search engine such as

Google. Try entering keywords such as “HIPAA violation”

under the “News” section. Or, go to your local library and

perform a search in the medical journals or professional

publications they have on file.

Writing Guidelines

1. Type your submission, double-spaced, in a standard

print font, size 12. Use a standard document format with

1-inch margins. (Do not use any fancy or cursive fonts.)

2. Read the assignment carefully, and follow the instructions.

3. Be sure to include the following information at the top of

your paper:

n Your name

n Your student number

n The course title (HIPAA Compliance)

n Graded project number (46081100)

n The date

4. Be specific. Limit your submission to the issues covered

by your chosen topic.

The student must

n Provide a clear discussion of the chosen topic

n Address the topic in complete sentences

n Support his or her research by citing specific information

from the textbook, Web sites, and any other references,

and by using correct APA or MLA guidelines for citations

and references

n Stay focused on the chosen topic

n Write in his or her own words and use quotation marks

to indicate direct quotations

Written Communication

The student must

n Discuss the topic in complete paragraphs that include an

introductory sentence, at least four sentences of explanation,

and a concluding sentence

n Use correct grammar, spelling, punctuation, and sentence

structure

Provide clear organization (for example, uses words like

first, however, on the other hand, and so on, consequently,

since, next, and when)

n Make sure the paper contains no typographical errors

Format

The paper should be double-spaced and typed in font size 12.

It must include the student’s

n Name and complete mailing address

n Student number

n Course title (HIPAA Compliance)

n Research project number (46081100)

 460810RR – IMPLEMENTING AND ENFORCING HIPAA

Questions 1 to 20: Select the best answer to each question. Note that a question and its answers may be split across a page

break, so be sure that you have seen the entire question and all the answers before choosing an answer.

1. Which of the following is used to code and classify morbidity data from patient medical records,

physician offices, and surveys conducted by the National Center for Health Statistics?

A. NPPES

B. ICD-9-CM

C. Claim status codes

D. HCPCS

2. You are employed by a small dentist office that has three employees. Under the Administrative

Simplification Compliance Act, your office is

A. required to file claims electronically.

B. excluded from the mandate to file a claim electronically.

C. required to append a waiver form and file all claims electronically.

D. required to file claims through paper submissions only.

3. Which of the following is the HIPAA standard code set for diseases, injuries, and other health-related

medical problems?

A. HCPCS

B. National Drug Codes

C. CDT-4

D. ICD-9-CM

4. Dr. Madison’s office calls an insurance company to determine whether they have paid for Mr. Rossi’s

last checkup visit. This procedure is known as a

A. referral authorization.

B. health care claim status inquiry.

C. functional acknowledgment.

D. remittance advice.

5. The agency of the federal government that combats fraud and abuse in health insurance and health care

delivery is the

A. Centers for Medicare and Medicaid Services (CMS).

B. Health Care Fraud and Abuse Program.

C. Department of Justice (DOJ).

D. Office of the Inspector General (OIG)

6. Which of the following is the HIPAA standard code set for dental services?

A. National Drug Codes

B. CDT-4

C. ICD-9-CM

D. Current Procedural Terminology

7. Which of the following advises covered entities about HIPAA compliance problems uncovered by the

OIG?

A. corporate integrity agreement.

B. OIG Work Plan.

C. Health Care Fraud and Abuse Control Program.

D. OIG Fraud Alert

8. The department of the federal government that investigates criminal violations of the HIPAA privacy

standards is the

A. Department of Justice (DOJ).

B. Health Care Fraud and Abuse Program.

C. Centers for Medicare and Medicaid Services (CMS).

D. Office of the Inspector General (OIG).

9. A written document created by a health care provider that’s designed to prevent fraud and abuse by

outlining the process for finding, correcting, and preventing illegal practices among their staff members is

called a(n)

A. compliance plan.

B. code of conduct.

C. audit report.

D. OIG Work Plan.

10. Which of the following are physicians, contractors, or employees who have been found guilty of fraud,

and are therefore prevented from participating in Medicare, Medicaid, and federal health care programs?

