Medicare, Medicaid, and the Health Insurance Portability and
Accountability Act (HIPAA) have significantly impacted the healthcare
industry. Medicare is a federal insurance program offered to
individuals over 65 regardless of income, disabled, or receiving
dialysis treatment for End-Stage Renal Failure (U.S. Department of
Health & Human Services, 2015, October). A significant benefit of
Medicare is that it offers health insurance coverage to vulnerable
populations. However, some vulnerable populations don't qualify for
all parts of Medicare, such as Part D, which covers prescription drugs
(Medicare, n.d.). The vulnerable populations mentioned above tend to
have limited income, so allocating the funds for medications can be
challenging without the additional support of Part D. Without the
financial means to pay for prescription medications, patients are at
higher risk of non-compliance with the treatment care plan.
Medicaid is a federal-state assistance program that benefits low-
income individuals of all ages (U.S. Department of Health & Human
Services, 2015, October 2). An example of Medicaid would be
Massachusetts' Masshealth program that aids residents without the
means to pay for health insurance. In some circumstances, Medicaid
may require recipients to pay small costs for some services (U.S.
Department of Health & Human Services, 2015, August). Like
Medicare, Medicaid is available for those vulnerable populations who
may not be able to afford traditional health insurance. A challenge
associated with Medicaid is additional service coverage. Most
Medicaid does not cover dental, eye, and hearing services. So those
who cannot afford these services are at a significant disadvantage
and higher risk for poor health outcomes.
HIPAA was passed in 1996 to protect individuals’ medical records and
other personal health information (Centers for Medicare & Medicaid
Services, 2021). HIPAA has specific guidelines to ensure that
healthcare organizations keep sensitive patient health information
(PHI) safe (Nowicki, 2022). Anyone with access to PHI is legally
obligated to uphold HIPAA regulations. According to Fremgen (2019),
PHI must not be shared with anyone outside the care team unless
written consent from the patient. Before 1996, organizations had no
obligation to release PHI, and now HIPAA allows patients to control
who has access to their information.
With strict rules over PHI come heavy consequences to disclosures,
accidental or intentional. According to Dyrda (n.d.), employee email
phishing attacks are becoming more frequent and intense. Phishing
attacks are external intentional leaks, but disclosures also happen
accidentally. Accidental exposures through social media also have
devastating consequences, even if the leak was without malice.
Healthcare workers who post pictures online from healthcare areas
may reveal PHI in backgrounds unintentionally. Organizations are
responsible for maintaining employee training and identifying cyber
security risks. In a PHI leak, organizations and individuals are held
accountable through fines and penalties. The Department of Health
and Human Services does permit some incidental disclosures, but
email phishing attacks and accidental online exposure are not covered
(Fremgen, 2019, p. 242).
Reference
Centers for Medicare & Medicaid Services. (2021, January 23). Health
Insurance Portability and Accountability Act of 1996.
https://www.cms.gov/Research-Statistics-Data-and-
Systems/Computer-Data-and-
Systems/Privacy/Health%20_Insurance_Portability_and_Accountabili
ty_Act_of_1996
Dyrda, L. (n.d.). 10 common reasons for HIPAA violations. Becker's
Hospital Review - Healthcare News.
https://www.beckershospitalreview.com/cybersecurity/10-common-
reasons-for-hipaa-violations.html
Fremgen, B. F. (2019). Medical law and ethics (6th ed.). Hoboken, NJ:
Pearson.
Medicare. (n.d.). What's Medicare? https://www.medicare.gov/what-
medicare-covers/your-medicare-coverage-choices/whats-medicare
Nowicki, M. (2022). Introduction to the financial management of
healthcare organizations (8th ed.). Gateway to Healthcare
Management.
U.S. Department of Health & Human Services. (2015, August 21).
What is the Medicaid program?
https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-
medicaid-program/index.html
U.S. Department of Health & Human Services. (2015, October 2).
What is the difference between Medicare and Medicaid?
https://www.hhs.gov/answers/medicare-and-medicaid/what-is-the-
difference-between-medicare-medicaid/index.html
