Gaoi Fa'amatalaga Fa'afoma'i, Fa'amaumauga Fa'alesoifua maloloina, ma Faiga Fa'a'ole'ole¶

Mauaina o se Fa'amatalaga o Fa'amanuiaga (EOB) fa'amatalaga mo se ta'otoga e $42,000, talavai o le opioid, po'o se asiasiga i potu fa'afuase'i e te le'i mauaina lava e sili atu nai lo le tiga o le ulu tau tupe: o se fa'alavelave fa'afuase'i e lamatia ai le ola. E le pei o le taufaavalea i kata fai aitalafu, pe a na ona toe suia e le faletupe se moliaga, gaoi e iloagofie ai faafoma'i e tu'ufa'atasia ai le ituaiga o toto o se tagata pepelo, allergies i fualaau oona, su'esu'ega o le mafaufau, ma tala fa'asolopito o taotoga sa'o i lou matai ** Faamaumauga Fa'alesoifua Maloloina (Electronic Health Record).EHR)** i fefa'ataua'iga fa'amatalaga tau soifua maloloina i le atunu'u (CareEverywhere, CommonWell, Carequality, ma Surescripts). Afai ua e faanatinati atu e te le iloa i totonu o se nofoaga autu o manu'a ma o lau siata leaga o le soifua maloloina o loʻo lisiina ai le ituaiga toto sese, aveese lou faʻamaʻi faʻamaʻi o le penicillin ona o le tala a le tagata pepelo "No Known Drug Allergies"NKDA)", po'o le fu'a o oe o se tagata su'esu'e fualaau fa'asaina, e mafai e foma'i fa'afuase'i ona faia ni mea sese tau togafitiga. O le taimi lava e fa'aumatia ai e se tagata fa'afoliga lau pulou fa'amanuiaga tau inisiua fa'aletausaga po'o tu'i fa'ama'i fa'ama'i sese i totonu o le MIB Group (Medical Information Bureau) database, e mafai fo'i ona fa'afitia oe inisiua ola, fa'alavelave fa'aletonu, ma faiga fa'apitoa fa'afoma'i.

Afai o oe po'o se tasi o lou aiga o lo'o feagai ma se fa'alavelave fa'afuase'i fa'afoma'i po'o ua le maua se tausiga fa'anatinati i le falema'i ona o se siata fa'alesoifua maloloina, vala'au lau numera fa'afuase'i (911 i le Iunaite Setete ma Kanata, 112 i totonu o le Iuni a Europa, 999 i Peretania) pe faʻafesoʻotaʻi la matou lisi o faʻasalalauga faavaomalo numera fa'afuase'i vave, ma ta'u atu i le foma'i fa'ata'ita'i e lē amana'ia le siata fa'aeletonika otometi ae fa'atino se ituaiga toto fou ma se fe'ai. Mo isi mataupu uma o le gaoi fa'amatalaga fa'afoma'i, fa'amaumauga sese o le soifua maloloina, po'o le fa'aseseina o pili tau soifua maloloina, mulimuli i le fa'asologa o galuega fa'aleleia o lo'o i lalo.

