FACTA AND HIPAA

[Why Chat]

Here are the new regulations under FACTA that I have been talking about, and the reason for using the "medical dispute letter" prior to using

any of the HIPAA letter program.

 

http://www.hipaadvisory.com/news/newsarchi...04/0216fact.htm

 

Excerpted passages:

 

New Consumer Credit Law Protects Medical Information

 

The Fair and Accurate Credit Transactions (FACT) Act, signed by President Bush on December 4, 2003 (Public Law 108-159), establishes

medical privacy provisions as part of consumer credit law. The bill amends the Fair Credit Reporting Act (FCRA) to include improved

medical privacy protections,in addition to new protections against identity theft. Credit bureaus and creditors will have to comply with

a number of medical privacy restrictions that ban the sharing of medical information. Title IV of the FACT Act limits the use and sharing

of medical information in the financial system and provides an updated and more expansive definition of medical information.

 

The legislation prohibits the furnishing of consumer reports that contain medical information about a consumers, unless the consumer

affirmatively consents to the furnishing of the report in the case of an insurance transaction, or the consumer provides specific written

consent in the case of the an employment or credit transaction. The legislation also prohibits creditors from obtaining or using medical

information in connection with any determination of the consumer's eligibility, or continued eligibility, for credit.

 

Section 411 under Title IV of the Act:

 

Revises the requirement for specific affirmative consumer consent (opt-in) regarding the use and sharing of medical information by

consumer reporting agencies for employment or insurance purposes.

 

States that medical information shall not be excluded from credit reports shared among affiliates unless it is prohibited by this title.

 

Directs the Federal banking agencies and the NCUA to prescribe regulations limiting the use of such medical information.

Section 412 under Title IV of the Act:

 

Requires information furnishers whose primary business is providing medical services, products, or devices to notify any credit reporting

agency to which they furnish consumer information that they are medical information furnishers, for purposes of compliance with medical

information coding requirements.

 

Prohibits a consumer reporting agency from including in any consumer report the name, address, and telephone number of any medical

information furnisher except in code, unless the report is provided to an insurance company for other than property and casualty insurance

purposes.

 

Requires the FTC, if a furnisher of information fails to comply with requirements for the coding of trade names, to take action, including

issuance of guidelines, to ensure the furnisher's compliance with such requirements.

 

The regulation text of Title IV of the FACT Act follows:

 

HR 2622

 

Fair and Accurate Credit Transactions Act of 2003 (Enrolled as Agreed to or Passed by Both House and Senate)

 

TITLE IV--LIMITING THE USE AND SHARING OF MEDICAL INFORMATION IN THE FINANCIAL SYSTEM

 

SEC. 411. PROTECTION OF MEDICAL INFORMATION IN THE FINANCIAL SYSTEM.

 

(a) IN GENERAL- Section 604(g) of the Fair Credit Reporting Act (15 U.S.C. 1681b(g)) is amended to read as follows:

`(g) PROTECTION OF MEDICAL INFORMATION-

`(1) LIMITATION ON CONSUMER REPORTING AGENCIES- A consumer reporting agency shall not furnish for employment purposes, or in

connection with a credit or insurance transaction, a consumer report that contains medical information about a consumer, unless--

`(A) if furnished in connection with an insurance transaction, the consumer affirmatively consents to the furnishing of the report;

`( if furnished for employment purposes or in connection with a credit transaction--

`(i) the information to be furnished is relevant to process or effect the employment or credit transaction; and

`(ii) the consumer provides specific written consent for the furnishing of the report that describes in clear and conspicuous language

the use for which the information will be furnished; or

`© the information to be furnished pertains solely to transactions, accounts, or balances relating to debts arising from the

receipt of medical services, products, or devises, where such information, other than account status or amounts, is restricted or

reported using codes that do not identify, or do not provide information sufficient to infer, the specific provider or the nature of

such services, products, or devices, as provided in section 605(a)(6).

 

`(2) LIMITATION ON CREDITORS- Except as permitted pursuant to paragraph (3)© or regulations prescribed under paragraph (5)(A),

a creditor shall not obtain or use medical information pertaining to a consumer in connection with any determination of the consumer's

eligibility, or continued eligibility, for credit.

