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Importance and Limits of H.I.P.A.A Essay

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Updated: Mar 4th, 2022


“H.I.P.A.A-Health Insurance Portability and Accountability Act.”, became a public law in 1996 when it was passed by the Congress and signed by the then President, Bill Clinton. H.I.P.A.A.covered such entities as health plans, health care providers who use certain electronic transactions, health care clearinghouses etc.Its major aims or goals were to improve portability and continuity of health insurance coverage in the groups and individual markets.

It was also drafted to fight waste, fraud, and bring about respect to the right for privacy and confidentiality of information by the health insurance and health care delivery to the patient.This applies mostly where the person may be denied his or her due as a result of a change of job. The HIPAA was also intended to reduce costs and administrative burdens of health care by improving efficiency and effectiveness of the health care system by standardizing the interchange of the electronic data for specified administrative and financial transactions. It was also intended to enhance the protection of the privacy of Americans’ personal health records by protecting the security and confidentiality of health care system. (Leckrone, 2009)

Main body

The “Health Insurance Portability and Accountability Act (HIPAA)” was intended to give security to all American workers and enhancing easy to access, good quality and informed health insurance cover. offer protections for millions of American workers thereby offering improved portability and continuity of health insurance coverage. The “Health Insurance Portability and Accountability Act” was drafted with the simple intention of giving security and make easier to access health insurance to the working families and their children. This made available the medical conditions that were excluded due to a condition that existed before you entered the health plan.

A person may have been excluded from a medical cover due to a medical condition that had existed before the application of the cover. Also, this was intended to aid in providing credit against maximum pre-existing condition(s) exclusion periods for prior health coverage and a process for providing certificates showing periods of prior coverage to a new group health plan or health insurance issuer. This will include prior coverage under another group health plan, an individual health insurance policy etc. (Leckrone, 2009)

It is the requirement of the “HIPAA that a certificate showing creditable coverage has been provided essentially and free without any charge by the insurance company when a person has lost his cover under the plan.” A certificate must also be provided free of charge upon request while you have health coverage or anytime within 24 months after your coverage ends”. Health Insurance Portability and Accountability Act” plays a crucial role when reaches to a point of providing new rights that will enhance persons to apply for a health coverage incase they loose their other health coverage, get spliced i.e. their spouses or even adds a new dependent upon their marriage through birth, adoption, or placement for adoption.

This will also include an individual who loses his or her coverage in certain situations, such as on separation, divorce, death, termination of employment and reduction in hours. Special enrolment rights also have been provided if the employer contributions towards the other coverage terminates. (Leckrone ,2009)

“The Health Insurance Portability and Accountability Act will also prohibit discrimination in enrollment and in premiums charged to employees and their dependents based on health status related factors”. Guaranteeing availability of health insurance coverage for small employers and the renew ability of health insurance coverage for both small and large employers and therefore enhancing the clients satisfaction was also the vision behind the HIPAA.

The HIPAA was also intended to enhance preservation of the states role in regulating health insurance, including the states authority, to provide greater protections than those available under federal law. This will have a tendency to make sure that persons are not done away with the cover, their benefits being denied or may be even charged more cover which is being offered by an insurance company in regard to the health condition of a person based on. (Scheinfeild, 2009)

“In 1996, Congress approved Health Insurance Portability and Accountability virtually unanimously”. The step was intended to make better and easier access to health insurance to the working Americans and all citizens at large, and the confidentiality of the sources thereby the medical information of patients, but since the act was passed into law and was put into effect, the regulation has been at times misinterpreted or abused to refuse to give information to the family members or the news media. Loop holes and weaknesses have brought about some unintended negative effects instead. This has given way to the abuse of denying information access even to family members by the medical practitioners.

There has been a proposed action to improve the federal law cause of its unintended negative effects. The biggest problem or challenge to the Health Insurance Portability and Accountability Act is the tendency for some hospitals to with hold information form certain people thereby this being seen as protecting their own interests above those of patients. (Leckrone ,2009)

Experts have gone into criticizing the coming into play of the rule suggesting that that it has caused problems in the record keeping because of confidentiality provisions and have gone into saying that, the philosophy behind the problem that the “HIPAA” is causing is less about the privacy than it is about to frustrate people.” As a result of persistent efforts being made by the critics, in December 2004 the Washington State Hospital Association, told all state hospitals to release information about patients’ location and condition to family members and close friends in cases where the patient cannot be asked if he or she wants this information disclosed, a clear citing that there is a problem with the HIPAA act.” (Leckrone ,2009)

The following are some of the limits of the HIPAA; According to HIPAA it does not require employers to offer or pay for health coverage for employees or family coverage for their spouses and dependents. Experts have argued while it’s a good Act it’s also true that the HIPAA does not guarantee health coverage for all its workers. “It’s also been seen that HIPAA does not control the amount an insurer may charge for coverage.”

