Question
My situation, ever so briefly, is as follows: I have recently discovered that my former employer has been attempting to obtain my health care records by surreptitious means. In October, while I was still under contract, the company pre-approved a surgery--which I had in mid-November. My contract ended on November 25. The day after the surgery the company sent me an e-mail stating they had changed their minds and would not pay for the surgery. (They had a full month between pre-approval and the surgery date, yet they made their changed determination on the day after the surgery.) Now, here is what leads to the problem, they are now claiming that they will not pay for the surgery because it is for a condition that existed prior to my employment. This is a fatuous claim since I had to undergo a complete physical, including chest x-rays, as part of my employment screening. Still that is what they are claiming and in an effort to find some justification for their decision they have been sending an old health care release form signed for a specific hospital to my other doctors, and trying to represent it as a blanket health care release form signed by myself. I have discovered that one of my physicians failed to read the form and sent out my health information to the company. Another of my physicians noticed that the form provided was misrepresented and refused to comply with the company's request. They then notified me of the situation and advised me that they believed the company's action to be illegal under HIPAA.
What I am trying to discover is, do I have an legal recourse against my former company for having done this? And, do I have any legal recourse again the physician's office who sent out my health care information without a legal authorization? As near as I can discover from reading on the Internet, HIPAA seems to be a toothless tiger that provides for little in the way of enforcement through litigation. Is this true?
Answer
There are plenty of ways to enforce laws that do not involve lawsuits. HIPAA for example provides incarceration and fines for violators. Hardly toothless.
Without viewing a copy of the signed release your physician was given and knowing specifically the info that was released, it is impossible to determine if the disclosure was illegal.
[[It is not clear to me how your former employer fits into this picture. You are mentioning "company"--do you mean your former employer? And why would your employer be rejecting health insurance claims on behalf of your health insurer? You also failed to mention the state you're in.]]
Regardless, you can certainly file a complaint with the Office of Civil Rights and let them investigate. It is impossible to predict the outcome, given the limited info we have.
Answer
Was your old employer self insured?
Just because they pre-approve a procedure, you always should just check on the status a week before and make sure it is still in approved status.
They (your previous employer) could have asked for the medical notes to be sure they were paying for something medically necessary- - if they are indeed self insured.
Can you prove that whatever your surgery for was not pre-existing condition prior to your employment with the company? And how come the employment ceased just days after this big procedure? That alone sounds a little fishy.