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FACTA AND HIPAA
Posted 05 May 2006 - 12:30 AM
Posted 10 June 2006 - 05:19 PM
I have done court research for two major information companies that sell the info to Equifax, Experian, and Transunion. I have seen some interesting lawsuits filed by collectors against medicare/medicaid recipients.
Additionally, I have had an awesome lawyer whom I have used regarding the health care needs of a child who passed away. We used medicaid for his needs.
I learned this, it is ILLEGAL for medicare/medicaid recipients to be "balance billed" by the medical provider. This is a common practice. Why? One could suppose that it is because of assumptions that medicaid recipients are not smart enough to know better or challenge it. Two, because seniors tend to be very conscientious about paying ALL of their bills--legitimate or not.
Here's the thing: If you are a medicare or medicaid recipient who has received a medical service for which the provider agreed to accept medicaid or medicare, they CANNOT bill you (providing they have the medicare/medicaid card/information. If they do bill you, they are violating federal law--report them to the insurance commissioner and the AG's office.
Further, the lawyer, firm, collection bureau who files a court action against you in order to collect on "balance billing" is also violating the law. Report them to the BAR and AG's office as well.
What happens if the medical providers are reported/investigated is potentially a withdrawal of the agreement for them to be medicare/medicaid providers--this is big business, they don't want that to happen.
I have been a victim of this very thing. I have been successful each time I challenged, but I still have more to challenge and it is time consuming.
Because I was additionally doing research, I suggested to my lawyer a class-action suit against one of the hospitals in our area notorius for this crap. The cases I read in one court house broke my heart as far as what happened to some individuals who lost their court cases but they had no idea they were illegal suits. Apparently, the judge had no idea they were medicare/medicaid recipients and of course the plaintiffs had no intention of mentioning that.
I believe that our consumer protection laws should be amended to include a provision that a collection agency/law firm collecting for medical bills should be required to inform the court if the respondent was a medicare or medicaid recipient.
Hope this info is helpful to someone.
Disclaimer: I am not a lawyer, this is not legal advice.
Posted 25 June 2006 - 09:03 AM
Your post is mostly inaccurate.
MEDICARE is a FEDERALLY administered program designed for seniors/Retirees with no financial restraints as to eligibility. Recipients must pay the SSA for Medicare part A and part B, separately. A recipient may only have Part A or Part B
MEDICAID is Federal program which is administered on a STATE by STATE basis to provide health benefits to indigent people who qualify financially and have no insurance coverage or inadequate insurance coverage. Some members may be billed a copay or even a premium. Some states have plans which will help families pay the premium for a private plan like BC but offer no additional coverage.
Medicare recipients MAY be billed the appropriate amounts as set forth in the Medicare EOMB, including their 20% coinsurance, yearly deductibles and services deemed non covered by Medicare.
The only amount the provider has to write off is the DISALLOWED amount as stated by Medicare.
MediCAID recipients may also be billed in certain circumstances as well. There are many types of coverage in each state, including plans where there is a set amount a patient MUST spend out of pocket before coverage kicks in and limited plans which only cover prenatal or emergency services, as well as services which are over and above plan limits (such as if Medicaid only allows for 50 diapers per month for a bedbound patient and you need 60, you can be billed for the extra 10 in some states) or non covered by Medicaid. Also, if you fail to advise the Provider that you have Medicaid and they miss filing limit because of this YOU are responsible for the bill.
Your use of the term "Balance billing" is vague at best, since there are instances in which patients MAY be billed the balance after insurance or even the entire balance. In some cases for Medicare, the patient may be liable for the entire billed amount, such as in the case of NON ASSIGNED claims (in this case, the patient would be sent the payment and would then be liable for the entire amount to the provider)
While I understand your concern for the subject, you can not lump the two programs together. They are two separate and unique entities which have their own rules and regulations, and for Medicaid this varies by state. They are not one in the same, nor do all Medicare recipients have Medicaid, and vice versa, though some may.
Additionally, this thread is for the discussion of HIPAA and FACTA and how they relate to each other. Please *only* post in this thread if you would like to discuss that issue or have questions of a general nature relating to HIPAA and FACTA. If you have a question or comment relating to your own specific situation, please start a new thread.
Posted 28 October 2007 - 03:21 PM
Posted 26 January 2008 - 09:54 AM
Posted 28 January 2008 - 12:22 AM
You are confusing two separate issues.
I contacted my HC provider regarding a bill that went into collections. I then found WHYCHAT's hipaa letter program and was reading it and trying to reference the information in the letter to the actual law. I can't find anything that says since there is no business purpose they can't contact the CA anymore and they must remove. the only information I found in Hipaa regarding my request for them not to disclose my PIH to the CA after payment is the following-
I have used the portions of the HIPAA rules that you cited in my new link on MedFico in a letter of redaction of permission.
There is of course, NOTHING in any HIPAA rules that deals with how an OC should act if they have no longer any permissible purpose in communicating private medical data when there is no longer any permitted purpose. That would be like requiring expungement of all medical records that HAD been transmitted to a Dr. after that Dr. is no longer involved in treating the patient.
The purpose of the HIPAA letter program is to prevent FURTHER communication after the account is paid and there is no longer any business purpose.
One can not redact prior disseminated data, but one can make sure that the CA is NOT permitted to verify to a CRA the validity of an account that has been disputed.
Edited by Why Chat, 28 January 2008 - 12:24 AM.
Posted 28 March 2008 - 09:35 AM
Posted 19 May 2008 - 04:44 PM
Posted 15 July 2008 - 09:33 PM
According to my reading, they cant even state the account as medical?
The name & address of the original creditor for medical accounts MAY appear on your credit report if the CRA is sending the report to the consumer himself/herself. Only if they are sending it to other businesses who have PP do they have to code the account as "Medical".
That seems to be the whole purpose of this, not to disclose anything medical.
So obviously when I see it it says who the medical office is, but how do you really know what others are seeing? I just got a letter from Home Depot saying they were lowering my credit line because of my TU report and I know for a fact they are only a few medical bills. What did they really see?? Mmmm makes me wonder...
Posted 17 November 2008 - 02:24 PM
Newbie here reading all the great advice on Hipaa so I thought I would give it a try. I tried calling to get the address of the Original Creditor and they are out of business or as the guy on the telephone said in transition. What do I do now?
Thanks in Advance
Posted 14 June 2009 - 06:17 PM
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