So, my mom is at a nursing facility. There is an organization affiliated with Medicare called Maximus, which you must go to for an appeals process. We asked that some supplemental reports be sent to the organization. The facility declined, saying that Maximus had to contact them and request the information. But Maximus doesn’t make requests, they just act on the information they are given. The facility claimed that they couldn’t send the information to Maximus due to HIPAA regulations. Can this be right? HIPPA is for the patient’s protection, and if the patient wants medical reports to be sent to Medicare or a company like Maximus that works with Medicare, why would HIPAA not allow that.
Is the facility wrong in their understanding of what HIPAA mandates and does not mandate?
Thanks.
I don’t know anything about Maximus, the Medicare appeals process you describe, or the dispute you are trying to resolve. Your best bet is probably to consult a competent lawyer.
I do know that many health providers take a very limited view of what they can do under HIPAA. Health care providers can face adverse consequences for disclosing things to people when they shouldn’t; there are effectively no sanctions for not disclosing things even when they are allowed to but choose not to. So, the general rule is that the patient is definitely entitled to his or her records. Employees of the health care provider can access them if they need them to provide care to the patient. Everyone else can pound sand. I am sure that the health care provider is even less willing to voluntarily provide records when they will be used against the health care provider in a dispute.
Can your mother get the records herself? If not, does someone have a durable medical power of attorney for your mother who can request the records? A good lawyer could help you navigate this terrain.
Getting the records directly from the healthcare provider and passing them along to Maximus is probably the best solution, even though it makes your mother/family into something of a middle-man.
It’s actually kind of refreshing to hear about a healthcare organization protecting patient confidentiality… as an industry vertical, healthcare is shockingly weak on privacy and security.
The facility is not required to get consent for disclosures related to medical suitability. Sounds like they just don’t want to send it.
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You should be able to obtain a form from Maximum for your mother to sign and give to the nursing home that authorizes the release of protected health information to them.