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Pharmacist FAQs

Frequently Asked Questions for Pharmacists on HIPAA

 

Reminder regarding the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule: A Guide for Law Enforcement.

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Q: Does HIPAA have a website?

A: Yes: www.hhs.gov/ocr/privacy.

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Q: Can the police get to protected health information in my pharmacy?

A: The Board recommends the following guidelines in the event law enforcement agencies seek PHI from a pharmacy.
(1) A pharmacy may disclose PHI to any law enforcement agency at any time if the pharmacy believes in good faith that such information constitutes evidence of criminal conduct that occurred on the pharmacy’s premises. For instance, if an employee of the pharmacy was stealing drugs or if an individual presented a forged prescription, the pharmacy may disclose PHI relevant to such crime.

(2) If a law enforcement officer serves a court ordered warrant or court issued subpoena upon the pharmacy, the pharmacy may disclose the PHI sought.

(3) Other situations should be reviewed on a case-by-case basis. A pharmacy should attempt to determine whether the law enforcement agency is conducting an oversight activity before releasing PHI under the less stringent oversight requirements. In the event that a law enforcement officer seeks PHI without a court order or warrant, the pharmacy should document the following and use its best judgment in determining whether to release PHI to a law enforcement officer:

a. Identity of law enforcement agency seeking disclosure of PHI;

b. Name of Officer;

c. Description of PHI sought; and

d. Description of specific oversight activity in which the law enforcement officer is engaged. Once again, Section 164.512(d)(2) defines a health oversight activity as directly related to (1) the receipt of health care; (2) a claim for public benefits related to health; or (3) qualification for, or receipt of, public benefits or services when a patient’s health is integral to the claim for public benefits or services.

(4) It is important to note that Section 164.512(d)(2) states that “a health oversight activity does not include an investigation or other activity in which the individual is the subject of the investigation or activity.” For instance, if the SBI is investigating a nurse, the SBI agent would not be entitled to obtain a list of that nurse’s personal prescriptions that were filled by the Pharmacy.

The Board recommends the following guidelines in the event a pharmacist desires to contact law enforcement.

A pharmacist may contact law enforcement in the following circumstances:

The pharmacist has contact with the prescriber or a responsible member of the prescriber’s staff and has confirmed that the document in question has not been authorized by that practitioner.

The pharmacist has evidence (such as obvious strikeovers in relevant parts of the rx order) that are normal indicators of a fraudulent order; however, due to circumstances beyond the pharmacist’s control, the prescriber can not immediately be contacted for authentication of the order before delivery of the product to the bearer of the document.

The pharmacist has received notice from the Board, other governmental agency, prescriber, or another pharmacist that the individual is attempting to have fraudulent prescriptions filled in the area, and the prescription presented to the pharmacist meets the description included in the notice.

The pharmacist has received verifiable information from the prescriber, another pharmacist, or a second prescriber who is currently involved in providing health care for the individual presenting the questionable order, which indicates the order may be fraudulent or otherwise violates the NC Controlled Substance Act (i.e. “doctor shoppers.”)

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Q: One of the many questions that has arisen due to Health Insurance Portability Accountability Act (HIPAA) is a patient’s right to review records. Specifically does the patient have the right to review notes in the pharmacy computer?

A: After reviewing the matter with counsel it is our opinion that the patient does have the right to see that information.

 

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