Short Hills Clinical Psychology Practice Violates Patients' Privacy -- New York Times

Was this discussed already? I just read it. This story is locally and nationally relevant. Unacceptable.

http://www.nytimes.com/2015/12/24/nyregion/a-patient-is-sued-and-his-mental-health-diagnosis-becomes-public.html?_r=0

"Short Hills Associates in Clinical Psychology, the group based in New Jersey that treated Philip, has filed dozens of collections lawsuits against patients and included in them their names, diagnoses and listings of their treatments.

In cases in which the patients were minors, the practice sued their parents and included the children’s names and diagnoses."

This is horrible. Any law firm that files a suit for collection in a medical case ought to know enough to redact the codes for diagnosis, which have no relevance in a billing dispute. As for the idea that Hipaa only applies in a matter where the filing was done electronically... Holy shyte. Such absurdity. 

PeggyC said:

As for the idea that Hipaa only applies in a matter where the filing was done electronically... Holy shyte. Such absurdity. 

Yes, this is true because the privacy provision of Hipaa is only one small piece of it. People think Hipaa is JUST a privacy law. It is actually a law about electronic medical records.

It is true about HIPAA ....however, I think professionally the choice to defend leaving the diagnoses in the suits is despicable. No matter how those psychologists rationalize this, it is unconscionable. I have had my own experience with that group that I thought was less than professional. 

Yup. Despicable is right. 

I believe star ledger had an article a couple weeks ago.

There were confidentiality laws before HIPAA...something must apply to this situation.

To make matters worse, it is likely the diagnoses are wrong.  I know someone that has been in 4 hospitals, 3 day programs, and with various outpatient providers.  Everyone comes up with a different diagnosis.  In one case a person who was a victim of abuse was told she was lying...it never happened and she had schiozophrenia and bipolar.  In a case in NY a young woman was labeled crazy and given anti psychotics because she had the flu and barely slept in days....

oh, I didn't mean to say I didn't believe that about the HIPAA loophole... I meant to say it's insane that the loophole exists. I didn't know that HIPAA was all about electronic records, though. There ought to be legislation that provides better privacy protections for all manner of medical issues and records of all kinds. Defending the revelation of diagnoses really is despicable. 

At some point the information became electronic, as it became electronically searchable.

I'm horrified by this.  I've recommended this practice several times.

I can understand that perhaps an administrator may have made a mistake and did not redact the diagnoses, but they should own up to this being an error.

Diagnoses are not factual. Like if I break a bone, we can see the break in an xray. But psychological diagnoses are subjective. They hoped in the development of the DSM (which is no longer accepted by insurance) that they could make the symptoms concise/precise enough to make diagnosis more accurate. But it is still subjective. Any professional knows this to be true. 

gerryl said:

I can understand that perhaps an administrator may have made a mistake and did not redact the diagnoses, but they should own up to this being an error.

It was no mistake. It was intentional. Here's a quote from the article:

"Philip asserted in legal documents that he confronted Dr. Helfmann in a phone call the following month and that the psychologist told him it was his fault his information was disclosed because he had not paid his bill."

In addition to HIPAA and other privacy issues, doctors (or usually insurance) report diagnoses to the Medical Information Bureau, which could get people denied things like life insurance, although it shouldn't affect health insurance anymore...and many of those diagnoses are wrong...I know I have had wrong diagnoses of simple things like osteoarthritis which should be easy to diagnose, and I also have things that were never medically diagnosed due to malpractice (post concussive syndrome) and there fore not listed...people could be listed as being schizophrenic or bipolar in the official record, when they are not....a study showed that 50% of people diagnosed with bipolar did not have it and 69% of people medicated for depression did not have it...yet they can be trapped by their false medical records.

doctors play god with our overall welfare..and not just physical, but also financial....and cause emotional harm with the stress of their attitudes

shoshannah said:

gerryl said:

I can understand that perhaps an administrator may have made a mistake and did not redact the diagnoses, but they should own up to this being an error.

It was no mistake. It was intentional. Here's a quote from the article:

"Philip asserted in legal documents that he confronted Dr. Helfmann in a phone call the following month and that the psychologist told him it was his fault his information was disclosed because he had not paid his bill."

This is according to Phillip so, as far as this particular question (was it intentional or not) we only have one side but don't get me wrong, the whole situation is pretty appalling.

How about just paying your bill?  Then none of this would have happened.  There were many steos between the services rendered and the filing with the diagnosis code. 

zoinks, have you ever had a medical billing problem?  Where you're trying to get the insurance company to meet its obligations, and trying to get the medical provider to cough up records for the insurance company, and going back and forth way more than once on this?  It can easily take months and months.  Meanwhile, the medical office manager is going into tizzy because the bill's not paid, and sending it to collections after 3 or 4 months.  It's nuts.  And that's not even starting on errors in the claims submitted by the doctor's office.

And yes, maybe the patient could pay and then wait to recover from the insurance company, but then again maybe that's not possible.  And what motivation would that dr's office have to assist in the insurance claim once they've been paid?

Stinks all around, not always subject to the one-sentence fix.

(end rant)

Single payer, please!

bramzzoinks said:

How about just paying your bill?  Then none of this would have happened.  There were many steos between the services rendered and the filing with the diagnosis code. 

