News & Resources

The year isn’t over quite yet, but 2010 has already logged a remarkable number of privacy breaches. As of November 30, the Office for Civil Rights of the U.S. Department of Health and Human Services had received reports of 197 health insurance companies, health care providers and health data clearinghouses failing to protect individually identifiable health information as required under HIPAA and HITECH regulations. Nearly half of those reports have been made since July.

Customers of Florida-based AvMed Health Plans have filed a class action lawsuit against the insurance company in connection with a breach of privacy that occurred in December 2009. Seeking unspecified damages, the plaintiffs claim that, in addition to failing to safeguard the private medical data, the company vastly underreported the number of customers affected by the breach.

Insurance regulators in Florida could not ignore the recent fines imposed on seven health maintenance organizations in California. The organizations were the targets of that state’s Department of Managed Health Care investigation into complaints from doctors and other health care providers about insurance claim payment practices. The fines totaling $5 million were just part of the decision: The seven HMOs must also pay restitution to the providers, and that could add up to tens of millions of dollars.

Both the federal government and the State of Michigan filed suit this week against Blue Cross & Blue Shield of Michigan, alleging that the insurer’s “most favored nation” clauses with hospitals violate the Sherman Antitrust Act and the Michigan Antitrust Reform Act. The Justice Department did not indicate if there are plans either to investigate or to take legal action against health plans in other states; the outcome of the suit, however, will likely affect how the Blues and other health insurance companies contract with hospitals throughout the nation.

In Florida and more than 30 other states, health insurance companies will stop writing policies for children this week. The move comes as provisions of the new health care law take effect.

A study released this week reported that employers are shifting most of the increase in health insurance premiums to their workers. The study is conducted annually by the Kaiser Family Foundation and the Health Research & Educational Trust.