Solo Dental Practice Hit with $70,000 Penalty for Violation of the HIPAA Right of Access Rule

You might be wondering what a dental practice has to do with podiatric medicine. Well, unfortunately, your podiatric medical practice could be just as vulnerable to a HIPAA violation as any other healthcare practice. This recent case illustrates the devastating repercussions of failing to comply with the HIPAA Right of Access Rules. Read below to find out how this happened.

Gums Dental, a solo dental practice and a “covered entity” under HIPAA, was found non-compliant with the Privacy Rule regarding a patient’s right to access medical records. In April 2019, a patient requested electronic copies of her and her children’s health records, which Gums Dental failed to provide. Following several follow-up requests and complaints to the Office for Civil Rights (OCR), Gums Dental did not produce the records, violating HIPAA’s 30-day timeline for access.

The OCR, the branch of CMS that enforces HIPAA rules, provided technical assistance and issued reminders, but Gums Dental continued to deny the requests, citing a flat fee of $25 for mailing the records and suspicions of potential insurance fraud as justification. The OCR noted that the Privacy Rule does not permit denial of access based on assumptions of intent or demand for non-applicable fees. Despite further requests and investigation reminders from the OCR, Gums Dental did not provide the records or demonstrate any mitigating factors.

The OCR determined that Gums Dental violated HIPAA by failing to provide patient access to medical records, despite lawful requests and repeated guidance from OCR. The violation, categorized as “willful neglect, uncorrected,” occurred from August 26, 2019, through March 29, 2022. The OCR considered several factors when determining the Civil Monetary Penalty (CMP) for Gums Dental's HIPAA violation, including:

1. Nature and Extent of Harm: The Complainant’s family was denied dental services by Gums Dental, reportedly as retaliation for the complaint filed with OCR, and could not access insurance reimbursement due to lack of records.
2. Nature and Extent of Violation: Gums Dental ignored repeated requests to provide the Complainant’s records and failed to act on OCR’s technical assistance and data requests, resulting in an ongoing two-year-plus violation.
3. Compliance History: Gums Dental previously disregarded OCR’s guidance and data requests but has no other recorded compliance issues.
4. Financial Condition: OCR acknowledged Gums Dental’s status as a solo provider, though it lacked detailed financial information due to Gums Dental’s noncooperation.

Given the ongoing nature of the violation and the impact on the Complainant’s access to care, OCR assessed a daily penalty of $63,973 for willful neglect. However, considering the financial implications on Gums Dental as a solo practice, OCR exercised discretion to reduce the penalty to $70,000, factoring in potential challenges from the COVID-19 pandemic.

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Article provided by: TLD Systems 

Source: Gums Dental Care, LLC Notice of Proposed Determination | HHS.gov

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