 

`(3) ACTIONS AUTHORIZED BY FEDERAL LAW, INSURANCE ACTIVITIES AND REGULATORY DETERMINATIONS- Section 603(d)(3) shall not be

construed so as to treat information or any communication of information as a consumer report if the information or communication is

disclosed--

`(A) in connection with the business of insurance or annuities, including the activities described in section 18B of the model Privacy of

Consumer Financial and Health Information Regulation issued by the National Association of Insurance Commissioners (as in effect on

January 1, 2003);

`( for any purpose permitted without authorization under the Standards for Individually Identifiable Health Information promulgated

by the Department of Health and Human Services pursuant to the Health Insurance Portability and Accountability Act of 1996, or referred

to under section 1179 of such Act, or described in section 502(e) of Public Law 106-102; or

`© as otherwise determined to be necessary and appropriate, by regulation or order and subject to paragraph (6), by the Commission,

any Federal banking agency or the National Credit Union Administration (with respect to any financial institution subject to the

jurisdiction of such agency or Administration under paragraph (1), (2), or (3) of section 621(, or the applicable State insurance

authority (with respect to any person engaged in providing insurance or annuities).

 

`(4) LIMITATION ON REDISCLOSURE OF MEDICAL INFORMATION- Any person that receives medical information pursuant to paragraph

(1) or (3) shall not disclose such information to any other person, except as necessary to carry out the purpose for which

the information was initially disclosed, or as otherwise permitted by statute, regulation, or order.

 

`(i) MEDICAL INFORMATION- The term `medical information'--

`(1) means information or data, whether oral or recorded, in any form or medium, created by or derived from a health care provider

or the consumer, that relates to--

`(A) the past, present, or future physical, mental, or behavioral health or condition of an individual;

`( the provision of health care to an individual; or

`© the payment for the provision of health care to an individual.

`(2) does not include the age or gender of a consumer, demographic information about the consumer, including a consumer's residence

address or e-mail address, or any other information about a consumer that does not relate to the physical, mental, or behavioral

health or condition of a consumer, including the existence or value of any insurance policy.'.

[MoxyFruvus]

(a) IN GENERAL- Section 604(g) of the Fair Credit Reporting Act (15 U.S.C. 1681b(g)) is amended to read as follows:

`(g) PROTECTION OF MEDICAL INFORMATION-

`(1) LIMITATION ON CONSUMER REPORTING AGENCIES- A consumer reporting agency shall not furnish for employment purposes, or in

connection with a credit or insurance transaction, a consumer report that contains medical information about a consumer, unless--

`(A) if furnished in connection with an insurance transaction, the consumer affirmatively consents to the furnishing of the report;

`( if furnished for employment purposes or in connection with a credit transaction--

...

`(ii) the consumer provides specific written consent for the furnishing of the report that describes in clear and conspicuous language

the use for which the information will be furnished; or

`� the information to be furnished pertains solely to transactions, accounts, or balances relating to debts arising from the

receipt of medical services, products, or devises, where such information, other than account status or amounts, is restricted or

reported using codes that do not identify, or do not provide information sufficient to infer, the specific provider or the nature of

such services, products, or devices, as provided in section 605(a)(6).

<{POST_SNAPBACK}>

Does the underlined text mean that medical credit report entries with $0 balance must be removed?

[ANGELWEEZY]

OK Whyhchat, I admit I am not the brightest in the bunch, so I need to ask a question that I do not understand about. I read through what you listed above. Are you saying that the credit bureus(Exp,Eq,Trans) are not supposed to be listing the name of the medical provider on your report, that it should only say: Medical? Every last medical collection I have on my reports, does list the name of the medical facility. Please correct me if I am wrong and if I am not wrong,how do I handle this?

 

I have been fighting to get,let's just say MANY medical collections removed from my reports, cause I do not believe I owe any money to these medical facilities. I gave each one a copy of my medicare and medicaid card, they said that they would file and that was that, I never heard from them again, that is until I pulled my credit report for the first time in years, back in June 05.

If I had recieve any bills or even a call, I would have been on top of it to find out why the medical facility had not filed my insurance. No medicare/medicaid does not pay as much as a conventional insurance plan or a cash patient, yet it is substantially more than they will get now, for failing to file.

 

Each of these collections are out of SOL, if that matters. Also ALL of the medical collections are out of Floridam too.

 

If you can offer me some advice as to what steps I might take next, I would appreciate it. When I first got my report back in June I did dispute the accts as unknown to me. When they came back verified, I sent of a DV, to see if maybe they had crossed me up with someone with a simular name, since there are only about 5000 people in Florida alone, with the same first and last name as mine. The collection agencies have either ignored my DV(s) or they have sent me a billing printout from the OC.

 

 

Thanks IN Advance,

[Why Chat]

A " not mine" dispute is, IMO, virtually useless as all the CRA does is have a computer match up of the spelling of your name with it's existing data from the creditor.

