·       investigate apparent violations of the Transactions and Code Sets, Security, and Unique Identifier provisions of HIPAA;

·       determine if there were violations;

·       store the results of investigations;

·       refer violations to law enforcement; and

·       maintain and retrieve records of the investigations.

HHS also proposes the following additional "routine" uses, to:

(1) support regulatory, reimbursement, and policy functions performed within the agency, HIPAA entities, or by a contractor or consultant;

(2) assist another federal or state agency in the enforcement of HIPAA regulations where sharing the information is necessary to complete the processing of a complaint, contribute to the accuracy of CMS's proper payment of Medicare benefits, and/or enable such agency to administer a federal health-benefits program;

(3) support constituent requests made to a congressional representative;

(4) support litigation involving the agency; and

(5) combat fraud and abuse in certain health-benefits programs.

The Federal Register announcement notes that HITS would provide a single, central, electronic repository of complaint documents and information, including investigative files, correspondence, and administrative records.

What's more, the notice states, "HITS will maintain a file of complaint allegations..  The collected information will contain name, address, telephone number, health insurance claim (HIC) number, geographic location, as well as, background information relating to Medicare or Medicaid issues of the complainant."

HHS notes that due to investigatory activities, it would exempt this new system from the notification, access, correction and amendment provisions of the Privacy Act of 1974.  This means that citizens' personal health information could be collected, stored and shared with many others involved in investigations regarding Medicare and other issues.  Yet, citizens (1) would not be notified about the data collection; (2) would not have access to the data; and (3) would not be able to correct and/or amend misinformation or errors contained in the federal government's HITS centralized electronic database.

SUBMIT COMMENTS BY AUGUST 7!

Address comments to the CMS Privacy Officer, Mail-stop N2-04-27, 7500 Security Boulevard, Baltimore, Maryland 21244-1850.

FOR FURTHER INFORMATION CONTACT: Michael Phillips, Health Insurance Specialist, OESS, CMS, 7500 Security Boulevard, Mail Stop S2-24-15, Baltimore, Maryland 21244-1849, Telephone Number (410) 786-6713, mphillips@cms.hhs.gov.

Source: Federal Register (Volume 70, Number 128), July 6, 2005, pages 38944-48.

Do Canadian Seniors Have More Health Freedom than American Seniors?

According to a recent article by Heritage Foundation researcher Derek Hunter, "Canada's Medicare [program] now allows Canadians more freedom (at least in Quebec) than American's Medicare does American seniors."  The article, titled "Doing Your Own Health Care Thing: American Seniors vs. Canadian Citizens," notes that because of Dr. Jacques Chaoulli's  recent Canadian Supreme Court victory overturning the Quebec ban on private health insurance, Canadians in the province are now free to contract with the physicians of their choice and to purchase private health insurance for the services they need and desire.

However, the article points out that the legal situation in the United States remains unchanged.  Hunter writes, "Under the terms of Section 4507 of the Balanced Budget Act of 1997, a senior can contract privately with a physician for a 'covered' Medicare service if, and only if, the doctor signs an affidavit to the effect that he is contracting privately with the senior citizen, submits that affidavit to the Secretary of the Department of Health and Human Services (HHS) within ten days, and agrees to forgo all Medicare reimbursement from all other Medicare patients for a period of two years."

He continues, "But this one-size-fits-all regulation does not fit the infinitely varying circumstances of seniors and especially the Baby Boom cohorts set to retire soon. In a free society, shouldn't a person's own reasons for deciding to spend his or her own money on a legal medical service without statutory or bureaucratic restrictions be enough? Privacy, personal convenience, the need for specialized care, or the skills and talents of a preferred physician could all explain a senior wanting to purchase care outside of Medicare. The current regulations make accommodating any of these reasonable desires difficult and oftentimes impossible."

The article reports that to fix the current law Rep. Sam Johnson (R-Tex.) in February introduced "The Medicare Beneficiary Freedom to Contract Act of 2005" (H.R. 709).  Hunter notes that the legislation "would eliminate prohibitions on seniors' entering into private contracts with medical professionals for legal medical services, regardless of whether those services are covered by Medicare."  However, on close examination H.R. 709 does not make clear that seniors are free to contract privately for all services under Medicare, including hospital (Part A) and prescription-drug services (Part D).  Thus to provide American seniors true freedom, there needs to be a clear law stating that all citizens are free to pay privately for the health-care services of their choice, including services covered under all parts of Medicare.

Some have proposed that allowing physicians to bill Medicare patients an additional amount for Medicare-covered services would increase seniors' freedom. (This is known as "balanced billing.")  While balanced billing can help patients who want to pay extra for Medicare-approved services, it does not help restore the freedom to maintain private contracts, which is the only way to bring decision-making power back to patients and their physicians.  He who pays the piper calls the tune.  Without the precious liberty to contract privately, citizens' health-care choices will be dictated by Medicare and insurance decision-makers. 

We need to move away from relying on and fostering a system in which patients and physicians have to ask Medicare (and insurers): "Big Brother, may I receive/give this treatment?"   And in reforming Medicare, we must stop building up Big Government health care (leaving health-care decision-making power with bureaucrats and third parties) and making wealthy people pay more for it!

Sources:

·       "Doing Your Own Health Care Thing: American Seniors vs. Canadian Citizens," by Derek Hunter (July 1, 2005): http://www.heritage.org/Research/HealthCare/wm782.cfm

·       "Medicare Beneficiary Freedom to Contract Act of 2005" (H.R. 709). To read the complete bill, visit the congressional legislative database http://thomas.loc.gov and search for bill number H.R. 709.

Health Freedom Watch is published by the Insitute for Health Freedom. Editor: Sue Blevins; Assistant Editor: Deborah Grady. Copyright 2005 Institute for Health Freedom.