What to do if Your Healthcare Provider Won’t Give You Your Medical Records

What to do if Your Healthcare Provider Won’t Give You Your Medical Records

Susan R.  Miller
 | 
There are many reasons you may want to get your hands on your medical records. It could be that you want to share it with another healthcare provider, or perhaps you want to check to make sure you are being billed properly.
 
What happens then if your doctor’s office ignores your requests, or tries to charge you a ridiculous amount of money to obtain them? He or she could be in violation of The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule.
 
That rule generally gives you the right to inspect, review, and receive a copy of your medical and billing records that are held by health plans and healthcare providers covered by the Privacy Rule (i.e. covered entities). A covered entity is anyone who provides treatment, payment and operations in healthcare.
 
By law, a covered entity must:
  • Act on a request for access to medical records no later than 30 days after receipt of the request.
  • If the covered entity cannot respond to the request within 30 days, the covered entity may extend the response time for an additional 30 days, provided that: the covered entity provides the individual with a written statement of the reasons for the delay and the date by which the covered entity will complete its action on the request, and the covered entity may only have one 30-day extension to act on the request.
  • The covered entity cannot charge more than a reasonable, cost-based fee for the copies of the individual’s medical records. A full explanation of those fees can be found here.
  • The right to access records extends to parents who seek medical information about their minor children, including unborn children.
 
There is an exception to the HIPAA rule when it comes to providing records to a third party, such as insurers or law firms which grew out of a July 2020 Federal District Court decision out of the District of Columbia (Ciox v. Azar). In short, that ruling found that law firms are not entitled to the patient fee rate.
 
Enforcement Crackdown
Recently, the U.S. Department of Health and Human Services Office for Civil Rights (OCR), which is charged with HIPAA enforcement, has cracked down on healthcare providers who are in violation of the rule.
 
As of March 2021, OCR had announced eighteen settlements of enforcement actions in its HIPAA Right of Access Initiative, which it launched in late 2019. At that time, the agency promised that it would vigorously enforce the rights of patients to receive copies of their medical records without facing overcharges.
 
Providers generally are provided with a warning by OCR to comply with the record request. It’s when they fail to do so that they face fines and sanctions. Fines thus far have ranged from several thousand dollars to as much as $200,000.
 
OCR says it considers a variety of factors in determining the amount of a settlement including “the nature and extent of the potential HIPAA violation; the nature and extent of the harm resulting from the potential HIPAA violation; the entity's history with respect to compliance with the HIPAA Rules; the financial condition of the entity, including its size and the impact of the COVID-19 public health emergency; and other matters as justice may require.”
 
In addition to fines, the offending entity will be ordered to create a corrective action plan and be monitored for a period of time.
 
If you believe that your healthcare provider has violated your health information privacy rights by failing to give you access to your medical record, you can file a HIPAA Privacy Rule Complaint with the U.S. Department of Health and Human Services (HHS) Office for Civil Rights. The easiest way to file a complaint is to go through the HHS Office for Civil Rights.  

 
This article is intended to convey generally useful information only and does not constitute legal advice. Any opinions expressed are solely those of the author, not LawChamps.
 
 
 
Susan R.  Miller

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