Is this a HIPAA violation?

Not sure where to post this, so please correct it if needed.

I have a SHOP (supplemental health options policy) for hospitalization coverage.  I had to have surgery and sent in the infomation they requested for my claim, but was denied based on previous medical records.

I appealed the denial, and asked for my medical records they based my denial on.  They sent me my records and when I opened them, they weren't even mine.

I received another person's full medical history, she has the same name, but different DOB, different SSN.  This information has her complete medical history, SSN, DOB, current residence, job info etc.  The 3rd party who does  searches for my insurer got this person's records from a website called E clinical works.

Is there a way to find out if they sent my medical records to someone else also?  If this is a HIPAA violation, what do I do or who do I report this to in the state of FL?

It's called a mistake. Return the records and ask them to send the correct ones.

This isn't "just a mistake" they based alot of important decisions on the wrong information.  I have all of my medical records in my possession and know when I've been to a doctor and had surgery, and  I have my birth certificate and SSN card to prove who I am

I sent them a certified letter and they insist these records are mine and what they based my denial of claims on.  They also cancelled my policy and said I lied on my application, sent me back my premiums I've paid for over a year and say these records that are someone else's are the proof they have.

This isn't a violation of HIPAA laws when they send you someone else's records?  So it's only a HIPAA violation when they send your records to someone else?  Maybe I read the information wrong on the website, that's why I wanted to see if anyone knew.

Now, I can't get another SHOP policy because of them since I have heart problems and didn't when I bought this policy.

I forgot to add: my policy was guaranteed renewal and when I purchased it, they did a full work up and medical background, which came back clean and I was uprated to a higher level.

It's just frustrating this kind of thing happens based on inaccurate information.

If they made any determinations based on the wrong records they will need to go back and re-do their evaluation.

Thanks and I totally agree..

Back to my original question - is receiving someone else's medical records a HIPAA violation and how do I find out if they sent my records to someone else....anyone know the answer to these specific questions?

You could contact the person whose records you have and let them know what happened.

I thought of that also, I may send her a letter telling her what happened.

yay! I won my lawsuit and prevailed based on the facts - one of them being that the insurance company used false information, then they even tried to use more false medical information saying I was DX with epilepsy instead of my mother - our names are no where near the same.

Even after all that, they still tried to say the medical history was mine and filed with the court the medical records of someone else even AFTER I told them they had the wrong person and medical records.  They said I lied and that the person whose medical records they received were me (what the heck???)

no, it wasn't just a "mistake" - they were sure they had the right records and sending the records back and telling them did nothing, except make them pay a high priced attny to look like he was less than intelligent by not cross referencing his facts.

HIPAA speaks to three levels of violations, a "simple" violation (with prison time up to one year), a violation by "false pretenses" (with prison time up to 5 years), and an offense committed with intent to sell, transfer, or use individually identifiable  health infomratino for commercial advantage, gain or malicious harm (with prison time up to 10 years).  It sounds to me like you have a "simple" violation (and to the "lawyer" who claims it is a "mistake" ... no such exception exists under HIPAA based on my reading, and such an exception would take the wind out of the sail of this serious piece of legislation).  If you want to report the violation, you can choose between the Office for Civil Rights/OSC or the F.B.I. - both have jurisdiction over "covered entities," which a hospital is, while only the F.B.I. has jurisdiction over others, such as lawyers who get their hands on private medical records, such as attendant to malpractice litigation, then disseminate them outside of the litigation, or file them with the court, making them public record. So while HIPAA speaks to covered entities, see 42 U.S.C. Sec. 1320d,  anyone who aids and abets a HIPAA violation as an agent or aider to a covered enity may also be prosecuted, see 18 U.S.C. Sec. 2(b).  HIPAA is a very serious body of law and should be taken very seriously.  For more information, see US Attorney Bulletin articles by Peter A. Winn (2005) and Ian Smith DeWaal (2007) on prosecutions under HIPAA for non-covered entities.

