Merging of patient records?

by A
(USA)

My health care provider seems to have merged my child's records with another child that is not ours. They now share the same medical information such as allergies and vaccinations. I have called to inform them of the problem, but they for the most part do not believe me. I have access to this other child's doctor visits and bills.

It has gotten to the point of my insurance company being billed for this other child and they have unknowingly paid out for some of this other child's claims. We have contacted our insurance company so they would stop paying further claims. This seems to be a HIPAA violation.

I'm wondering how could such a huge mix-up happen, why they don't believe me, and if this is actually a HIPAA violation? What can I do to resolve this? Thanks.

Visitor Question:
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ANSWER for "Merging of patient records?":

A (USA):

The Health Insurance Portability and Accountability Act, or HIPAA, regulations apply to health plan administrators, healthcare clearinghouses, and to any healthcare provider who transmits health information in electronic form.

The Department of Health and Human Services' Office for Civil Rights (OCR) is responsible for administering and enforcing HIPAA regulations. Upon receipt of notices of alleged HIPAA violations, OCR has the right to conduct complaint investigations and compliance reviews.

If the OCR finds violations have occurred they can impose severe penalties upon the violator. According to the OCR, "Penalties will vary significantly depending on factors such as the date of the violation, whether the covered entity knew or should have known of the failure to comply, or whether the covered entity’s failure to comply was due to willful neglect."

Whether or not the insurance company believes you is a matter between you and them. If you are having a problem with the insurance company representative, ask to speak with a supervisor. If you continue having problems, you can file a complaint with your state insurance board.

For additional information about HIPAA go to U.S. Dept. of Health and Human Services.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.

Best of luck,

Judge Calisi

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