Sample Situations: Knowing the Law

Riverside, Ca –

Here are some HIPAA-related questions and answers. Though your situation may not be identical to these, they may give you an idea of what to expect. If you have any questions, please contact Director of Clinical Compliance and Privacy Paul Hackman by email at  or by phone at (951) 827-3257

Q: I think a nurse may have made a mistake in administering a drug to a patient. When I mentioned it to the nurse, he seemed annoyed and said he would handle it. I am not sure anything was done. Should I do anything else?

A: If you are uncertain, keep raising the issue. Talk to your supervisor. The nurse may have done what was needed, but you should be satisfied that you have an answer. Errors do occur in practice, but with care and attention from everyone, they can be prevented or corrected.

Q: My supervisor wants me to change a billing code so that the charge will be covered by the patient's insurance company. However, the code does not accurately reflect the service provided.

A: Doing this constitutes fraud and could create legal problems for you, the patient and the university. Talk with your supervisor to make sure you understand what you are being asked to do. If you are not satisfied with the answer, contact the compliance office.

Q: I was told by my supervisor to process charges for services even if the chart note did not support the level of service.

A: This is very serious compliance issue and should be reported to a senior manager in your department. If you are not satisfied that this practice is changed, notify the compliance office or call the compliance hotline.

Q: I'm a university accountant and a senior manager told me how to record a transaction. These instructions are not in compliance with generally accepted accounting principles or the university guidelines. What do I do?

A: Try to explain the accounting requirements and the reason the transaction cannot be recorded as instructed. If you are unable to resolve the situation with this manager, contact your manager's supervisor, the chief financial officer, or the compliance office.

Q: I happened to review a draft of an official financial report and noticed that some of the data was incorrect. Should I assume someone else will catch this mistake or should I report the error?

A: Immediately bring this information to the attention of your supervisor. If an official statement is published with the incorrect information, there can be serious consequences for the university and those in charge of preparing the document.

Q: I discovered that a fellow employee is looking at laboratory reports on other employees and is telling his friends about them. What should I do?

A: This is a serious problem. Immediately report the problem to your supervisor. If you are reluctant to do that, contact the compliance office.

Q: The Department of Medical Records occasionally receives calls from patients wanting copies of their medical records. Can we provide this information?

A: Generally, patients are entitled to receive copies of summaries of their records. The patient must make the request in writing. There are many exceptions to this rule for example, in the case of minors and mental health patients. If there is a question, get advice from either the medical records supervisor, privacy officer or legal department before releasing any medical record information.

Q: I received a call from the employer of a former university employee asking a question about the employee's performance while at the university. Should I give out this information?

A: Information concerning employee performance is confidential. Refer all such calls to the Department of Human Resources.

Q: I am an RN. A fellow RN called me from home after she completed her shift. She told me that she forgot to enter a verbal order she received for a change in medication. The nurse asked me to log the change into the patient's chart and to use her initials. She said charts are often updated in this way and no harm is done. Is this okay?

A: While the nurse did the right thing by calling to report the chart error, the error should be promptly reported to the shift supervisor. You should never record an order you did not hear and never sign someone else's signature or initials. Even if no harm occurred in this case, the error needs to be reported. The chart can be corrected in proper fashion by the supervisor.

Q: The local district attorney called and asked me to give a statement regarding treatment of a particular university patient. Should I respond?

A: We have a responsibility to protect patient confidentiality. Do not provide confidential patient information to the person who identifies himself or herself as a district attorney until you have spoken with the legal department.

Q: What should I do if a government investigator comes to my home and asks to talk to me about the activities of my department?

A: The university cannot prohibit you from talking to a government investigator if you wish to do so. However, you may consult with the legal department or your personal attorney before answering any questions. Asking to speak with legal counsel before answering questions is your right and in no way indicates that you are not cooperating fully.

Q: I work in the payroll/accounts payable department and every month I process a check for a medical director. Recently I learned from a friend that the physician never performs services as a medical director. What should I do?

A: When encountering such questionable circumstance bring the information to the attention of your supervisor, a higher level manager or the compliance office.

Q: I sometimes attend trade shows or professional meetings at which I run into old friends who work for competitors of the university. Are there subjects that I should avoid?

A: Avoid anything that affects competition in the marketplace including prices, pricing policy, profit margins, or credit and billing practices. Trade shows, professional meetings and other gatherings pose problems when competitors "talk shop." The most serious problems often arise in informal gatherings such as lunch or dinner after the meeting has concluded. Stay away from any business discussions with competitors.

Q: Many airlines, hotels and rental car companies have frequent traveler programs through which I can receive free trips, car rentals or hotel stays for my personal use. Does the university allow me to accumulate these points for university travel?

A: Yes, you may use these credits as long as you are aware of certain responsibilities. You must be sure that you haven't subjected the university or a government grant to additional expenses by scheduling a particular routing, carrier or trip simply to pursue these credits. The trip should be clearly necessary and use the most cost-effective carrier, routing and services. Employees should be able to clearly explain their choices of timing, routing, location and carrier.

Q: A doctor I work with always arranges for her patients to go to one skilled nursing facility even if it is distant from where the patient's family lives.

A: This doctor may have had particularly favorable experiences at the facility. On the other hand, it is proper for you to raise a question about any possible improper financial arrangements between the skilled nursing facility and the doctor. Ask the doctor or your supervisor. Keep asking until you are satisfied with the answer.

Q: My supervisor is a member of a minority ethnic group. I am not. He seems to give the best assignments and promotions to minority workers in our department.

A: Promotions and assignments should be based on your ability compared to your fellow worker. If your supervisor cannot explain his decisions to your satisfaction, ask his supervisor or the human resources department. You should not be harassed because you ask questions. On the other hand, when you have received a proper explanation, you have an obligation to accept these supervisory decisions and work to improve your performance so that you will be selected next time.

Q: I have a disability. My supervisor and most of my fellow workers have been fair and helpful in their interactions with me, but one worker tries to make me feel uncomfortable and makes me feel that I am receiving favorable treatment.

A: Ask your supervisor to deal with this employee. Managers need to treat you fairly and make sure that others in your workplace do the same.