Fai nei loa¶

1. ** Faʻatonu lau "Seti Faʻamaumauga Faʻatulagaina" MA le "Faʻamatalaga o Faʻamatalaga" mai falemaʻi uma, falemaʻi, ma inisiua ua afaina**: I lalo ole US Health Insurance Portability and Accountability Act (HIPAA, 45 CFR § 164.524 ma § 164.528), ua ia te oe le aiā faaletulafono e maua ai se kopi atoatoa o au faamaumauga faafomai ma pili i totonu o le 30 aso faakalena, faatasi ai ma le 6-tausaga Accounting of Disclosures e faaalia ai faalapotopotoga uma i fafo na mauaina au faamatalaga tau soifua maloloina. Aua le fa'alagolago i le va'aiga masani a tagata fa'atau i totonu o lau faitoto'a fa'ama'i i luga ole laiga (MyChart), lea e natia ai tulafono tau pili i totonu ma fa'amatalaga tau pulega.
2. Fai se lipoti aloaia a le Federal Trade Commission Identity Theft Report (IdentityTheft.gov) ma se Lipoti a Leoleo i le lotoifale: E masani ona teena e fomaʻi ma tagata inisiua soifua maloloina e tape aitalafu taufaasese pe suia siata falemaʻi i luga o le upu a le tagata maʻi. O le fa'atupuina o se FTC Fa'amatalaga Gao Lipoti ma le mauaina o se Numera o Lipoti Fa'alavelave a Leoleo e fa'aoso ai puipuiga fa'aletulafono e taofia ai aitalafu i lalo o le Fair Credit Reporting Act (FCRA § 605B, 15 U.S.C. § 1681c-2) ma fa'amaonia ai o oe ose tagata solitulafono.
3. ** Lapata'i lau foma'i tausi ma'i ma le laulau fa'ata'ita'i a le falema'i e tu'u se "Fu'a Saogalemu Fa'alema'i" i lau siata**: A'o le'i alu le 30 i le 60 aso e fa'agasolo ai pepa fa'aletulafono, fesili i lau foma'i moni ma le Falema'i Fa'amatalaga Fa'amatalaga Fa'amatalaga (HIM) matagaluega e tu'u vave se High-Visibility Clinical Alert Banner i le pito i luga o lau siata faaeletonika lapatai clinicians: *"Faamaonia le Faailoaga Faafomai Gaoi Victim. Faamaonia le Toto, Allergies, ma Lisi Vailaau tuusao ma le maʻi aʻo leʻi faʻaaogaina. Faʻamaumauga taufaasese mai [Aso] o loʻo i lalo ole HIPAA § 164.526.
4. ** Tuuina atu se tusi aloaia HIPAA § 164.526 Talosaga mo Teuteuga i le Ofisa Fa'alilolilo a le kamupani**: Aua ne'i taulimaina fa'aletonu fa'amaumauga faafoma'i i luga o le telefoni fa'atasi ma se failautusi masani. Tu'u sa'o mai le USPS Certified Mail ile falema'i HIPAA Privacy Officer ma Health Information Management (HIM) Fa'atonu e mana'omia ai fa'ailoga sese uma (ICD-10), tulafono fa'atino (CPT), fa'alilolilo allergy, ma fa'amatalaga fa'afoma'i na faia e le tagata pepelo e fa'amama tumau pe tu'u'ese'ese mai lau siata, ma fa'asa'o fa'asilasilaga e fa'asalalau atu i le Epic CareEverywhere ma Surescripts.
5. Valaau le Vaega o Suesuega Faapitoa a lau inisiua (SIU) po'o le Medicare Fraud Hotline (1-800-MEDICARE): E le mafai e sui o auaunaga masani a tagata faatau i kamupani inisiua soifua maloloina ona fa'amuta le gaoi e iloagofie ai foma'i. Fesili fa'apitoa mo le Special Investigations Unit a le fai inisiua (SIU) / Fraud Department e fa'ailo ai tagi fa'a'ole'ole, toe fa'afo'i lou olaga atoa ma le maualuga o penefiti fa'aletausaga, toe fa'atatau lau toesea, ma tu'u atu ia te oe se numera ID fou a le Sui Usufono.
6. Toso lau lipoti fa'afoma'i fa'apitoa ma talavai (MIB Group, Milliman IntelliScript, ma LexisNexis): E tusa lava pe a uma ona toe faaleleia e le falemaʻi lana faʻamaumauga i le lotoifale, o suʻesuʻega sese ma tala faʻasolopito o loʻo faʻaauau pea i totonu o faʻamaumauga faʻamaufaʻailoga a isi vaega o loʻo faʻaogaina e le soifua, manaʻoga faʻapitoa, ma tausi inisiua umi. Talosaga ma fefinauai au faila fa'apitoa i le MIB Group, Milliman IntelliScript, ma LexisNexis Risk Solutions, ma fa'aisa au faila aitalafu muamua i Equifax, Experian, ma TransUnion pe a uma la matou fa'amatalaga soli fa'amatalaga ma fa'aupuga ta'iala.

La'au fa'ai'uga: fa'asalaina fa'amaumauga a falema'i leaga vs. tau fa'ailoga tau inisiua¶

O le gaoi fa'asinomaga fa'afoma'i e pa'u'u i ni vaega ma'oti se lua e masani ona felavasa'i: Impostor Patient Gaoi (pe a siaki tino e se tagata ese e le'i inisiua pe masani i se potu fa'afuase'i po'o se fale talavai e fa'aaoga ai lou igoa gaoia, aso fanau, Numera Saogalemu, po'o le pepa inisiua) ma le **Insider / Provider Upcoding & Phantom Billing Fraudlinic (pe'o se kamupani fa'alesoifua maloloina leaga, Medicare) po'o le numera inisiua tumaoti mo su'ega fa'aletagata, puipui puipui, po'o asiasiga e le'i tupu lava). Fa'aoga le siata fa'asolo lea e fa'amavae uma ai fa'amata'u:

flowchart TD
    Start["Ua maua le Fu'a Mumu: Fa'amatalaga uigaese EOB, Asiasiga La'u Siata e le masani ai, Lapata'i Fale Talavai, po'o le Va'au Aoina."] --> Audit["1. Talosaga Fa'atonu Fa'amaumauga Atoa & 6-Tausaga HIPAA Fa'amatalaga Fa'amatalaga mai le Fa'asoa & Inisiua."]
    Audit --> Type{"2. Na Maua Fa'aletino e se Tagata Fa'afoma'i I lalo o Lou Suafa, po'o se Fa'asesega Fa'apepa?"}
    Type -->|"Ma'i Faafoliga Na Maua Tausiga Fa'aletino / Talavai"| Clinical["FA'AMATALAGA FA'AMATALAGA FA'AMATALAGA: O Tulaga Toto, Allergies & Labs o lo'o tu'ufa'atasia i lau EHR."]
    Type -->|"Na'o le Fa'atauga a le Fa'atonuga Phantom (DME, Labs, Upcoding)"| Financial["Tulaga Mata'utia Tau Tupe & Fa'atauva'a: Ua Fa'a'a'a'e Fa'apena Fa'amanuiaga & Fa'asese ICD-10 Su'esu'ega Fa'amau"]
    Clinical --> Alert["3A. Tu'u Vave le Lapataiga o le Saogalemu Falema'i ile Siata a le Falema'i Fa'aitumalo & Toe Fa'amaonia Allergies / Ituaiga Toto"]
    Alert --> Both["4. Fa'aulu Lipoti FTC Fa'amatalaga Gao (IdentityTheft.gov) + Lipoti a Leoleo Fa'apitonu'u + HHS OIG / SIU Fa'asea"]
    Financial --> Both
    Both --> HIPAA["5. Meli aloa'ia HIPAA § 164.526 Siata Teuteuga & Tu'uese'ese Mana'oga ia IA / Privacy Officer"]
    HIPAA --> HIE["6. Fa'asalaina Fa'asa'oga i le Epic CareEverywhere, CommonWell, Carequality & Surescripts"]
    HIE --> Specialty["7. Feeseesea'iga & Fa'amama le Vaega MIB, Milliman IntelliScript, LexisNexis & Credit Bureau Collection Lines"]

