Before a patient or caregiver files a HIPAA violation about your doctor’s office or hospital, often they will complain to your staff about the problem. How you handle patient complaints is crucial in helping you avoid HIPAA lawsuits or complaints. A patient can’t sue you for a HIPAA violation directly. They can file a complaint with the Office of Civil Rights, with the Department of Health in the State they live in, and the insurance providers they use. Once the complaint is filed it will be investigated.
Handling Patient Complaints
When a patient or caregiver complains about a HIPAA violation to your office, have a staff member sit down and talk with them personally. Don’t ask them to fill out a form immediately, since this depersonalizes the problem and sometimes make the patient or caregiver angrier. Before they fill out a form let them tell you in their own words what happened.
When you receive a written complaint, call the person and make an appointment to speak with them. When discussing the problem, ask them to tell what you what happened. This is an open ended question. Try to listen and realize that their complaint might be valid. In many cases people just want to be heard, and this could keep the patient from reporting the incident to an outside agency as a HIPAA violation.
Listen to the complaint and why the person is making it. What do they want from your doctor’s office or hospital? You can ask how you can resolve the problem or make it right. Perhaps you might want to investigate the complaint by talking with staff and finding out their side of the story as well. Give the patient or caregiver a date that you will respond to their complaint.
Review medical records and billing records and note information that supports or refutes the complaint. Try to find a resolution. Get back to the patient or caregiver in writing in a few weeks or less with your findings.
Reporting the Complaint to Your Healthcare Insurance and Attorney
If the complaint is very serious you may be required to report the complaint to your healthcare practice attorney and malpractice insurance company. Some carriers expect all complaints to be reported. Often reporting is only necessary if there is an insurance claim. Your staff may find themselves working with the risk manger and insurance claims rep. Your office or healthcare facility will have to decide if you need help from legal counsel.
A good healthcare attorney helps your practice investigate and resolve serious HIPPA violations. If the person that has complained has an attorney, you should notify your insurance carrier and get legal advice from an attorney yourself.
Resolution of the Complaint or HIPAA Violation
When you review the complaint, think about the damage done to your patient or caregiver. When your office did violate HIPAA regulations ask what you can do to resolve the problem. Perhaps the patient just wants an apology or you can take some disciplinary action against the employee that violated HIPAA. A cash amount or refund for medical expenses or loss or work is another option. This is for more serious HIPAA violations.
Serious HIPAA Violations
When a serious breach has been discovered, contacting your practice’s attorney to help investigate, document the HIPAA violation, and resolve the problem is important. Contacting your malpractice insurance company and reporting the complaint or violations is required. Often an attorney and their staff can offer advice and recommend where to get HIPAA training for your medical staff in dealing with HIPAA regulations and procedures. Legal advice from an attorney about HIPAA compliance can save your practice money and damage to your reputation. Need someone to help you navigate complicated HIPAA violations? We can help with that.
Written by: Joan Russell