Jan 25, 2018 in Research

How HIPAA Violations Affect the Medical Billing Process

Confidentiality and privacy have always been one of the major concerns facing medical professionals. However, it is not until the 20th century that these issues entered the legal domain. Today, numerous laws, policies, and regulations govern the processes of information disclosure in the medical field. Still, certain privacy and confidentiality issues remain unresolved. It is no secret that confidentiality violations affect the medical billing processes. The Health Insurance Portability and Accountability Act (HIPAA) places severe restrictions on how and when patients' health information can be disclosed. Patients' HIV/AIDS status is a matter of chief confidentiality concern, because this information is extremely sensitive, and its disclosure has profound social, legal, and ethical implications for the patient, medical community, and society.

Why HIV and AIDS Information Is More Sensitive

With the growing scope of the HIV/AIDS epidemic, the society has become particularly concerned about possible ways to deal with the disease. More individuals come to hospitals and medical facilities, looking for professional help. At the same time, the prevailing majority of those, who are diagnosed with HIV/AIDS, are willing to keep this health information confidential. Reasons why HIV and AIDS information is more sensitive than the data on other health conditions are related to the history and social image of the disease. Since the beginnings of the HIV/AIDS history, the epidemic has disproportionately affected members of the socially marginalized groups, including gays (Doughty, 1994). By that time, gay men and lesbian women had already learned the taste of discrimination due to their sexual orientation. As a result, keeping their health status in secret became the only possible way to avoid further discrimination and abuse.

Another reason why HIV/AIDS information is more sensitive than the data on other health statuses is because the disease itself is responsible for the development of discriminative attitudes (Doughty, 1994). The sensitive status of HIV/AIDS information is justified by "the widespread fear and even hysteria which surrounds the epidemic" (Doughty, 1994, p.124). Therefore, keeping this information confidential is one of the best ways to make sure that the patient diagnosed with HIV/AIDS does not lose his (her) house or job.

Finally, given that the disclosure of sensitive HIV/AIDS information leads to grave personal and social consequences for the patient, only confidentiality can help persuade such patients to enter the health care system (Doughty, 1994). Only through anonymity and confidentiality those with HIV/AIDS can be sure that the status is never linked to their identity. Meanwhile, through confidential and anonymous treatment, health institutions will guarantee that HIV-positive patients do not pose any public health threat. HIPAA guarantees that all individuals with health insurance have access to quality health care services, regardless of their health status and that their information is kept confidential under any circumstances.


The Legal, Ethical, and Social Ramifications of Information Disclosure

It is clear that any instance of information disclosure by the health care facility has profound legal, ethical, and social implications for the patient and the entire medical community. The common law, federal and state statutes protect patient confidentiality and privacy. HIPAA represents one of the most solid privacy and confidentiality rules ever adopted in the field of health care (Moskop et al., 2005). Any disclosure of the patient's HIV/AIDS status is a severe violation of numerous regulations and laws, namely, HIPAA and state (federal) statutes. Under HIPAA, healthcare providers are obligated to protect the confidentiality of patients' identifiable health information, which relates to their physical and mental health (Moskop et al., 2005). HIV/AIDS are not included in the list of reportable conditions, and healthcare providers are not authorized to disclose this type of information without patient's informed consent.

The ethical ramifications of information disclosure are no less serious. The breach of confidentiality exemplifies a serious violation of the fundamental ethical principles in medical practice. Since antiquity, confidentiality has been one of the most essential elements of codes of ethics and medical oaths (Moskop et al., 2005). Today, respect for confidentiality is the foundational element of ethical practices in healthcare, because it is grounded in other moral principles, such as dignity and patient's autonomy (Moskop et al., 2005). In other words, failure to keep the patient's HIV/AIDS information confidential violates the principles of patient's autonomy and beneficence. Moreover, such failures are likely to discourage patients with HIV/AIDS from seeking medical care. Moskop et al. (2005) are right: "if patients are confident that their physicians will protect their privacy and confidentiality, they are more likely to seek medical care and to communicate personal information fully and accurately" (p.55). In this sense, information disclosure also has social ramifications, because the success of such treatment will predetermine the way, in which medical institutions deal with one of the chief public health problems.

Other social consequences of HIV/AIDS information disclosure are related to the problems that were discussed earlier in this paper, including stigma and discrimination. Despite the growing HIV/AIDS awareness, many myths surrounding the disease continue to dominate public thinking. Doughty (1994) even writes that individuals, whose HIV/AIDS status becomes known to the public, may lose their employment and living support. Everything is possible in the world, where individuals with HIV/AIDS are regarded as a marginalized group.

HIPAA Violations and the Medical Billing Process

Failure to keep patients' HIV/AIDS information confidential is a serious violation of HIPAA, which greatly impacts the medical billing process. According to the American Medical Association (n.d.), HIPAA violations result in numerous penalties, which alter the financial balance and budget efficiency of medical practices. Depending on the nature of the violation, the minimum penalty will range from $100 to $10,000, with a maximum of $1.5 million to be paid annually (AMA, n.d.). In case of disclosing patients' individual HIV/AIDS information, the exact amount will depend on the nature and reason of such violation. For instance, an individual who did not know he (she) was violating HIPAA will have to pay a minimum of $100, with up to $25,000 charged annually for repeat violations (AMA, n.d.). At the same time, a HIPAA violation that occurred due to reasonable cost would cost medical practitioners between $1,000 and $100,000 for repeat violations (AMA, n.d.). However, given the severity of the social, ethical, and legal consequences of such information disclosure, these financial penalties seem as of minor importance. The whole life of a HIV-positive patient is at stake, when it comes to confidentiality and personal health information management in the system of health care.


A whole set of rules, regulations, and laws was designed to ensure patient confidentiality in the system of health care. At present, HIPAA guarantees that all patient information is kept confidential under any circumstances. However, in case of HIV/AIDS, such information becomes even more sensitive, mainly because of the grave social, ethical, and legal consequences of information disclosure. That the HIV-positive status is associated with stigma and marginalization is a well-known fact. Those, who are known to be HIV-positive, experience considerable social and cultural difficulties. Each act of HIV/AIDS information disclosure is likely to have profound social, ethical, and legal consequences, because it violates a number of laws, ethical standards in medicine, and contribute to the subsequent marginalization of HIV-positive patients. Each violation of HIPAA will certainly impact the medical billing process, but even the greatest penalties become minor against the background of isolation and social discrimination facing HIV-positive patients due to such violations. 


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