HIPAA does not require group health plans to offer specific benefits. Its been seen that HIPAA does not restore the same health cover an individual had before in their previous employment when they move to a new job. Its also been highlighted that HIPAA will not eliminate all uses of pre existing conditions exclusions.HIPAA will also not replace the state as the primary regulator of health insurance. While HIPAA set minimum standards for providing coverage of lost last resort, but it let each state devise its own rules.Its consequences have been a confusion of rules that are different from one state to another state and which give different standards of help to the “(Scheinfeld, 2009)

Its been by some experts that health insurance portability and accountability act hasn’t solved the problems that the people are going through and therefore has ended up with an unchanged market situation. The hipaa hasn’t really ensured, for instance, that everyone in need of this health insurance cover could get it in disregard of his or her health status.

Where as some experts have defended the good course of hippie it will also be true to suggest that it’s had some negative results or influences upon the public, there was a need to stop people such as private investigators, media and insurance companies from getting a patient’s information.” It is true that health insurance portability and accountability act got so many things wrong, but it can also be agreed that its made a lot of other things right”, HIPAA got a lot of things wrong, but it also got a lot of things right. (Leckrone, 2009)

An interim rule which was meant to enforce this rule was established seven years after its passing into the law to allow government enforcement This rule provided other rules to be followed when one is to be sued by the secretary of health and human services, of the amount of money to be charged on a situation that violated the levels that were adopted by the secretary according to “health insurance portability and accountability act” money penalties on entities that violate standards adopted by the secretary under “HIPAA”.

The interim rule was effective until September 16, 2004.This was intended by the government as a way of taking a step towards enforcing the organizations to comply with the Act. The proceedings within the health insurance portability and accountability have set levels for all health plans, clearing houses and storage of health care information thereby making sure there is a level of integrity, privacy and that information stored electronically is protected by the health care organization. (Owen, 2009)

More money ought to be ingested over the next many years to accomplish compliance by the government to the health care organizations with the health insurance portability and accountability act legislation and to see the long-term advantages. These benefits will include, “lowering the administrative costs, improved efficiency for patients and providers, increasing customer satisfaction, improved security and privacy of information to the HIPAA covered entities which includes health plan, health care providers who use certain electronic transactions and health care clearinghouses. HIPAA will be expected to make simple the administration of health care organization in regard to business undergoing i.e. billings,claims,computer systems and communication uniformity in order that the insurance organizations will not have to change the way in which they associate with one another’s own systems.

The administrative simplification of HIPAA will be making business practice i.e. the billings, claims, computer systems, and communication uniform in order that providers and payers do not have to change the way in which they interact with each other’s proprietary systems. Its been noted by the experts that the changes will go along way into affecting such activities as enrolling an individual as an employee into a health care plan, and also when it comes to paying the health insurance premiums, also confirming the eligibility of an individual, being permitted or allowed to refer a patient to a specialist, processing claims that have been made by patients, letting the provider know about the payment of the claim “(Apple, 2008)

The legislation of the Act has tough civil and criminal punishments when a health care organization decides to disregard it and therefore not comply with it. The government has set tough measures with failure to comply with the HIPAA regulations.

Failure to comply with the HIPAA can have severe consequences for all the members of the wound care team.” In the situations where health care organizations violate the Act, the government has established severe penalties in regard to this. The fine goes up to $100 for any violation, or a fine of $25000 on a person for standard one year. Penalties of one year in jail or a fine of up to $50000 will be imposed for getting or giving information of a patient which has been protected for privacy reasons knowingly will have violated the Act. A punishment of up to five years behind the bars or an equivalent fine of $100000 and will be imposed acquiring information in false pretences.

A penalty of up to ten years behind the bars or an equivalent fine of up to $250000 will be charged for getting or giving information thereby violating the Act with the intention of transferring that information for commercial or personal gain or even the intention to harm the patient. In addition to these penalties, health care organizations who will not comply as this Health Insurance Portability and Accountability Act suggests will be subjected to losing of goodwill, credibility to serving the public, public trust and revenue.” (Privacy and security, 2002)

This Act suggests that the medical practitioners should teach their employees on the rules and instructions with regard to health Act as it is necessary for the staff to carry out their given jobs. It is a requirement by the Government that the medical practitioners should train their employees of which according to the law was supposed to have been ended before April 14, 2004.Also, and staff training on HIPAA should be documented. (Scheinfeld, 2009)


There are tough punishments by the government for not complying with the Act by the Health care organizations but hard enforcement has been neglected by the Health and Human Services.Though it is a requirement by the government that all healthcare organizations should comply with the Act, having some laid down process to follow to comply with the Act shows some good efforts of willing to comply with the Act., which might reduce any penalty that the Human Health services may decide to undertake.

Good faith efforts by the various health care agencies to comply with the Act will embrace the spirit of privacy of HIPAA thereby permitting its easier implementation. Two groups are responsible for the enforcement of the HIPAA.The Human Health Services will handle the civil enforcement while the criminal enforcement will be the responsibility of the department of justice. (Apple, 2008).

List of references

Leckrone, J. (2009) HIPAA’s portability lost in privacy over kill. Web.

Scheinfeld, N. (2009). HIPAA for the Wound Care Team: Penalties, Enforcement, and Plans for Compliance, 50(5). Web.

Privacy and security, (2002). penalties for failure to comply with. Web.

Apple, G. (2008). Understanding HIPAA Enforcement-Trust. Web.

Owens, P, (2009). Health insurance and portability and accountability act. Web.

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