Posted: May 13th, 2023

Law Case studies : Employee Unlawful Access to Hospital Records

Law Case studies
: Employee Unlawful Access to Hospital Records – A former UCLA Health System employee became the first person in the nation to be sentenced to federal prison for violating HIPAA. Huping Zhou, 47, of Los Angeles, was sentenced to four months in prison on April 27 after pleading guilty in January to four misdemeanor counts of accessing and reading the confidential medical records of his supervisors and high-profile celebrities, according to the US Attorney’s Office for the Central District of California. Zhou was also fined $2,000.

In 2003, Zhou, who was a licensed cardiothoracic surgeon in China before immigrating to the United States, was employed as a researcher with the UCLA School of Medicine. On October 29, 2003, Zhou received notice that UCLA intended to dismiss him for job performance reasons unrelated to the illegal access of medical records. That night, Zhou accessed and read his immediate supervisor’s medical records as well as those of other co-workers. Over the next three weeks, Zhou abused his access to the organization’s electronic health record system to view the medical records of celebrities and high-profile patients, including Drew Barrymore, Arnold Schwarzenegger, Tom Hanks, and Leonardo DiCaprio. According to court documents, Zhou accessed the UCLA record system 323 times during the three-week period. In the plea agreement, Zhou admitted he obtained and read patient health information on four specific occasions—with no legitimate reason, medical or otherwise—after he was terminated from his job. Zhou did not improperly use or attempt to sell any of the information he illegally accessed, according to the press release. In January Zhou’s attorney Edward Robinson was quoted in the UCLA student newspaper saying Zhou did not know that accessing the records was a federal crime.

As a member of the UCLA workforce, would Zhou have a legitimate right to view patient records in his normal course of employment?
In managing access and disclosure of PHI how do you think UCLA discovered Zhou’s infractions?
[3:44 AM, 4/3/2020] Roxana Law: Brodnik, M.S. (2017). Fundamentals of law for health informatics and information management (3rd ed.). Chicago, IL. American Health Information Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment Association.

Chapter 10: HIPAA Privacy Rule, Part I
Chapter 11: HIPAA Privacy Rule, Part II
Chapter 12: The HIPAA Security Rule
[3:44 AM, 4/3/2020] Roxana Law: Source: AHIMA. “Californian Sentenced to Prison for HIPAA Violation.” August 29, 2010 – Essay Writing Service: Write My Essay by Top-Notch Writer.

Case 2
[6:42 AM, 3/27/2020] Roxana Law: Instructions: Read the case study from page 470 in your text, and then answer the questions which follow. Use APA formatting.

A hospital compliance auditor noticed during a routine audit that an unusually high number of pressure ulcers submitted on claims over the last six months were coded as state 3 or 4. A deeper analysis of the medical records revealed that an upgrade in the computer-assisted coding software had resulted in a glitch whereby the system was automatically assigning the codes for either a stage 3 or 4 pressure ulcer regardless of the stage identified in the clinical documentation. While the coders were supposed to review auto-assigned codes, they had missed the errors in the pressure ulcer codes. Since a stage 3 or 4 pressure ulcer is a major complication/comorbidity in the Medicare MS-DRG system, the coding error had led to inappropriate higher-paying MS-DRGs in some cases.

What should the auditor do?
What should be the next step to confirm whether incorrect doses were submitted and resulted in overpayment?
If overpayment did occur, should the hospital just keep quiet about it and assume that other errors likely resulted in underpayments, so the overpayments and underpayments would probably balance each other out? If not, what actions should be taken?
Failure to report overpayments may result in liability under what federal statute(s) and / or law(s)?
: Brodnik, M.S. (2017). Fundamentals of law for health informatics and information management (3rd ed.). Chicago, IL. American Health Information Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment Association.

Chapter 15: Access, Use, and Disclosure and Release of Health Information
Chapter 16: Required Reporting and Mandatory Disclosure Laws
: chapter 18 :Chapter 18 Corporate Compliance
: Journal of Modern Accounting and Auditing, Eradicating Fraud in Healthcare: Possibly a Matter of Life or Death
Int. J. Sc. Res. in Network Security and Communication, An Improved Approach For Fraud Detection In Health Insurance Using Data Mining Techniques
Reference:
US Department of Health and Human Services. (n.d.). Office of Inspector General Retrieved from http://oig.hhs.gov/

[11:24 PM, 3/22/2020] Roxana Law: Case Study: The director of health information management, as the custodian of medical records, is having a great deal of difficulty responding to subpoenas for patient records. The facility is in the midst of converting from a paper-based to an electronic patient record. Some information is on paper (such as consents), some information is scanned immediately following discharge (such as nurses’ notes), some information is automatically (COLD) fed into the EHR system (such as transcription reports) and some information resides only within electronic systems (such as lab results and physician orders). The process of finding and identifying the various parts of the patient’s record from the various sources is time-consuming and there is concern about ensuring the same response (that is, that the legal health record is produced) each time a record is requested. An attorney requested a record, followed by an additional request. What he received from the organization the first time was substantially different from what he received the second time. When the attorney deposed the custodian, many questions were raised about how record requests were handled, daily operational processes including how the patient’s legal health record was compiled in response to this subpoena, and if this was the true and complete record for the patient.

1. What steps should the director take to ensure that responses to subpoenas consistently result in the true and complete health record of a patient?
Brodnik, M.S. (2017). Fundamentals of law for health informatics and information management (3rd ed.). Chicago, IL. American Health Information Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment Association.

Chapter 9: Legal Health Record

Order | Check Discount