Le 6 fa'amaumauga natia lea e fa'aleagaina ai lou olaga e le gaoi fa'asinomaga fa'afoma'i¶

Pe a maua e le tele o tagata gasegase le gaoi e iloagofie ai le soifua maloloina, latou te vili le numera o le telefoni i luga o se pili ma manatu o le taimi lava e aveese ai e le falemai le pili, ua foia le faafitauli. I atina'e fa'alesoifua maloloina fa'aonaponei, e tasi se asiasiga fa'asese i potu fa'alavelave fa'afuase'i po'o le siakiina fa'anatinati e toe fa'afo'i i le 6 fa'alapotopotoga fa'anatura o fa'amaumauga a le atunu'u i totonu o sekone. Afai e te le fa'amamāina uma vaega e ono, o le a toe a'afia lau siata i taimi uma e te asiasi ai i se foma'i fou.

Vaega 1: Va'aia o fa'ailoga vave o le fa'ailoaina o le gaoi fa'afoma'i¶

Talu ai o falemaʻi ma fale suʻesuʻe e seasea valaʻau i se tagata maʻi aʻo leʻi tuʻuina atu se tagi faʻaeletoroni, 65 pasene o tagata gaoi e iloagofie ai fomaʻi e le o iloa o latou faʻamatalaga soifua maloloina ua faʻafefeteina seia oʻo i masina mulimuli ane. Su'e au faamaumauga pe a e matauina se tasi o nei fu'a mumu e valu:

1. ** Mea e le masani ai i luga o se Faʻamatalaga o Faʻamanuiaga (EOB) po'o le Fa'aaliga Aotelega a le Medicare (MSN)**: Aua ne'i tia'i se EOB teutusi ona o le itulau pito i luma o lo'o ta'u mai ai "E LE'O SE PILI LENEI: O MA'I AITAU LE $0.00." Fa'aleagaina mea faigaluega fa'afoma'i tumau (DME) pili ole falema'i Medicare po'o inisiua fa'apisinisi mo tui fa'amama, siaki pea o le kulukose, PCR panels, po'o su'ega fa'aletagata a'o fa'ate'aina le kopi o le ma'i ina ia aua ne'i e mauaina se pili o le tausiga. Faitau mea uma o laina i luga o mea uma EOB ma MSN e fa'amaonia na e va'ai i lena foma'i i lea aso.
2. ** Tulaga ese ile falema'i, allergies, po'o suiga maualuga/mamafa i totonu MyChart**: Fa'asolo i totonu o lau faitoto'a o gasegase i luga ole laiga (Epic MyChart, Oracle Health, Healow, Athenahealth) ma asiasia Otootoga Soifua Maloloina -> Allergies, Vailaau, Tuiina, ma Asiasiga ua mavae. Afai ua suia lou ituaiga toto, ua oso lou maualuga o loo lisiina i le 10 senitimita (4 inisi), ua aliali mai se tala faasolopito o vailaau e le masani ai, poo se asiasiga a le matagaluega o faalavelave faafuasei e le iloa, MPI (Master Patient Index) ua ave faamalosi pe tuufaatasia ("siata overlay").
3. ** Tete'e fa'afuase'i le inisiua mo se faiga fa'afoma'i talafeagai po'o se talavai**: Afai e musu lau faletalavai e fa'atumu lau talavai ona o fai mai inisiua na fa'atumu i aso ua mavae i le taulaga, pe ua te'ena e lau inisiua le fa'atagaina muamua mo se tui tuli, masini CPAP, po'o se fa'asologa o togafitiga fa'aletino ona ua uma lau penefiti fa'aletausaga, o lo'o fa'aumatia e se isi lau inisiua.
4. ** Fa'aaliga fa'afuase'i mai MyChart fa'atatau i feso'ota'iga o falema'i i fafo**: O fa'aonaponei EHR fa'aonaponei e lafo fa'ailoga fa'apitoa pe a feso'ota'i se falema'i i se isi faiga fa'alesoifua maloloina i lau fa'amaumauga pe fa'atulaga se feiloa'iga fa'alesoifua maloloina. Fai so'o se feso'ota'iga a le falema'i e le masani ai o se soliga malosi.
5. ** Valaau o le aoina o aitalafu, feau tusitusia, po o tagi mo le falema'i e le masani ai, pathology, radiology, po'o pili a le falema'i**: O asiasiga i potu fa'alavelave fa'afuase'i e maua ai pili eseese e lima (totogi o falema'i, vaega foma'i fa'afuase'i, radiologist, pathologist, ma le falema'i). O le mauaina o se fa'asilasilaga mai se foma'i e le masani ai 'aufaigaluega (Envision, TeamHealth, po'o US Acute Care Solutions) e masani lava o le fa'ailoga muamua lea na fa'aaoga ai e se tagata fa'afoliga lou igoa ma le SSN i ​​se potu fa'afuase'i i masina ua mavae.
6. Masaloaga mai foma'i e tusa ai ma fa'atonuga o vaila'au fa'atonutonu: Afai e fa'afuase'i ona fesiligia oe e se foma'i po'o se tausima'i e uiga i le fa'aogaina o le opioid, e tete'e i vaila'au masani pe a mae'a le taotoga, pe ta'ua ni asiasiga e te le'i faia lava, fai i ai e siaki lau State PDMP (Prescription Drug Monitoring Program) ma le Epic CareEverywhere mo se gaioiga faafoliga.
7. ** Mauaina se IRS Form 1095-A, 1095-B, pe 1095-C mo se inisiua tau soifua maloloina e le masani ai**: E fa'aaoga e le au fai inisiua leaga i nisi taimi Numera Saogalemu ma aso fanau ua gaoia e lesitala ai i latou ua afaina i le fesoasoani Affordable Care Act (ACA) Fuafuaga tau maketi e aunoa ma se fa'atagaga i komisi fai fa'atau tupe. A e faila lau fa'amatalaga lafoga a le feterale, e te'ena e le IRS lau fa'afo'i pe mana'omia le toe totogiina o Advance Premium Tax Credits (APTC).
8. ** Mauaina o se tusi faʻamatalaga soliga faʻamatalaga mai se falemaʻi, fale kilia (Change Healthcare), po'o le fale su'esu'e (Quest, LabCorp)**: O soliga tau soifua maloloina ua fa'aalia ai le afifi tonu e mana'omia e tagata solitulafono: Igoa Atoa, Aso Fanau, Numera Saogalemu, ID Su'e Inisiua Soifua Maloloina, ma Numera Vaega.

