Federal law provides certain exceptions to HIPAA when a whistleblower uncovers Medicare and Medicaid fraud.  Whistleblowers combatting fraud under the False Claims Act (FCA) often need medical records to substantiate their claims.  Federal law helps with recovery of government funds by allowing some disclosures that would otherwise violate HIPAA.

HIPAA restricts the transfer of “individually identifiable health information.”  This includes an individual’s medical condition, name, address, date of birth, and Social Security Number. However, a whistleblower may disclose this information to their attorney if they have a good faith belief that there has been illegal activity, violations of clinical standards, or risk to patients.  45 C.F.R. § 164.502(j).

This exception is critical, because whistleblowers filing a claim under the FCA must provide the government with a disclosure containing all material evidence of the alleged fraud.  31 U.S.C. § 3730(b)(2).

While there are HIPAA exceptions, whistleblowers should always consult an attorney before acquiring or disclosing medical records.  Not only may this implicate HIPAA, but it could violate a whistleblower’s employment agreement.

If you have uncovered fraud against the government, contact the whistleblower attorneys at Miller Law Group today for a free consultation or call us at (919) 348-4361.

Additional Resources: 

Whistleblower’s Award in False Claims Act Case

Recent Developments in Whistleblower Protection

Medicare and Medicaid Fraud – Kickbacks and Self-Referrals

Whistleblower for Medicare and Medicaid Fraud