JKO Remedial HIPAA Questions and Answers

True or False? Under HIPAA, a person or entity that provides services to a CE that do not involve the use or disclosure of PHI would be considered a BA.

False

Do Betty's actions in this scenario constitute a HIPAA Privacy Rule violation?

Yes, because Betty's actions are in violation of the minimum necessary standard in that John did not need access to the patient's complete medical file (PHI) to perform his job duties

A friend of Phillip Livingston, a military service member who is being treated for a broken leg at Valley Forge MTF, asked what room Phillip is in so that he can visit.
Which of the following is required?

The patient must be given an opportunity to agree or object to the use or disclosure

The Chief Medical Officer for Valley Forge MTF utilizing PHI is conducting a monthly physician peer review operations exercise.
Which of the following is required?

Neither an authorization nor an opportunity to agree or object is required

Abigail Adams is a TRICARE beneficiary and patient at Valley Forge MTF and is applying for Sun Life Insurance. Sun Life has requested some of Abigail's medical records in order to evaluate her application.
Which of the following is required?

An authorization is required

Dr. Jefferson sends a patient's medical record to the surgeon's office in support of a referral for treatment he made for the patient.
Which of the following is required?

Neither an authorization nor an opportunity to agree or object is required

Valley Forge MTF discloses a patient's information in response to a request from HHS in the investigation of a patient complaint.
Which of the following is required?

Neither an authorization nor an opportunity to agree or object is required

Did Valley Forge MTF handle George's request appropriately?

No, because the MTF is required to respond to George in writing, providing an accounting of certain disclosures going back 6 years from the date of the request

Which of the following would be considered PHI?

An individual's first and last name and the medical diagnosis in a physician's progress report

Select the best answer. The HIPAA Privacy Rule applies to which of the following?

All of the above

Which of the following is not electronic PHI (ePHI)?

Health information stored on paper in a file cabinet

Select the best answer. Which of the following are true statements about limited data sets?

All of the above

How should John advise the staff member to proceed?

Both B and C

Was this a violation of HIPAA security safeguards?

Yes --- Thomas violated DoD's policy in downloading ePHI to a flash drive. As a result of this policy violation, Thomas put the ePHI of a significant number of Valley Forge....

Physical safeguards are:

Physical measures, including policies and procedures that are used to protect electronic information systems and related buildings and equipment, from natural and environmental hazards, and unauthorized intrusion

Select the best answer. Which of the following statements about the HIPAA Security Rule are true?

All of the above

The HIPAA Security Rule applies to which of the following:

PHI transmitted electronically

Administrative safeguards are:

Administrative actions, and policies and procedures that are used to manage the selection, development, implementation and maintenance of security measures to protect electronic PHI (ePHI). These safeguards also outline how to manage the conduct of the workforce in relation to the protection of ePHI

What enforcement actions may occur based on Janet's conduct?

All of the above

Which HHS Office is charged with protecting an individual patient's health information privacy and security through the enforcement of HIPAA?

Office for Civil Rights (OCR)

Select the best answer. If an individual believes that a DoD covered entity (CE) is not complying with HIPAA, he or she may file a complaint with the:

All of the above

A covered entity (CE) must have an established complaint process.

True

Select the best answer. Which of the following are categories for punishing violations of federal health care laws?

All of the above

How should John respond?

Yes. Privacy Act Statements and a SORN should both be considered prior to initiating the research project

Major Edmund Randolph, an active member of the United States Air Force, recently discovered through a publicnotice that his PII is being maintained by the federal government in a system of records. Because Major Randolph isvery diligent about safeguarding his personal information and is aware of how this information could bevulnerable, he is interested in obtaining a copy and reviewing them for accuracy. Is Major Randolph able to obtain acopy of his records from the system of records and request changes to ensure that they are accurate?

Yes, Major Randolph is able to request to inspect and copy his records and can request an amendment to correct inaccurate information.

The e-Government Act promotes the use of electronic government services by the public and improves the use of information technology in the government.

True

A Systems of Records Notice (SORN) serves as a notice to the public about a system of records and must:

All of the above

Select the best answer. Which of the following statements about the Privacy Act are true?

All of the above

Select the best answer. Which of the following are examples of personally identifiable information (PII)?

All of the above

George is reminded of a conversation he overheard between two co-workers who were contemplating selling some old Valley Forge MTF computers instead of disposing of them through the MTF's IT department. With reason to believe Alexander is telling the truth as to the computers and PHI in his possession, what is the appropriate course of action for George?

George should immediately report the possible breach to his supervisor and assist in providing any relevant information for purposes of the investigation

Is Carla's time saving measure appropriate provided she only sends unencrypted emails on occasion?

No, because unencrypted emails containing PHI or PII may be intercepted and result in unauthorized access

Select the best answer. Which of the following are common causes of breaches?

All of the above

Select the best answer. Which of the following are breach prevention best practices?

All of the above

A breach as defined by the DoD is broader than a HIPAA breach (or breach defined by HHS).

True

When must a breach be reported to the U.S. Computer Emergency Readiness Team?

Within 1 hour of discovery

In which of the following circumstances must an individual be given the opportunity to agree or object to the use and disclosure of their PHI?

-Before their information is included in a facility directory
-Before PHI directly relevant to a person's involvement with the individual's care or payment of health care is shared with that person

Which of the following statements about the HIPAA Security Rule are true?

All of the above
-a national set of standards for the protection of PHI that is created, received, maintained, or transmitted in electronic media by a HIPAA covered entity (CE) or business associate (BA)
-Protects electronic PHI (ePHI)
- Addresses three types of safeguards - administrative, technical and physical - that must be in place to secure individuals' ePHI

A covered entity (CE) must have an established complaint process.

true

The e-Government Act promotes the use of electronic government services by the public and improves the use of information technology in the government.

true

When must a breach be reported to the U.S. Computer Emergency Readiness Team?

1 hour

Which of the following statements about the Privacy Act are true?

All of the above

What of the following are categories for punishing violations of federal health care laws?

All of the above

Which of the following are common causes of breaches?

All of the above

Which of the following are fundamental objectives of information security?

All of the above

If an individual believes that a DoD covered entity (CE) is not complying with HIPAA, he or she may file a complaint with the:

All of the above

Technical safeguards are:

Information technology and the associated policies and procedures that are used to protect and control access to ePHI (correct)

A Privacy Impact Assessment (PIA) is an analysisof how information is handled

All of the above

A breach as defined by the DoD is broader than a HIPAA breach (or breach defined by HHS).

true

Which of the following are breach prevention best practices?

All of the above

An incidental use or disclosure is not a violation of the HIPAA Privacy Rule if the covered entity (CE) has:

All of the above

Under the Privacy Act, individuals have the right to request amendments of their records contained in a system of records.

true

Which HHS Office is charged with protecting an individual patient's health information privacy and security through the enforcement of HIPAA?

Office for Civil Rights (OCR) (correct)

Physical safeguards are:

Which of the following would be considered PHI?

An individual's first and last name and the medical diagnosis in a physician's progress report (correct)

The minimum necessary standard:

All of the above