Vaega 2: Puipuia o lou saogalemu ile falema'i ma su'e au fa'amaumauga fa'afoma'i atoa¶

A'o le'i tau ma matagaluega o pili, o lau fa'amuamua o le fa'amautinoa e leai se foma'i, tausima'i, po'o foma'i fa'alagolago i fa'amatalaga fa'afoma'i leaga e togafitia oe i se fa'alavelave fa'afuase'i.

Laasaga 1: Tu'u loa se "Gaoi Fa'amatalaga Fa'afoma'i Fa'amatalaga Saogalemu Falema'i" i luga o au Siata Moni¶

Fa'afeso'ota'i le Fa'amatalaga Soifua Maloloina (HIM) / Matagaluega o Fa'amaumauga Fa'afoma'i i le ofisa o lau foma'i tausi muamua ma le falema'i lata ane e ave ai oe i le falema'i. - Fa'ailoa le HIM Fa'atonu o oe ose tagata ua fa'amaonia i le gaoi fa'asinomaga fa'afoma'i (po'o se "Mixed / Overlaid Medical Record" lea na tu'ufa'atasia ai le faila a le isi ma'i i lau faila). - Talosaga ina ia latou tu'u se Ta'e-le-Katioata / Va'aiga Mata'utia Fa'asinomaga Saogalemu Falemai i lau Master Patient Index (MPI) fa'amaumau ina ia va'aia e so'o se foma'i e tatalaina lau siata se lapataiga fa'afuase'i e fa'amaonia lou fa'asinomaga i se ID ata, toe fa'amaonia lou allergies i vaila'au, ma fa'agasolo se ituaiga toto fou ma le mata. - Talosaga i lau foma'i tausi muamua e lolomi se Signed, Verified Paper Clinical Summary (lisi o lou toto moni, allergies o fualaau faasaina, vailaau malosi, ma tulaga faaumiumi) ma ave se kopi i lau atotupe faatasi ma lau ID ma lau pepa inisiua.

Laasaga 2: Manaʻomia lau "Seti Faʻamaumauga Faʻatonu" ma le "Faʻamatalaga o Faʻamatalaga" I lalo ole HIPAA¶

Aua le na'o le fesili atu i se ofisa talimālō mo se kopi o au fa'amatalaga asiasi. I lalo o le tulafono feterale (45 CFR § 164.524 ma 45 CFR § 164.528 i le Iunaite Setete; UK GDPR Subject Access Request i Peretania; PIPEDA / PHIPA i Kanata; GDPR Article 15 i le isi itu o le Iuni a Europa), tuʻuina atu se talosaga tusitusia i le HIPAA Privacy Officer poʻo le Faʻasalalau o Faʻamatalaga (ROI) Matagaluega e mana'omia ni fa'amaumauga se tolu:

