Work comp hipaa

nurse2033, MSN, RN · Jan 5, 2017

Wow, it's definitely a violation of your privacy. The facts are thin here though. Why was she following you? Did she feel that your case was fraudulent? If she was not on the clock while following you, then it was not part of her job. My advice is to get a lawyer. If you don't want to do that, call her employer and file a complaint. If you don't get any traction there, report her to the board of nursing. Maybe you are upset, or I'm just old, but your grammar and syntax are really hard to follow. You look better in all respects when you write in whole, complete words, that are wrapped up in complete sentences. :)

Medic22 · Jan 5, 2017

I just like to sum things up. Get to the point. She was off the clock. Did it on her own. She thought I was not following Dr's orders. So that's why she stalked me. My lawyer told me to file for violation of HIPAA. I did that. Here it is over a year later and their just getting back to me. The person who had my case retired and now someone else is taking it over. This case worker for the health department is confused bc she doesn't know if it's a violation bc it's a work comp case. This Dr sees work comp pts along with non work comp pts. So she didn't know I was work comp till she went through my file. She was not the nurse providing care for me. She was just a nurse working there. So all in all. I feel like my rights are violated.

crazin01 · Jan 5, 2017

I don't know if this would indeed be a HIPPA violation, but it sure sounds like it should be.

By sheer coincidence, sees you at doctor's office and then decides to follow you/stalk? I don't see how the workers comp company would employ a nurse who happens to work at this doctors' office. That just seems way too coincidental. Does this office have somebody assigned to comp claims, that she was in your file for a legitimate work reason? (monthly audits etc) I have a hard time believing she works for that company as well. Especially since you stated she was off the clock.

IMO, she went through your file (for whatever reason) but was not even assigned to you as a patient. So, other than being nosey, she had no valid reason to open your personal file. I'm pretty sure that's HIPPA. And she then drove by your home and made a record of your time and activities at the gym. And then she calls the WC lawyer to report you for disobeying doctors' orders and in court admitted she saw your info, despite having no business in your chart.

Workers' comp is different than other illness/disease, for insurance purposes. But again, she isn't employed by WC insurance company. She did all this for what reason? If you did not mention a WC claim when saying hello, how did she find out that's what you were there for? If she happened to be off that day, or didn't see you in the office, would she have known you were there/ had a WC claim and that's what you were there for? If this were the case (she didn't know you were there) would any of her allegations have occurred?

So sorry she put you through all this & I hope you & your attorney are able to enjoy a favorable outcome.

Please keep us informed, if anything changes (after the court stuff is complete and all that jazz)

Best wishes...

ETA: your WC case manager retired, but shouldn't his/her notes & records be thorough enough, that your new case manager can easily review? If you would have a hearing, regarding her being charged with HIPPA, could the previous case manager be subpoenaed to appear? Likewise the transcript from your hearing could be used for reference: she testified she went through your chart and is the one who started this whole ball rolling)

Medic22 · Jan 5, 2017

My WC case is settled. They forced a settlement bc another company bought the hospital and offered more than I would of received for my injuries. The person who retired was the health department of human rights who does the HIPAA cases. I filed the day she testified in court in November of 2014...March of 2015 they contacted me about the Hipaa case. So bt March 2015 and now the Hipaa case worker retired. So a lady from the Dallas headquarters told me she saw my case was still open bc the Dr is refusing to respond to them and the nurse won't respond to them and my case worker retired and their just now discovering my case is still open. This new case worker said if this Dr was only a work comp Dr then hipaa privacy doesn't apply. If he does WC and general or whatever then it does apply. He does both. He does a little bit of everything. Yes. I think this nurse was expecting a pay out for reporting a fraudulent case. Which turned on her bc I was with in my restrictions limit while at the gym. Yes. She openly admitted to going through my file only bc I looked familiar to her. Bc of her it did hinder my case bc the opposing lawyer was trying to prove I'm ok since I worked out. But we came back with I was supposed to be with certain restrictions that of which I followed. When I researched the hipaa violation the one she committed was intentionally getting my information for personal gain and causing harm to me on purpose. Which is one of the highest violations you can commit on hipaa. I'm just really irritated I've waited this long to only be told they don't know what to do bc the Dr or the nurse won't respond and it was a WC case. Their just getting to it bc my old case worker retired and no one knew till now about my case! I just need to go to OBN and ask them. Find another lawyer that deals with this. Get the court records of her admitting going through my file only bc I liked familiar and admitted to stalking me in court. It's so crazy. The things that should help and protect us are not even there doing their job.

morte, LPN, LVN · Jan 5, 2017

i would also report her to the board. And what the h..... difference does it make if it was WC, or not? you info is private either way. a paid investigator would be different.

crazin01 · Jan 6, 2017

The more details you give, the more it appears to be a definite violation.