A. Excluded parties

B. Advisors

C. Relators

D. Self-referrers

11. On a HIPAA 277 transaction, a claim status code of “A” indicates that

A. the claim has been finalized.

B. an error occurred in the transmission of the claim.

C. a request for more information has been sent.

D. the claim has been received.

12. Under the HIPAA transaction standards, the supplemental health information that’s provided to clarify

and support a health care claim is called a

A. paper claim.

B. implementation guide.

C. claim attachment.

D. remittance advice remark.

13. There are eight mandated transactions described under the HIPAA transaction standards. The 270/271

transaction represents

A. an inquiry to an insurance company to determine is a claim has been paid.

B. remittance advice that explains how a payment amount was calculated.

C. a delivery of information to an insurance company to apply payment to an individual’s account.

D. an inquiry to an insurance company to check whether a patient is covered for a specific service.

14. Under HIPAA, the nonmedical code sets that are used to capture general information, such as state

abbreviations and payment explanations, are called

A. implementation guides.

B. administrative code sets.

C. ICD-9-CM codes.

D. CPT codes.

15. Which of the following statements about electronic medical claims is correct?

A. Dentists are required to submit all claims electronically.

B. Medicare pays electronic claims in half the time required to pay paper claims.

C. No covered entity is required to use electronic claims; they may continue to send paper claims indefinitely.

D. Electronic claims are more expensive to send than paper claims.

16. The annual list of the OIG’s planned projects for sampling billing in various settings (such as hospitals,

doctor’s offices, and long-term care facilities) to check for potential fraud is called the

A. OIG Work Plan.

B. Deficit Reduction Act.

C. corporate integrity agreement.

D. triggered review.

17. Which of the following is the second part of an 835 that explains how the payment was arrived at?

A. Functional acknowledgment

B. Remittance advice

C. Claim payment status

D. Claim status inquiry

18. The Jefferson Pediatric group sends an 837 to the Rhode Island Insurance Company. An 837 is a type

of HIPAA transaction that represents a

A. referral certification and authorization.

End of exam

B. health care payment and remittance advice.

C. health plan enrollment.

D. health care claim.

19. A physician’s office “upcoded” office visits to an insurance provider in order to receive a higher

reimbursement for patient services. Upcoding is an example of

A. abuse.

B. benchmarking.

C. compliance.

D. fraud.

20. The federal law that prohibits physicians from making self-interested referrals, or referrals in which

they have a financial interest or may receive a kickback, is called

A. Deficit Reduction Act (DRA).

B. Sarbanes-Oxley Act.

C. Stark II.

D. False Claims Act (FCA).

UNDERSTANDING HIPAA

Questions 1 to 20: Select the best answer to each question. Note that a question and its answers may be split across a page

break, so be sure that you have seen the entire question and all the answers before choosing an answer.

1. Under the HIPAA Security Standards, according to the category of _______ standards, covered entities

are required to create policies and procedures that concern authentication, transmission, and other issues

when electronic protected health information is accessed.

A. emergency

B. technical

C. administrative

D. physical

2. In a situation where a patient’s protected health information is required as evidence in a court of law, the

provider may release the information

A. only with the patient’s approval.

B. upon the request of any attorney.

C. only if the patient signs a release form.

D. without the patient’s approval upon receipt of a judicial order.

3. Michael has just paid for a property and casualty insurance policy for the Dalton Medical Clinic. How is

this type of insurance classified under HIPAA?

A. Property and casualty insurance policies are federally funded clearinghouses.

B. Property and casualty insurance polices are not classified as covered entities.

C. Property and casualty insurance policies are non-exempt entities.

D. Property and casualty insurance policies are covered entities.

4. A provider instructs an administrative staff member to bill a patient for a particular procedure. The

conversation is overheard by another patient who is sitting in the waiting room. This situation would be

describes as a(n)

A. incidental use and disclosure, which is not a violation of HIPAA rules.

B. illegal disclosure of protected health information.

C. release of information, which is a violation of HIPAA rules.

D. disclosure of de-identified health information.

5. In an electronic healthcare information system, a type of program that harms the information system,

and that’s often brought into the organization through e-mail attachments or Internet downloads, is called