1. ** Le Seti Fa'amaumauga Fa'atonu Atoa (45 CFR § 164.524)**: Talosaga pepa resitala uma, kopi kopi o le laisene aveta'avale ma pepa inisiua na tu'uina atu i le resitalaina, pepa fa'ataga saini e togafitia, fa'amatalaga tau tausima'i fa'ata'ita'i, fa'amatalaga a le foma'i, su'esu'ega ma fa'ai'uga o le leitio, otootoga fa'asalalau, ma pepa tagi UB-04 / CMS-1500 ua fa'aalia uma ICD-10 fa'ailoga fa'ailoga ma CPT fa'ailoga tulafono fa'atino. I lalo ole feterale HIPAA tulafono, e tatau i le kamupani e tu'uina atu fa'amaumauga nei ona tu'uina atu i totonu o le 30 aso fa'alekalena (po'o le 15 aso i Kalefonia i lalo o le Tulafono o le Soifua Maloloina & Saogalemu. § 123110).
2. A 6-Tausaga HIPAA Tausitusi o Fa'amatalaga (45 CFR § 164.528): Mana'omia se fa'amaumauga tusitusia o so'o se fa'alapotopotoga i fafo, resitala, po'o pa'aga fa'apisinisi na maua lau Fa'amatalaga Puipuia o le Soifua Maloloina (PHI) i le ono tausaga ua tuana'i, fa'atasi ai ma se ogalaau o So'o se Fa'amatalaga Fa'amatalaga Fa'alesoifua maloloina (HIE) fesili (Epic CareEverywhere, CommonWell, Carequality) lea na tosoina ai le feiloaiga taufaavalea i totonu o faiga o falemai i fafo.
3. EHR Su'etusi Auala / Avanoa Fa'amau (45 CFR § 164.308(a)(1)(ii)(D) & 42 U.S.C. § 17935(e)): Afai e te masalomia na gaoia pe suia e se tagata mai totonu (e pei o se tagata faigaluega a le falemaʻi poʻo se failautusi pili) lau faʻamaumauga, talosaga le Electronic Health Record Audit Trail e faʻaalia ai ID tagata faʻaoga, faʻamaufaʻailoga taimi, ma nofoaga faʻagata o tagata faigaluega uma na maua lau siata i le taimi ole aso faʻasese.

Vaega 3: Faʻamalosia falemaʻi e faʻamama faʻamaumauga pepelo a falemaʻi (HIPAA § 164.526)¶

A mae'a ona e iloiloina fa'amaumauga ma fa'ailoa uma asiasiga, su'esu'ega a le fale su'esu'e, su'esu'ega, po'o talavai e le o oe, e tatau ona e fa'amalosia faaletulafono le tausi soifua maloloina e aveese pe tu'u'ese'ese fa'amaumauga leaga mai lau siata.

E faapefea le Tulafono HIPAA § 164.526 Galuega Teuteuga Fa'agasologa¶

lalo 45 CFR § 164.526 (Aiā Tatau e Teuteuina Faamatalaga Puipuia o le Soifua Maloloina): 1. Lau Teuteuga Tusia Mana'oga: Tu'u atu se tusi ua uma ona sainia i le falema'i HIPAA Privacy Officer ma le Faatonu o le Soifua Maloloina Fa'amatalaga (HIM) fa'ailoaina aso ta'itasi o auaunaga, fa'ailoga fa'ailoga (ICD-10), vaila'au, fa'ailoga allergy, ma fa'amatalaga a le falema'i e patino i se tagata gaoi e iloagofie ai po'o mea sese fa'apipi'i siata. 2. O le 60 Aso Fa'agata ole Falemai: I lalo 45 CFR § 164.526(b)(2), ole tausi soifua maloloina e tatau ona galue i lau talosaga toe teuteu i totonu ole 60 aso faakalena talu ona maua. 3. Chart Unmerging ("De-Overlay") vs. Line-Item Teuteuga: Tomai Fa'apitoa HIM tulaga faatonuina na tuuina mai e AHIMA (American Health Information Management Association) faatonu le falemai e ** aveese ma tuueseeseina le feiloaiga atoa a le tagata pepelo i se isi "John/Jane Doe Fraudulent Account" Master Patient Index (MPI) numera**, tatala le sootaga mai lou moni MPI siata ma toe fa'afo'i au fa'amaumauga fa'apitoa tau falema'i. 4. Fa'atulafonoina Fa'asilasilaga i lalo (45 CFR § 164.526(c)(3)): O le taimi lava e talia ai e le kamupani au'aunaga lau teuteuga ma fa'amavae le fa'alavelave fa'asese, e mana'omia e le tulafono feterale le 'au'aunaga e fa'asalalauina fa'amaumauga fa'asa'o/le feso'ota'i i tagata uma po'o fa'alapotopotoga e te fa'ailoaina (au foma'i moni, lau inisiua soifua maloloina, ma ofisa fa'apitoa e pei o MIB Group), ma so'o se Fa'amatalaga Fa'amatalaga Fa'alesoifua maloloina (Epic CareEverywhere, CommonWell, Carequality) ma fale talavai (Surescripts) na maua ai faʻamatalaga leaga.

