Public Health Law Map - Beta 5 - Medical and Public Health Law Site

contain, the potential for harm in any subsequent nonconsensual disclosure, the
injury from disclosure to the relationship in which the record was generated, the
adequacy of safeguards to prevent unauthorized disclosure, the degree of need for
access, and whether there is an express statutory mandate, articulated public policy,
or other recognizable public interest militating toward access.” [United States v.
Westinghouse Elec. Corp., 638 F.2d 570, 578 (3d Cir. 1980).]
In most cases that involve billing fraud, the court will allow the discovery of the
Medicare/ Medicaid patients’ medical records. The Health Insurance Portability and
Accountability Act (also known as the Kassebaum-Kennedy bill) makes fraud against
private medical care insurers a federal crime. This means that in the future, medical
care practitioners can expect to see search warrants for private patient records, as
well as for Medicare/Medicaid patients. The courts do recognize that the physician
has the right to contest these orders on behalf of the patients because the patients
have no way of knowing about the order and thus cannot assert their rights. [In re
Search Warrant (Sealed), 810 F.2d 67 (3d Cir. 1987).]
4. Quality Assurance and Accreditation Review of Records
State confidentiality laws anticipate that medical information must be shared when
taking care of the patient. (Some states enacted restrictions on entering information
about AIDS/HIV into the medical chart that made it very difficult to care for these
patients.) This is assumed to include quality assurance activities and accreditation,
and the review of medical records and confidential patient information by private
accrediting associations such as the Joint Commission. Interestingly, there is no clear
legal mandate for this release of confidential medical information to a private group.
In many states it could be argued that this release comes under the exception for
quality assurance review.
This exception is not an unlimited right to use medical information for all
administrative purposes. In one case, plaintiffs sued a hospital for releasing records
to its law firm so that the attorneys could determine if any patients were eligible for
additional federal benefits. The hospital moved for summary judgment, claiming that
the general consent patients sign on admission covered this release of information.
The court disagreed, noting that the general consent mentioned only releases to
insurers. The court also rejected the defendant’s claim that this release was allowable
under their attorney–client relationship. The court held that the hospital could be
sued for releasing the records. [Biddle v. Warren Gen. Hosp., 86 Ohio St.3d 395, 715
N.E.2d 518 (Ohio 1999)]
Perhaps most interestingly, the court also found that the law firm may have
improperly induced the hospital to violate its fiduciary duty toward the patient by
releasing confidential medical information. The court applied a standard drawn from
a case involving an improper disclosure of psychiatric information to an employer,
who was alleged to have induced the psychiatrist to disclose the information: “(1)
[T]he defendant knew or reasonably should have known of the existence of the
physician–patient relationship; (2) the defendant intended to induce the physician to
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