Maybe you’ve been planning for retirement for some time or perhaps you’ve had a bad month and have decided that you’re better suited for life on the lake. In either circumstance, when you get ready to leave your practice and wind down your affairs, don’t forget that you still have responsibilities pursuant to state and federal laws and regulations and those obligations don’t cease just because you won’t be returning to the office.
The Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH) require providers ensure the confidentiality, integrity and availability of their patient’s protected health information (PHI). Thus, providers are tasked with preventing unauthorized access to PHI, ensuring that their records are not inappropriately altered or destroyed, and assuring that the records are available to the patient or other authorized individuals or entities.
Pursuant to Alabama law, “When a physician retires, terminates employment or otherwise leaves a medical practice, he or she is responsible for ensuring that active patients receive reasonable notification and are given the opportunity to arrange for the transfer of their medical records.” The law does not specifically define how much time is considered “reasonable,” thus; the type of practice or scope of services provided should be considered in determining reasonable notice. In all instances, notification should be provided in a manner that allows the patient adequate time to act upon the notification and either obtain a copy of their records or find a new physician.
Patient notification should be provided via U.S. mail and should include the following:
- The date that the practice intends to close;
- How the individual may obtain a copy of their medical record or have their records transferred to another physician; and
- Contact information for the new physician if the patient records are being transferred to another physician without the patient’s consent. (Note: The retiring physician should enter into a Business Associate Agreement (BAA) with the purchasing physician to permit the purchasing physician to obtain and maintain the aforementioned patient records. By virtue of that agreement, the purchasing physician is acting as a custodian of records and is required to ensure the confidentiality, integrity and availability of those patient records regardless of whether the patient decides to utilize the purchasing physician for their treatment services. Pursuant to HIPAA, the purchasing physician cannot utilize those patient records unless and until the patient consents.) Alternatively, if the records are not being transferred to another physician, the notice should inform the patient of where the records will be located after closure, how long they will be retained, and contact information to make record requests.
Tip #1: While not required, it is suggested that patient notification be sent via certified mail, return receipt requested to the patient’s last known address. This allows the retiring physician to place those receipts in the patient files to demonstrate the attempt to notify the patient of the retirement or closure.
Tip #2: Don’t forget about the patient’s right to confidential or alternative communications when performing the mail-out. If your practice has agreed to a reasonable request of a patient to receive communications by alternative means, you must ensure that you have considered that request. For example, if they have requested that you use a particular P.O. box, instead of their home address.
Malpractice Carrier Notification
At the top of your list for entities to notify should include your medical malpractice carrier. Your medical malpractice carrier can give you a tremendous amount of guidance and many offer a checklist that you can use to ensure that you are covering all of the steps that will keep you eligible for coverage at the time of closure and beyond. Be sure to ask them about any extended malpractice coverage that can be considered for any allegations of medical malpractice that may arise after closure.
Sell v. Closure
When a practice is sold to another physician, the aforementioned BAA between the retiring physician and the purchasing physician may be utilized for the appropriate maintenance and availability of records. But when a practice closes, it is often necessary for the retiring physician to contract with an outside entity to maintain the records and ensure their future availability in accordance with HIPAA and state laws. Finding the right record management company is essential in this circumstance, in addition to entering into the required BAA.
Whether you enter into a BAA with a purchasing physician or record management company, ensure that the agreement includes provisions relating to record retention and disposal applicable to the types of records your practice utilizes. For example, there are special rules for mental health, substance abuse, and notifiable disease records. As the BAA is being drafted, attorneys and compliance experts should be consulted to ensure that appropriate provisions are included.
Closing Won’t Allow You to Escape HIPAA Fines
On Feb. 13, 2018, the Department of Health and Human Services announced a settlement with Filefax, Inc. for $100,000. It was determined that Filefax was a medical record storage company which inappropriately handled the medical records of approximately 2,150 patients by not ensuring that the records were secure. “The careless handling of PHI is never acceptable,” said OCR Director Roger Severino. “Covered entities and business associates need to be aware that OCR is committed to enforcing HIPAA regardless of whether a covered entity is opening its doors or closing them. HIPAA still applies.” Though Filefax closed its business, HHS was able to secure settlement proceeds via an appointed receiver which “liquidated its assets for distribution to creditors and others.”
Whether you are currently facing the prospect of retirement or whether it is still on the horizon, it’s never too early to speak with a health care compliance professional about the appropriate steps to take to ensure compliance with state and federal laws.
 Alabama Board of Medical Examiners Rule 540-X-9-.10(3)
Article contributed by Samarria Dunson, J.D., CHC, CHPC, attorney/principal of Dunson Group, LLC, a health care compliance consulting and law firm in Montgomery, Alabama. Find more of Ms. Dunson’s contributions on her partnership page.