Ae fa'afefea pe a Fa'afitia e se Fa'asoa HIPAA § 164.526 Talosaga Teuteuga?¶

Afai e musu le falema'i po'o le falema'i e teuteu pe tatala le feso'ota'iga o fa'amatalaga sese, tulafono feterale (45 CFR § 164.526(d)) e tu'uina atu ia te oe faiga fa'aletulafono e tolu: 1. ** Aia tatau e faila ai se "Ta'utinoga o le le maliliega" (45 CFR § 164.526(d)(2)): Tuuina atu se Faʻamatalaga o le Tetee (faʻapipiʻi lau FTC Identity Gao Lipoti ma le Lipoti a Leoleo) e faʻamatala ai poʻo fea faʻamatalaga e faʻaʻoleʻole ma pe o le a le ituaiga toto moni, allergies, ma talaʻaga faafomaʻi. 2. ** Fa'atonu Fa'apipi'i Tumau i Fa'amatalaga uma i le Lumana'i (45 CFR § 164.526(d)(4)): O le taimi lava e te faila ai se Faʻamatalaga o le le maliliega, e manaʻomia faaletulafono le falemaʻi e faʻapipiʻi tumau lau Faʻamatalaga o le le maliliega i le faʻamaumauga faafomaʻi ua finau, ma e tatau ona aofia ai lau Faʻamatalaga o le le maliliega ma faʻamatalaga uma i le lumanaʻi poʻo le faʻaeletoroni HIE faʻasalalau o lena faʻamaumauga. 3. Faasea a le Malo Fa'amalo ma HHS Office for Civil Rights (OCR): Fa'aulu se fa'aseā aloa'ia HIPAA Tulafono Fa'alilolilo ile ocrportal.hhs.gov i totonu ole 180 aso, ma kopi lau Komiti Fa'afoe Fomai a le Setete ma le Loia Sili a le Setete.

Kopi-ma-Pape Tusitusiga: Fa'aliga HIPAA § 164.526 Fa'amama Fa'amaumauga Fa'afoma'i & Mana'oga Teuteuga¶

Auina atu lenei tusi e ala i le USPS Certified Mail with Return Resit Requested i le kamupani HIPAA Privacy Officer, Health Information Management (HIM) Fa'atonu, ma le Au'aunaga Tau Tupe a Tagata ma'i/Matagaluega Fa'asese:

[Your Full Legal Name]
[Your Current Mailing Address]
[Your Date of Birth] | [Your Telephone Number]
[Date]

VIA USPS CERTIFIED MAIL: RETURN RECEIPT REQUESTED

TO: HIPAA Privacy Officer & Director of Health Information Management (HIM)
[Name of Hospital, Health System, or Medical Clinic]
[Hospital/Clinic Street Address]

RE: FORMAL DEMAND FOR MEDICAL RECORD AMENDMENT, CHART SEGREGATION, AND FCRA § 605B DEBT SUPPRESSION
Victim Name: [Your Full Legal Name] | DOB: [MM/DD/YYYY]
Affected Account / MRN Number(s): [List Numbers] | Disputed Date(s) of Service: [List Dates]
FTC Report #[Number] | Police Report #[Number]

Dear HIPAA Privacy Officer and HIM Director:

I am a confirmed victim of medical identity theft involving medical services and billing claims recorded under my identity at [Name of Facility] on [Disputed Date(s) of Service]. Enclosed are copies of my photo ID, my Federal Trade Commission (FTC) Identity Theft Report, and Police Incident Report #[Number]. I never visited [Name of Facility] on [Disputed Date(s) of Service] and never authorized anyone to use my identity or insurance. Because an impostor's clinical data has been merged into my Electronic Health Record (EHR), this corruption poses an immediate clinical safety hazard to my care. Pursuant to federal law, I make the following statutory demands:

1. DESIGNATED RECORD SET & ACCOUNTING OF DISCLOSURES (45 CFR § 164.524 & § 164.528): Within 30 calendar days, provide a complete copy of all intake forms, scanned IDs, signed consents, clinical notes, and itemized UB-04/CMS-1500 claims for the disputed encounters, plus a 6-year HIPAA Accounting of Disclosures and Health Information Exchange (HIE) transmission log (Epic CareEverywhere, CommonWell, Carequality, Surescripts).
2. CHART AMENDMENT & CLINICAL SEGREGATION (45 CFR § 164.526): Within 60 calendar days, permanently extract, unlink, and segregate all clinical notes, ICD-10 diagnosis codes, CPT codes, lab results, allergy changes, and prescriptions from [Disputed Date(s) of Service] out of my Master Patient Index (MPI) chart into a separate fraud investigation file.
3. DOWNSTREAM HIE NOTIFICATION (45 CFR § 164.526(c)(3)): Transmit an electronic Correction / Chart Unlink Notice to all Health Information Exchanges, Surescripts, my insurer ([Insurer Name, Member ID]), and every recipient on my Accounting of Disclosures.
4. BILLING SUPPRESSION (FCRA § 605B): Cancel all patient statements for Account(s) #[Numbers], withdraw claims submitted to my insurer so my benefit caps and deductibles are restored, and recall any accounts sent to collectors or credit bureaus under 15 U.S.C. § 1681c-2.

Sincerely,
[Your Signature & Printed Name]

Vaega 4: Fa'amamāina o tagi tau inisiua tau fa'asese, ofisa fa'apitoa, ma faiga fa'asese a le ACA Marketplace¶

A uma ona loka i lalo lau siata a le falemaʻi, faʻamama le faʻamaumauga tau tupe, underwriting, ma lafoga e fafaga ai tagi tau soifua maloloina.