A. a proxy server.

B. encryption.

C. a firewall.

D. malware.

6. In the United States, the main federal government agency that’s responsible for healthcare and that

administers the Medicare and Medicaid programs is

A. the American Health Information Management Association (AHIMA).

B. the Centers for Medicare and Medicaid Services (CMS).

C. the American Medical Association (AMA).

D. the Health Care Financing Administration (HCFA).

7. To protect electronic health information, many covered entities prevent employees from accessing the

information unless they have a certain job title or job function. This type of technical security safeguard is

called

A. a firewall.

B. antivirus software.

C. encryption.

D. role-based authorization.

8. A pathology laboratory is contracted with Winchester Hospital to review the hospital’s biopsy specimens.

Under HIPAA, the laboratory would be classified as a(n)

A. business associate.

B. direct provider.

C. clearinghouse.

D. indirect provider.

9. A hospital’s security system requires an individual’s unique fingerprint, voice pattern, facial pattern, or

eye/iris pattern to access protected health information. These unique methods of individual identification

are known as

A. biometrics.

B. backup procedures.

C. audit controls.

D. digital certificates.

10. According to the HIPAA Security Standards for electronic protected health information, issues such as

workstation security, facility access controls, and device controls are covered under _______ standards.

A. physical

B. technical

C. administrative

D. organizational

11. To protect electronic health information, the information may be transformed into an unreadable format

before it’s distributed to anyone. This type of security safeguard is called

A. antivirus software.

B. encryption.

C. a firewall.

D. password protection.

12. Which of the following statements about the HIPAA Privacy Rules is correct?

A. It’s a HIPAA violation if a provider’s name appears on a patient’s telephone caller ID.

B. There are no restrictions on the use or disclosure of de-identified health information.

C. Providers are required to provide the Notice of Privacy Practices to patients receiving emergency treatment.

D. It’s a HIPAA violation to have a patient sign-in sheet at a facility’s front desk.

13. Which of the following is the computer-to-computer transfer of routine business information that has

helped healthcare businesses to greatly simplify their administrative practices?

A. Treatment, Payment, and Health Care Operations (TPO)

B. Electronic data interchange (EDI)

C. Notice of Privacy Practices (NPP)

D. Group health plans (GHP)

14. Having a backup procedure for the computer systems in a health clinic is an example of satisfying

A. a technical security standard.

B. an implementation specification.

C. a physical security standard.

D. an administrative security standard.

15. Any direct personal contact between a patient and a health care provider in any place of service for the

diagnosis and treatment of an illness or injury is called a(n)

A. complaint.

B. encounter.

C. authorization.

D. liability.

16. Which of the following organizations creates and promotes standards for the transfer of data to and

from the pharmacy services sector of the health care industry?

A. The National Committee on Vital and Health Statistics (NCVHS)

B. The Strategic National Implementation Process (SNIP)

C. The National Drug Code (NDC)

D. The National Council for Prescription Drug Programs (NCPDP)

17. Rachel receives health insurance through her job as a privacy officer at the MEA clinic. She has just

resigned from her job, but the office manager tells her that she’ll be allowed to continue her health coverage

under the employer’s plan for a limited time period, at a cost of $395.00 per month. Which of the following

acts allows Rachel to continue her health care coverage with her former employer?

A. FEHB

B. ERISA

End of exam

C. IHP

D. COBRA

18. The Blue Ridge Surgery Group has developed a new Web site that describes its services and benefits.

According to HIPAA rules, which of the following must be included on the organization’s Web site?

A. A complete description of all procedures provided

B. A list of the types of insurance they accept

C. A Notice of Privacy Practices

D. A listing of all physicians on staff and their professional credentials

19. Frequently, electronic health information must be transferred from one user to another over the Internet

or through a computer network. To ensure that the remote user is authorized to receive the data, an

electronic authorization called a(n) _______ can be issued to the remote users by a covered entity.

A. emergency access procedure

B. digital certificate

C. contingency

D. computer administrator

20. HIPAA refers to any item, collection, or grouping of individually identifiable protected health

information as a

A. notice of privacy practices.

B. billing record.

C. designated record set.

D. health plan identifier.

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