Class Actions On HITECH Violations? Sounds Good To Me

     From a blog post on JD Supra:

In the wake of the 2019 United States Department of Health and Human Services, Office of Civil Rights (“OCR”) enforcement actions against Bayfront Health St. Petersburg (“Bayfront”) and Korunda Medical, LLC (“Korunda”) pursuant the HIPAA and HITECH Right of Access Initiative—for violations of the rights of patients to obtain access to their medical records promptly, without being overcharged, and in the readily producible format of their choice—private lawsuits have been on the rise to enforce patients’ right to access.

Of most recent note, the matter Russell v. Healthalliance Hospital Broadway Campus, and Ciox Health, LLC, 1:20-cv-01204 (USDC No. Dist. of NY), seeks not only monetary damages for failing to grant access to the medical records of the deceased husband of the Plaintiff, but also certification of a class action on behalf of those similarly situated. ...

Given the fact that 42 U.S.C. § 1320d-5 provides for penalties of $50,000 per violation and up to $1,500,000 in fines per calendar year, the prospect of class actions under this law are to be taken very seriously. ...

     If you work at Social Security, you may wonder why I post this. If you represent claimants, you know all too well. Almost all larger medical providers and some who aren't all so large have entered into contracts with outside companies, such as Ciox, to handle medical records requests for them. It's obvious that these companies, if not the medical providers, regard responding to medical records requests as an opportunity to gouge the requesters. It's a monopoly situation. If my client was treated at a particular hospital or medical practice, there's only one place I can go to get those medical records. There are supposed to be limits on this, provided by HITECH and state laws but these companies try to evade the limits with ever more inventive explanations for why they're allowed to charge more than the law allows. They know in the end we need the records now and we'll have to pay up. We file complaints with the OCR but those take time and the medical records companies involved are almost never punished for their outrageous behavior. The situation has devolved into almost hand to hand combat. Class actions sound like a good idea to me.

Ever Heard Of HITECH?

     If you work at a hearing office, you probably already know that Social Security disability claim files have been getting longer over the last few years. Let me explain why this is happening and why it is going to get worse over the next year or two. Also, I'll explain why this has major implications for the Social Security Administration.

     The most important reason files have been getting longer is electronic medical records. It has become easier for medical providers to create and store medical records. When they were storing medical records in physical files, medical providers had incentive to keep the records concise. How do you store a 2,000 page physical file? How does a physician make use of such a huge physical file? Once things went electronic, medical files started ballooning. Medical records systems used in many physician offices and at some large providers, including the VA, regurgitate almost the entire medical history as a new medical record every time a patient sees a physician. With VA records in particular, the new material gets lost in a mass of repetition.

     Because of electronic medical records, Social Security hearing files are exploding. Files of 1,000 pages or more used to be rare. Now, they're common. Files of 2,000 pages or more were almost never seen in years past. Now, I see them on a regular basis.

     This is going to get a lot worse because of a statute that I'll bet that almost no one at Social Security has heard of -- the HITECH Act. HITECH stands for Health Information Technology for Economic and Clinical Health Act. The Act was designed to encourage physicians to convert to electronic medical records. HITECH happens to address, in passing, a couple of problems that attorneys representing Social Security claimants have had -- slow processing of requests for medical records and excessive charges for providing those records. HITECH puts a time limit on responding to requests for medical records and prohibits providers from charging more than what it actually costs them to provide medical records as long as the records are provided in an electronic format. Attorneys are rapidly switching over to making their requests for medical records under the HITECH Act. It's cutting our costs significantly and making the turnaround time on medical records requests shorter.

     Before HITECH, attorneys were careful to specify exactly what they wanted because they would be paying for each page of medical records. Now, that's no longer important. One thousand pages of medical records are no more expensive to obtain than ten. Even when an attorney makes a narrow request for medical records, providers often send far more than was requested. If you don't have to print out the records and you're not able to charge for each page, why bother sorting out exactly what the attorney requested? Just send the whole thing. And once an attorney receives medical records, even if they are records the attorney didn't ask for he or she has no alternative but to send everything to Social Security. EVERYTHING. That's what agency regulations demands. If you don't do that, you get in trouble. I recently submitted more than 850 pages of medical records recently covering about ten months of outpatient treatment for one of my clients and the medical care she was receiving wasn't all that intensive.

     So why is this important for the agency? It takes a lot longer to review a 2,000 page file than a 300 page file even if most of the 2,000 page file is of zero consequence for the disability claim. Administrative Law Judges cannot be expected to hear 40-50 cases a month and know what they're doing if they have to deal with such huge files. There's no technical fix for this. Exhorting employees to work harder isn't going to help. Social Security is running headlong into a brick wall on this one. And those foolish regulations demanding that attorneys submit EVERYTHING are just making things worse. I told you that you were trying to go after a fly with a sledgehammer but you wouldn't listen.