Laasaga 1: Inisiua Soifua Maloloina SIU, Medicare (1-800-MEDICARE), ma le Pepa ID Tagata Fou¶

1. Inisiua Soifua Maloloina a Tagata Ta'ito'atasi/Tagata faigaluega: Valaau le numera o lo'o i tua o lau pepa inisiua ma fesili mo le Iunite Su'esu'ega Fa'apitoa (SIU) / Matagaluega Fa'asese. Tu'u lau numera FTC ma le Lipoti a Leoleo, ma fai i le tagata su'esu'e e fa'aleaogaina uma tagi fa'asese i lau EOB fa'amatalaga, toe fa'afo'i lau toese fa'aletausaga ma lou olaga po'o fa'amanuiaga fa'aletausaga, ma tuuina atu se pepa fa'ailoga fou a le Sui Usufono.
2. ** Original Medicare (Part A, Part B, Part D) po'o le Medicaid**: Valaau 1-800-MEDICARE (1-800-633-4227) e lipoti atu mea tau faasese i lau Fa'asilasilaga Aotelega a le Medicare (MSN), faila se lipoti i le HHS Office of Inspector General (HHS-OIG) i oig.hhs.gov/fraud/report-fraud/(1-800-447-8477), ma fa'afeso'ota'i le Senior Medicare Patrol (SMP) i smpresource.org(1-877-808-2468) ina ia maua se fa'aletonu Medicare Beneficiary Identifier (MBI) sui.

Laasaga 2: Su'etusi ma Feeseesea'i le 3 Ofisa Fa'apitoa Fa'afoma'i & Talavai¶

O lo'o fa'amauina e le au inisiua mo le soifua, mana'o le mafaufau, ma tausi taimi umi lipoti mai le tolu Fair Credit Reporting Act (FCRA) ofisa fa'apitoa e fa'ailoa lipoti. Afai o se asiasiga a se tagata pepelo ile falema'i po'o se fale talavai na fa'atumu ai se su'esu'ega sese po'o se talavai ole opioid i lalo o lau SSN, su'e su'e ma fefinaua'i mea uma e tolu:

Laasaga 3: Foia le Fa'a'ole'ole ACA Maketi Fa'ailoga (IRS Form 1095-A Fa'asese lafoga)¶

Afai na fa'aulu e se sui inisiua leaga po'o se gaoi fa'amatalaga lau Numera Saogalemu i totonu o se Affordable Care Act (ACA) HealthCare.gov / Fuafuaga a le Maketi a le Setete e aunoa ma lau fa'atagaga, o le a teena e le IRS lau toe faafoi lafoga a le feterale (Form 1040) ona ose eletise Form 1095-A na tu'uina atu i lalo o lau SSN e fa'aalia i masina ta'itasi ** Fa'aitalafu Lafoga Fa'alumaina (Advance Premium Tax Credits) (APTC). Aua ** aua le faapipiiina le taufaasese 1095-A peisea'i o lau faiga fa'avae. Mulimuli i le CMS / IRS Unauthorized Marketplace Enrollment Protocol: 1. Valaau le HealthCare.gov Marketplace Call Center (1-800-318-2596) ma taʻu mai o loʻo e lipotia se Faʻataga Maketi Faʻailoga / Agent Fraud. Talosagaina se su'esu'ega ma se ** Fa'aleaogaina / Fa'asa'o Pepa 1095-A (fa'aali le $0 i masina uma) e tu'uina atu ia te oe ma le IRS. 2. Lipoti le Suisui/Broker of Record: Fesili i le Sui Maketi mo le Igoa ma le Numera o le Fa'atosina a le Atunu'u (NPN) a le Agent/Broker i luga o le talosaga taufaasese, ma lipoti atu i lau Komesina Inisiua a le Setete ma IdentityTheft.gov. 3. Fa'auluina o Lau Fa'amatalaga Lafoga: I le IRS Instructions for Form 8962 ("Policy Obtained by Another Taxpayer"), pe a uma ona e lipoti atu le faiga faavae e le'i fa'atagaina i le Maketi ma fa'amaonia e le'i fa'aogaina e lou aiga le pepa fa'avae, mulimuli i faatonuga a le IRS mo le fa'auluina ma se fa'asoasoa fa'aletonu pe fa'apipi'i IRS Form 14039 seia oo ina faaleaogaina 1095-A taunuu.

Fesili e fai soo¶

E mafai e se falema'i po'o se ofisa e aoina le tupe ona fa'aleagaina la'u togi fa'aletupe i se pili fa'afoma'i taufaasese?¶

Leai, pe afai e te fa'aaogaina au aia tatau fa'aletulafono i lalo o le Fair Credit Reporting Act (FCRA Section 605B, 15 U.S.C. 1681c-2) ma le Fair Debt Collection Practices Act (FDCPA). I totonu o le Iunaite Setete, ua le aofia ai e le ofisa aitalafu e tolu i le atunuu atoa (Equifax, Experian, ma TransUnion) aitalafu totogi mo le aoina mai o fomai, aitalafu faafomai i lalo ole 500 tala, ma aitalafu faafomai e itiiti ifo i le tasi le tausaga mai lipoti aitalafu a tagata faatau. Mo so'o se pili fa'afoma'i tau fa'asese o so'o se aofa'i tala, o le tu'uina atu o se kopi o lau FTC Identity Theft Report ma le Lipoti a Leoleo i le ofisa fai aitalafu e fa'amalosia ai i latou e le tulafono feterale e poloka tumau le laina fefa'ataua'iga i totonu o le 4 aso pisinisi ma fa'asa ai le falema'i po'o le ao aoina mai le toe fa'atau atu pe toe lipotia le aitalafu.