I have a doctor's bill that I refuse to pay because the in-network doctor's staff billed incorrectly and the insurance company denied payment, not my fault and I shouldn't be on the hook for the $250 because of their mistake.  The point is, there may be many reasons why a bill isn't paid, whether it be a billing dispute or if a patient fell on hard times and is unable to come up with the money.  Either way, releasing confidential medical information in retaliation to an unpaid bill is not cool.

Short Hills Associates does not take any insurance.  It is stated up front it is all self pay. With payment due at time of service. 

And a court filing is a stap beyond a collection agency.  So a lot of time passes. 

So while it would be best not to include the diagnosis code in the filing the client id primarily responsible for what has happened. 

Again, if a patient's financial situation suddenly changed and they fell behind on payments that still would not justify releasing confidential information.  Sue them, sure.  But releasing this information is wrong.

There is a sign in the lobby that payment is due at time of service.  So clint would have had to have had a very quuck change of financial condition or have gone in planning not to pay according to policy. 

He owed $4,000+ for services between 2012 and February 2014, so evidently the practice kept seeing him anyway. Regardless, it's inexcusable that they released this information. 

I agree that the patient should have paid the bill. And, I have no problem with them using a collection agency to get their fees. The number of people who try to walk away from their bills is also abhorrent. However, I do feel it speaks to the moral integrity of the professional to leave the diagnosis on. As a therapist myself, I would not be able to justify that breach of privacy. Even though I understand that it sucks not to get paid. It is human to want to seek retribution, but having the desire, is different from acting on it. This is what we try to teach our clients.

if payment is due at the time the service is provided, why on earth did the practice keep seeing hi if he was racking up that kind of debt? They were breaking their own policy willingly, it seems to me. So it is a little strange to then turn around and go vindictive to the point of revealing the diagnosis. 

bramzzoinks said:

There is a sign in the lobby that payment is due at time of service.  So clint would have had to have had a very quuck change of financial condition or have gone in planning not to pay according to policy. 

Oh, please. Get off your high horse. Or maybe it's not that; maybe you are just a black-and-white thinker. 

Regardless of what the patient did or did not do, there is NO justification for releasing his diagnosis in the court filing. The punishment for failure to pay a bill is not public humiliation. 

Maybe they were trying to be nice and finally got fed up. Once thing gets to court it is a different game.  There is no playing nice.  

They used to throw debtors in prison.  

.just pay your bills. 

I am in a billing dispute now....the provider billed for services not rendered..I have medicare.  I gave them a chance to correct it, when they didn't,  paid the copay on the legitimate amount and reported the provider for fraud.  It is highly likely, the doctor will send it to collections..so my choice is to pay or risk having my private info (which likely includes a wrong diagnosis since the doc didn't pay attention --even when I wrote out notes for them) made public...

so yes, sometimes there are billing issues that cause this....there have been times people have honestly thought something was covered, only to get a bill many months later.
i had a doc that would send bills to collections if they did not have payment within a week of them mailing the bill...so figure a couple days for the bill to reach me and a couple for the check to get back to the doc (they didn't have electronic payment)...add in Sunday..if you didn't mail the check within 2 days of getting the bill..it went to collections...

even if its cash pay..things happen, maybe a person forget to mail a check..they went to the mailbox with a pile and didn't realize 1 item dropped...and slid behind a seat..maybe the check bounced and the person didn't realize it..when you have mental health issues, it can be very hard to think clearly and manage your affairs...i have a friend going through this now..she can't make decisions for herself, mail sits unopened for weeks..even months.....and there is no in home help...the quality of the available programs is deplorable...those workers can't manage their own lives..forget about helping someone else manage theirs..I tried talking to the workers....they were clueless about basic life skills and various government programs that are supposed to help...and had every excuse in the book as to why they couldn't do simple things

bramzzoinks said:

There is a sign in the lobby that payment is due at time of service.  So clint would have had to have had a very quuck change of financial condition or have gone in planning not to pay according to policy. 

apparently they did not enforce this.  I've seen that happen...if a long time patient forgets a check..some docs will let them pay later..or if they take medical leave from work due to the health condition being treated...or are applying for disability, etc

Maybe there should be an additional sign in the lobby which states: 

"We respect your confidentiality, unless you fail to pay your bills on time, in which case our right to pursue you for payment will override your right for confidentiality.  Prompt payment for our services is of greater value to this practice than any professional ethical commitment to patient confidentiality."   

There are clients who choose not to use insurance because they are concerned that their confidentiality could be breached. 

I am a private practitioner, so I do my own books. A few times I have missed that a debt has run up. I consider this a joint responsibility. It becomes a part of the therapy. Why did we both miss this? What does it mean? How can we work with the problem. How people handle money says a lot about them. Why was I avoiding the topic? Sometimes that plays into the central dynamics of the client's life.  But then, not all therapy is concerned with psychodynamics.  

There is NO excuse for releasing private medical information.  That is or should be completely separate from payment or nonpayment of bills.

The practice obviously has the right to go after a client (parents) for non-payment.  However, I can't for the life of me understand why the diagnosis would be helpful to the case?  Non-payment is non-payment whether it be a psych bill or any other bill.  I would think what they need to prove is services being rendered not why the client came in.  When searching for services for our daughter we were referred here.  I'm thankful now we chose to go elsewhere.