Policy Manual


Permitted Uses and Disclosure of Protected Health Information Regarding Health Oversight Activities      

Type: Policy                 Category: General                 Level: Community Care 

Parties: Community Care employees and contractees

Printer Friendly Version: http://apps.comcareme.org/policymanual/default.aspx?code=1.ME.34&nonav=yes

Supporting References: HIPAA Privacy Rule Standard 164:512d

Parent Effective Date Approval Level Revision Dates Last Reviewed
N/A  4-13-2003  Board    4-13-2003
Related Document Code Related Document Name Type

Policy:  Community Care may disclose protected health information to a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight of: The health care system; Government benefit programs for which health information is relevant to beneficiary eligibility; Entities subject to government regulatory programs for which health information is necessary for determining compliance with program standards; Entities subject to civil rights laws for which health information is necessary for determining compliance. A health oversight activity does NOT include an investigation or other activity in which the individual is the subject of the investigation or activity and such investigation or other activity does not arise out of and is not directly related to: the receipt of health care; A claim for public benefits related to health; or Qualification for, or receipt of, public benefits or services when a patient’s health is integral to the claim for public benefits or services. If a health oversight activity or investigation is conducted in conjunction with an oversight activity or investigation relating to a claim for public benefits not related to health, the joint activity or investigation is considered a health oversight activity.