The Office for Civil Rights (OCR) and the U.S. Department of Health and Human Services (HHS) recently completed their investigation into UnitedHealthcare Insurance Company (UHIC) for not providing health records in a timely manner. UHIC will now have to pay $80,000 and implement a corrective action plan.

This investigation is the 45th to be settled regarding HIPAA Right of Access. OCR and HHS have been focusing on Right of Access since early 2021 and do not seem to be losing any steam. Make sure your organization knows the process when patient information is requested!

Here is a reminder of what formal process documents should include when dealing with a PHI access request:

  • Any documentation that the patient needs to complete in order to request access.
    • A form that includes the following is advised:
      • Patient name and DOB
      • Contact information
      • Delivery Type (Printed or Electronic)
      • Records that are being requested
      • How the organization will notify the patient when their records are ready for pick up
      • Date and Signature of patient or their legal representative
    • A form that outlines the copying and mailing costs the patient will be responsible for.
      • See 45 CFR 164.524(c)(4) for what fees can be charged to a patient
  • Forms of identification that are acceptable to prove patient identity.
  • Personnel in which access requests should go through.
    • State a specific person, role, or department that should carry out requests and who has final approval.
  • The expected timeframe that an access request should be completed.
    • This should be determined by the organization but cannot exceed 30 calendar days from the date of the request.
      • The covered entity may extend the time, if needed, by an additional 30 days but the patient must be notified in writing within the initial 30 days of the delay. Only one extension is permitted per access request.
  • Grounds for denial
    • Any grounds for denial should be carefully researched and compared to 45 CFR 164.524(a), 45 CFR 164.524(b), 45 CFR 164.524(d) for legality.
  • It’s important to note that the handling of sensitive information, such as psychotherapy notes, substance abuse, and blood borne diseases may require a different approach.