HELP!!!!  My case is somewhat similar.  It is very exciting that this lady won a case against a doctor.  I have paid for some legal advice on another site and was told to file for "filing of false medical records" under HIPAA.  However, I can't find this as being a direct HIPAA violation.

I have been a patient of the same pain mangement dr. for over 2 years.  He runs a very busy office where getting a 30 day appointment for refills never happens so I have often had to be on and off my pain meds-not healthy.  Several months ago his wife took over his practice as an office manager, she was abrasive, rude and downright demeaning.  The dr. apologized for several of my complaints,  then he said he just has no control- she is now his office manager, so I decided to leave this practice. My husband & I went to my last appointment and told him we would be leaving because her behavior was so erratic and upsetting I could not recover from my 5th surgery ( in 2 years) I was recovering from the @ the time.  We arrived 1/2 hour before this appointment and went through each page of my file to make sure nothing was out of order-it was fine.  My doctor assured us everything would be fine, and he'd help every step of the way with my transition.

I already had made an appointment before, so less than 2 weeks later I walked into what I thought would be my new pain dr's office.  Within 1 minute of sitting down I was accused of being a violent, untreatable patient who requests multiple early refills, loses meds & steals meds & that I was FIRED!?  When I would not admit to that the PA that was interviewing me became angry and kept telling me, "you're not getting any meds from our clinic".  I kept saying, "I don't want any pills-I want to see where your getting this information.  I went through every page 10 days ago."  He shoved the file in my face and snatched it back away.  Then told me, "the only way you'll ever see this is if you request your records up front, now you better get out of my office."  Once in the hall, I asked if he would at least tell me who accused me of these obscene charges and he kept repeating, "your not getting any pills here today".  Then he called the police on me.  I told him I would not leave and the police could come, but I must know if I'm being accused of stealing, losing, and getting extra narcotics & being violent...who is my accuser."  He finally said, "if you request your records you'll find out and walked away."  I was crying & everyone was staring.  I left before the police got there.

I have since had another interaction with another pain clinic.  The main problem is-- THEY are NOT looking at my records!!!!  Only the notes written by this dr's wife, office manager.  These notes are very damaging, but are also outright lies.  If one dr. would look past the notes from the dr.'s wife and look at my records from the past 2 years they'd see I have nothing but a stellar record with my dr.  And have never, ever gone beyond the prescribed med usage and usually am behind because his practice is so busy.  Furthermore, the violent behavior is not documented either.  Somehow, every dr. I see has received these notes from this woman from my ortho surgeon to my chiropracter-she is sending them out like wildfire.  Do I have any recourse?  Attorney's do not want the case as there is no money to be made.

ANY advice would be soooooo appreciated-I am at the end of my rope:(

It's not a HIPAA violation but you might have a case for slander.

And fyi - next time start your own thread. This one is about 18 mos old and likely to be overlooked.

Thanks-I was unsure.  the rules stated to not make a new thread if it was already a common one-should I start a new one now?  I don't want to get in trouble?

You're not going to get in trouble. And there's no point in starting a new one now. But your question really has nothing to do with this one.

Well-to me- I see how false records in her file and mine were keeping her from getting proper medical care and are keeping me from getting any medical care. 

It sounds very similar to me, but perhaps that's because I am a patient in the ugly world where dr.'s and Insurance companies can basically destroy a person's life and the general public has no recourse.

An animal would not be treated this badly-The point is yes she is slandering me, yes my medical record now appears to present me as a former elementary school teacher who is now a violent narcotic addict that steals and has been fired from 3 pain clinics.  This is truly a nightmare and I have no recourse-it's insanity.  Besides the fact that I am in terrible pain and am recovering from my 5th major surgery that left me unable to walk until about a month ago.  I have had to make 20 days of pain meds last 60 days & have run out.  Yes, I am starting to get bitter:(