Why won't your doctor (or this nurse) contact the WC company? Is the health department requesting your records for the violation and they just don't want to be bothered? Are they worried because they both know she did something she should not have done and are thinking/hoping time passes & your case slips through the cracks? Especially since it's been quite a long time without the health department contacting them.

Sounds like you have a good lawyer, but maybe he/she could send them a polite letter the reiterated they need to respond, as it's a legal matter and it needs to be dealt with.

It's sort of ridiculous that the gov't agency/ person that deals with HIPAA is not sure if it is really a violation. Sounds like maybe somebody is not doing their job, needs re-educated or something. I'm just baffled they choose to ignore communications from the health department.

I'm in a relatively rural area, not quite the 'everybody knows everybodies' business' but primarily farms & country in the county. If I ran into an acquaintance somewhere I receive healthcare and they pulled this BS, I would be pretty mad.

(Sorry I made a typo earlier, with HIPPA rather than HIPAA.) :facepalm:

Medic22 · Jan 6, 2017

Today I contacted my lawyer for the transcripts of the day she appeared in court where she openly admitted to going through my file. Then my lawyer is writing a letter where it had a impact on my case. I'm just in shock by her. I'm from a small town. So I'm wondering if it's something personal my family did? I'm a medic and working on my nursing degree. So I'm wondering if I ran a call on her family member that may of passed we couldn't save? Idk what would cause someone to become so obsessed with someone that looked familiar to them. It is just really weird her actions and dedication to stalking me on her own time. Here's the thing if she was hired by the WC company to follow me. They have to let me know someone is following me. Never once did I get a letter about that. Nor my lawyer. So this nurse is legit crazy...

bsyrn, ASN, RN · Jan 6, 2017

Wow, sounds like a pretty clear HIPAA violation to me. I am sorry this happened to you!

12reasons2run · Jan 10, 2017

If you really want her to be punished. Report her to the board of nursing. Send them the transcripts of the trial where she admitted going through your chart and following you. There is no way this doesn't violate the nursing code of ethics and the state board's standards of conduct. I can almost guarantee the board of nursing will do something about it especially since she already admitted it under oath in court. However, she will probably know its you unless she's done the same thing to other people.

The reason they're probably not sure about HIPAA is because it requires insurance payment for services. HIPAA requirements do not apply to private offices who don't take insurance. In court an office would likely be held responsible for patient privacy due to standards of care, but they could not be fined via HIPAA.

Medic22 · Jan 10, 2017

Well I guess obn will be getting a phone call. Waiting on transcripts requested then last week.

AliNajaCat · Jan 20, 2017

There is always confusion about how/whether HIPAA "applies" in work comp cases. The answer is that yes, HIPAA confidentiality rules apply in exactly the same way that they do with any other health insurance (you do know that wc is health insurance, right?). If you go to the OCR (Office of civil rights) website you will find their FAQs about this (OCR administers HIPAA).

When you are injured at work, you sign the same form in the ER or at the MD office or therapist's that says you give permission for your medical records to be sent to the insurance company; in this case, it's the comp carrier.

What they CAN'T do is disclose anything to the comp carrier that is not related to the work injury. For example, if you got a broken leg at work, the paperwork they send in cannot mention anything about your reproductive or mental health history (including meds).

As to the OP, this is probably where some confusion comes in; the office might think that "It's a work injury so HIPAA doesn't apply," but that's because they don't understand that comp is health insurance, and they're wrong.

The behavior of the nurse OP describes is wildly out of control and is a very clear HIPAA violation.

One, she had no business getting into your chart if she wasn't involved in your care.

Two, she had no business using information in your chart (address of your gym, information on your physician and adjuster) for any purpose, much less stalking you with it.

Three, HIPAA violations are called against the employer not the nurse employee, because the employer is supposed to be sure their employees know the law and understand their responsibilities under it; the employer will get fined by OCR because of her actions (and they might just fire her because of them).

Finally, though, regardless of what happens between OCR and the employer, that nurse is gonna be in a world of hurt from the BoN, because she violated professional ethics, and they will definitely sanction her, if not suspend or revoke her license (depends on how they feel that day, sometimes). By all means send them the transcript of her trial testimony or deposition or both with an affadavit (sworn signed statement-- your atty can help you with that) of what you observed.

DO let us know what happens!