 

Send the CRA's the medical dispute letter from my website,(linked within the HIPAA letter program)

[wayhigh]

A " not mine" dispute is, IMO, virtually useless as all the CRA does is have a computer match up of the spelling of your name with it's existing data from the creditor.

 

Send the CRA's the medical dispute letter from my website,(linked within the HIPAA letter program)

<{POST_SNAPBACK}>

 

Ya know.. when I sent them the medical dispute letter I received a letter back saying they don't provide the info on the accounts and I'll have to get that from the CA.

[cotterpin]

I think this should be pinned......

 

Thanks for the info WhyChat

[Why Chat]

Ya know.. when I sent them the medical dispute letter I received a letter back saying they don't provide the info on the accounts and I'll have to get that from the CA.

<{POST_SNAPBACK}>

( Thanks for the " pin " Cotter)

 

It doesn't matter WHAT their first automated response is, if you haven't received a COMPLETE verification OR a COMPLETE deletion within the time frame, 35 days from their receipt of your letter, 50 days if it was a free report, ( track the certified # on line and print out the delivery data for your "paper trail")then you file a complaint on line with the FTC and redispute with a copy of your filed complaint.

[LadyRelm2]

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".

[cotterpin]

( Thanks for the " pin " Cotter)

<{POST_SNAPBACK}>

 

No problemo

 

The only thing I would like to ask people is that if they have a specific question regarding the new laws and how they pertain in general then please post it here, if you have a question that is more involved and more specific to your personal situation, then I do ask you start a separate topic. This will keep the information in this thread neater and more on topic.

 

Thanks.

[starglacier]

Ok i am writing Medical Dispute letter now. Who Do I report To Ftc The Cra Or Oc. thanks in advance

[BlueGhost]

(a) IN GENERAL- Section 604(g) of the Fair Credit Reporting Act (15 U.S.C. 1681b(g)) is amended to read as follows:

`(g) PROTECTION OF MEDICAL INFORMATION-

`(1) LIMITATION ON CONSUMER REPORTING AGENCIES- A consumer reporting agency shall not furnish for employment purposes, or in

connection with a credit or insurance transaction, a consumer report that contains medical information about a consumer, unless--

`(A) if furnished in connection with an insurance transaction, the consumer affirmatively consents to the furnishing of the report;

`(i) if furnished for employment purposes or in connection with a credit transaction--

...

`(ii) the consumer provides specific written consent for the furnishing of the report that describes in clear and conspicuous language the use for which the information will be furnished; or

`� the information to be furnished pertains solely to transactions, accounts, or balances relating to debts arising from the receipt of medical services, products, or devises, where such information, other than account status or amounts, is restricted or reported using codes that do not identify, or do not provide information sufficient to infer, the specific provider or the nature of

such services, products, or devices, as provided in section 605(a)(6)

 

Could that be construed that Medical accounts can not be provided/included on a credit report that is being made/pulled for A job and/or credit decision unless it is for a Medical Credit decision or has permission signed for a job consumer report by the consumer?

 

In other words are not allowed to show up on any credit report except the Consumers Own report or one pulled in conjunction for Medical services and/or without express permission?

 

BG

[Special K]

BlueGhost has your research been able to answer this question, as I am extremly interested as well? When I come across the answer I will post it, unless WhyChat beats me to it.

 

(a) IN GENERAL- Section 604(g) of the Fair Credit Reporting Act (15 U.S.C. 1681b(g)) is amended to read as follows:

`(g) PROTECTION OF MEDICAL INFORMATION-

`(1) LIMITATION ON CONSUMER REPORTING AGENCIES- A consumer reporting agency shall not furnish for employment purposes, or in

connection with a credit or insurance transaction, a consumer report that contains medical information about a consumer, unless--

`(A) if furnished in connection with an insurance transaction, the consumer affirmatively consents to the furnishing of the report;

`(i) if furnished for employment purposes or in connection with a credit transaction--

...

`(ii) the consumer provides specific written consent for the furnishing of the report that describes in clear and conspicuous language the use for which the information will be furnished; or

`� the information to be furnished pertains solely to transactions, accounts, or balances relating to debts arising from the receipt of medical services, products, or devises, where such information, other than account status or amounts, is restricted or reported using codes that do not identify, or do not provide information sufficient to infer, the specific provider or the nature of

such services, products, or devices, as provided in section 605(a)(6)

 

Could that be construed that Medical accounts can not be provided/included on a credit report that is being made/pulled for A job and/or credit decision unless it is for a Medical Credit decision or has permission signed for a job consumer report by the consumer?