Aisea e le mafai ai e le falemaʻi ona oomi le "Tape" e tape ai se asiasiga taufaasese mai laʻu faʻamaumauga faʻalesoifua maloloina faʻaeletoroni?¶

I lalo o le feterale HIPAA tulafono faatonutonu mo le saogalemu (45 CFR 164.312) ma tulafono a le setete o faamaumauga faafomaʻi, Electronic Health Record (EHR) software e pei o le Epic ma Oracle Cerner ua fausia e avea o se ogalaau suʻega e le mafai ona suia lea e le mafai ona toe faʻauluina faʻamatalaga a le falemaʻi e aunoa ma se faʻailoga. Nai lo lena, pe a e tuʻuina atu se HIPAA Vaega 164.526 Talosaga mo Teuteuga ma au Leoleo ma FTC Identity Gaoi Lipoti, o le 'au a le falemaʻi Health Information Management (HIM) e faia le "Chart Unmerging" poʻo le "De-Overlay": latou te aveese le feiloaiga atoa a le tagata pepelo mai lau Master Patient Index (MPI) numera, tuʻu i totonu o se faʻailoga tuʻufaʻatasia, tuʻu i totonu o se suʻesuʻega tuʻufaʻatasia. ma fa'amatalaga allergy, ma fa'asalalau atu se fa'aaliga fa'aeletoroni e le so'oga i luga ole Epic CareEverywhere ma isi Fetufa'aiga Fa'amatalaga Fa'alesoifua maloloina.

E fa'afefea ona ou iloa pe na fa'aaoga e se tasi lo'u fa'asinomaga e fa'atumu ai talavai ole opioid po'o vaila'au fa'atonutonu?¶

E tatau ona e su'eina ni faiga eseese e lua e siaki ai talavai. Muamua, fesili i lau foma'i muamua po'o le foma'i masani e fesiligia lau tala'aga o vaila'au fa'apisinisi e 5 tausaga e ala i le Surescripts (le feso'ota'iga e-prescribing a le atunu'u) ma talosagaina lau fa'amatalaga fa'atau fua mai Milliman IntelliScript (rxhistories.com). Lona lua, talu ai ona o talavai e pulea e le tinoitupe (Schedule II-V opioids, stimulants, ma benzodiazepines) e vaʻavaʻai eseese e malo o le setete, faʻafesoʻotaʻi lau State Board of Pharmacy poʻo le Matagaluega o le Soifua Maloloina a le Setete e talosagaina lau lava Patient Prescription Drug Monitoring Program (PDMP), ma tuʻuina atu lau Lipoti a Leoleo ma le FTC Identity Gaoi Lipoti e faʻatumu ai soʻo se mea faʻavalea.

Punavai ua siaki¶

• US Department of Health and Human Services, Office for Civil Rights (HHS OCR): Lalaula o Tulafono Fa'atonutonu a le Feterale Ulutala 45, Vaega 164, Tulafono Fa'alilolilo a le HIPAA Aia Tatau mo Avanoa (45 CFR § 164.524), Aia Tatau e Teuteuina Faamatalaga Puipuia o le Soifua Maloloina (45 CFR § 164.526), ma le aiā tatau i se fa'amatalaga o fa'amatalaga (45 CFR § 164.528).
• American Health Information Management Association (AHIMA): Fa'ata'ita'iga Pu'upu'u: Fa'aitiitia le Gaoi Fa'asinomaga Fa'afoma'i ma le Puleaina o le Fa'asinomaga Matai o Ma'i (MPI) Fa'apipi'i ma Teuteuga i Fa'amaumauga Fa'atekonolosi Soifua Maloloina.
• Federal Trade Commission (FTC, Iunaite Setete): Ta'iala mo le Toe Fa'aleleia o le Gaoi Fa'afoma'i, IdentityTheft.gov Fuafuaga Toe Fa'aleleia, ma le Tulafono o Lipoti Fa'aaitalafu Talafeagai Vaega 605B (15 U.S.C. § 1681c-2) 4-Aso Poloka Pulea.
• Centres for Medicare & Medicaid Services (CMS) & HHS Ofisa Asiasi Sili (HHS-OIG): Medicare Beneficiary Identifier (MBI) Fetuuna'i Maliega, Senior Medicare Patrol (SMP) Fa'afouga Fa'a'ole'ole, ma le Fa'aigoaina o Maketi e le'i Fa'atagaina e le HealthCare.gov (Form 1095-A) Faiga Fa'ai'uga.
• Ofisa e Puipuia Tupe Fa'atau (CFPB, Iunaite Setete): Lisi Ofisa Faapitoa Lipoti Fa'aaitalafu Tulafono Fa'apitoa mo Tagata Fa'atau (MIB Group, Milliman IntelliScript, LexisNexis, ExamOne) ma Tulafono mo le Aoina mai o aitalafu i lalo o le Tulafono Faatonutonu F (FDCPA).

Taiala fa'atatau¶

• Tali atu i le soliga o fa'amatalaga, fa'amalo upu fa'amalo, ma fa'agata aitalafu
• O le gaoi e iloagofie ai tamaiti ma faila fai aitalafu fa'akomepiuta ua malolo
• O fa'asesega fa'akomepiuta tau galuega mamao, fa'asesega o mea faigaluega, ma le gaoi fa'asinomaga I-9
• Fa'amatalaga imeli na hacked, tulafono fa'asalalau natia, ma toe fa'aleleia
• Numera o fa'alavelave fa'afuase'i ile atunu'u