Fraud And Abuse In Health Care Essay

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Title II procedural policies focus on fraud and abuse within Health Care industries. Because this title is so extensive, it can be further broken down into 5 rules. These rules include- the Privacy Rule and the Final Omnibus Rule update, the Transactions and Code Sets Rule, the Security Rule, the Unique Identifiers Rule, also known as the National Provider Identifier, and the Enforcement Rule.
The Privacy rule regulates the use and disclosure of Protected Health Information (PHI), which is, by definition, any health status information, including personal and financial information, that can be linked to a specific person. The Omnibus Rule, additionally, added an extension of security requirements of business associates involved in practices. This also increased breach and disclosure measures, which are strict even in regard to disclosure of PHI to relatives.
The Transactions and Code Sets Rule standardized how health care transactions are made and is broken down
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This is due to the fact that it lays out three specific types of safeguards in response to breaches in Electronic Protected Health Information (ePHI) when in rest and in transit. The three safeguards include Administrative Safeguards, which are policies and procedures put in place to maintain security within administrative and professional environments. Some examples of this are: risk assessments, employee training, and restriction of third-party access of information. Physical Safeguards, which are physical restrictions put in place to protect and maintain security and access to PHI and ePHI. Some examples of this include: workstation protocol, surveillance protocol, and mobile devices protocol. Lastly, there are Technical Safeguards, which target the more technical security breaches due to ePHI, specifically. Some examples of these are as followed: file encryption to NIST standards, secure login information, and automatic logoff

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