 

In other words are not allowed to show up on any credit report except the Consumers Own report or one pulled in conjunction for Medical services and/or without express permission?

 

BG

Edited February 11, 2006 by Special K

[Rebuilder2006]

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".

According to my reading, they cant even state the account as medical?

 

That seems to be the whole purpose of this, not to disclose anything medical.

[sdalcher]

For goodness sake, anyone who understands this stuff and has used it, please give us a plain english translation.

 

Thanks

Steve

[Rebuilder2006]

For goodness sake, anyone who understands this stuff and has used it, please give us a plain english translation.

 

Thanks

Steve

LOL, I know what you mean, it is rather confusing, I have just sent off the letters, not sure if I did it the right way though....

[Special K]

Did you send letters to the CRA requesting information that is in WhyChat's medical dispute letter?

 

For goodness sake, anyone who understands this stuff and has used it, please give us a plain english translation.

 

Thanks

Steve

LOL, I know what you mean, it is rather confusing, I have just sent off the letters, not sure if I did it the right way though....

 

[yorkiemom_2]

If these provider were Medicaid providers, you should not owe them anything, unless the services were non-covered by the Medicaid plan.

[Rebuilder2006]

If these provider were Medicaid providers, you should not owe them anything, unless the services were non-covered by the Medicaid plan.

Thats pretty much the idea......

[Cam552GQ1]

If these provider were Medicaid providers, you should not owe them anything, unless the services were non-covered by the Medicaid plan.

Thats pretty much the idea......

 

 

Okay I just joined the site today, but I have been reading the site for the past couple of weeks and I can tell you that my eyes are about to bleed. I will take newbie bashing if it helps me get answers. I have decent credit lets say an average of 660 or so (never a late payment, seveal mortgages, cars, cc, etc) but it is taking a huge hit from three medical bills that I have that went to collections. They were actually from my daughter, that my X toook to the emergency room gave her new home address and then proceded to throw them in the trash. I never new they existed until recently. I called the CA's and explained the situation and they told me to bad. I even offered to pay them if they would remove them but no dice. I have read a lot of Why Chats post and even visited his website and read the Hippa forms etc but I have to tell you I am completely lost. I did file online disputes for the 2nd time, still awaiting the results of the second dispute, the first yielded "we have found the items belong to you" I even called the original HC provider and they said they only show one bill that is past due and it was for $107.00 not the $172 that the CA is asking for. Also there are disputes for $37 and 60$ which I did pay and they said it was coming off my CR but that was six month ago and no dice. So now that I have filed disputes, what is next? Do I send the HIPPA letter with the amount in question to the original HC provider? Letters to the CA, the CRA? I need a little help as I am somewhat lost. Sorry about the length......Thanks

 

 

Cam

[Cam552GQ1]

If these provider were Medicaid providers, you should not owe them anything, unless the services were non-covered by the Medicaid plan.

Thats pretty much the idea......

 

 

Okay I just joined the site today, but I have been reading the site for the past couple of weeks and I can tell you that my eyes are about to bleed. I will take newbie bashing if it helps me get answers. I have decent credit lets say an average of 660 or so (never a late payment, seveal mortgages, cars, cc, etc) but it is taking a huge hit from three medical bills that I have that went to collections. They were actually from my daughter, that my X toook to the emergency room gave her new home address and then proceded to throw them in the trash. I never new they existed until recently. I called the CA's and explained the situation and they told me to bad. I even offered to pay them if they would remove them but no dice. I have read a lot of Why Chats post and even visited his website and read the Hippa forms etc but I have to tell you I am completely lost. I did file online disputes for the 2nd time, still awaiting the results of the second dispute, the first yielded "we have found the items belong to you" I even called the original HC provider and they said they only show one bill that is past due and it was for $107.00 not the $172 that the CA is asking for. Also there are disputes for $37 and 60$ which I did pay and they said it was coming off my CR but that was six month ago and no dice. So now that I have filed disputes, what is next? Do I send the HIPPA letter with the amount in question to the original HC provider? Letters to the CA, the CRA? I need a little help as I am somewhat lost. Sorry about the length......Thanks

 

 

Cam

 

 

I believe I have found a post that has answered quite a few of my questions but any help is still greatlly appreciated.

[genseeker]

Has anyone seriously read the privacy notice you get from the med provider. I sat down with a copy, and at least in my state, you have to sign a new release EVERY YEAR. That may be an additional point to push, that any release previously signed has expired. And it can't hurt to send a letter to the provider REVOKING consent for release of information. Under HIPAA, you have the right to revoke consent and then the provider can only release your info (without consent) in specific situations. You have to read your state medical privacy laws to see what those purposes consist of but they generally seem to include reporting suspected abuse, contacting an insurance provider, general statics for research purposes, etc. I'm betting most states do not all contact for payment purposes, except insurance company, without consent of the patient or parent. I sent letters CMRRR to our last providers and have paid part of our bills off. Not a one of the CAs has been notified of the payments and the accounts came off our credit reports quite easily. When I sent my parents, I did include a paragraph referencing that I had revoked consent and gave them the date they received the letter and the CMRRR #.

[angelkelly]

The wording on every form I have signed said I can write and revoke consent but they do not have to comply. What good is writing, then?

[joeblow]

Please give advice...

 

I sent a request for Validation to a local collection agency when I found their TL on my credit report.

 

Here is the response I get. Please note they leave out 5 © of the FDCPA which expressly states that if the consumer does not reply in the 30 day period, it is not an admission of liability.

 

Dear Mr. Joe Blow,

 

Validation under the Fair Debt Collection Practices Act, Section 809 (15 USC 1692g) stipulates that a consumer may request such verification if the consumer supplies a written request within the 30 (thirty) day period immediately following the initial communication. The debt collector is required to provide:

"(a) Within five days after the initial communication with a consumer in connection with the collection of any debt, a debt collector shall, unless the following information is contained in the initial communication or the consumer has paid the debt, send the consumer a written notice containing-

 

1. the amount of the debt;

2. the name of the creditor to whom the debt is owed;

3. a statement that unless the consumer, within thirty days after receipt of the notice, disputes the validity

of the debt, or any portion thereof, the debt will be assumed to be valid by the debt collector;

4. a statement that if the consumer notifies the debt collector in writing within the thirty-day period that the

debt, or any portion thereof, is disputed, the debt collector will obtain verification of the debt or a copy of a

judgment against the consumer and a copy of such verification or judgment will be mailed to the consumer by the

debt collector; and

5. a statement that, upon the consumer's written request within the thirty-day period, the debt collector will

provide the consumer with the name and address of the original creditor, if different from the current creditor.

( If the consumer notifies the debt collector in writing within the thirty-day period described in subsection

 

(a) that the debt, or any portion thereof, is disputed, or that the consumer requests the name and address of the original creditor, the debt collector shall cease collection of the debt, or any disputed portion thereof, until the debt collector obtains verification of the debt or any copy of a judgment, or the name and address of the original creditor, and a copy of such verification or judgment, or name and address of the original creditor, is mailed to the consumer by the debt collector."

 

Your request for validation exceeds the thirty-day period allotted by the FDCPA. The first written communication from our office was on 08/27/04. This account is for the anesthesiologist when you had surgery on 4/09/04. The original charge was $2170.00. Your insurance company paid $1388.80 and adjusted $434.00 leaving you responsible for the remaining balance of $347.20.

If you dispute all or a portion of this debt(s), you must provide our office with the specific reason for the dispute in order for us to begin an investigation. Otherwise, the dispute is deemed frivolous.

Please contact our office if you have any further questions.

 

Sincerely,

 

Collection Supervisor

 

I have an idea where I go here. I tell them that the letter is basically a refusal to verify, yada yada.

 

Any suggestions? I am about to start writing.

[genseeker]

The wording on every form I have signed said I can write and revoke consent but they do not have to comply. What good is writing, then?

 

 

If you have revoked consent in writing and have prrof they were notified (CMRRR) then it might give you a little more leverage if you need to file a complaint against the provider. Also, if you notice, at least in my state, it states that consent is valid for 1 yr. I know, here in VA, that my dr is REQUIRED to have us sign a new privacy statement every year. The statements expire after 1 yr and they have to have a current statement on file.

 

Depending on state law, the wording may be slightly different. On the forms I signed fo rmy previous providers, it stated we could revoke consent and said nothing about they could choose to ignore our request.

 

Also, consider it this way, the privacy notice may say they can refuse to honor your request but if you revoke consent by CMRRR, a complaint of HIPAA violation would carry more weight. It costs providers time and money to show they did not violate HIPAA, plus the number of complaints are logged. I believe most providers want to stay away fomr being accused of violating privacy and will gladly ignore the CA if you pay them directly.

[joeblow]

Anybody have advice on how I should proceed after reading their reply to my validation request?