What is a “Covered Entity”?
What is a “Covered Entity” when it comes to HIPAA laws?
When people think about the Health Insurance Portability and Accountability Act (HIPAA), they usually think about medical privacy. But HIPAA doesn’t apply to everyone who handles health information. It applies specifically to certain organizations called “covered entities.”
If you’ve been affected by a medical or data breach, understanding whether an organization qualifies as a covered entity is the first step in determining whether HIPAA protections apply.
What Is a Covered Entity?
A covered entity under HIPAA is a person or organization that must comply with HIPAA’s Privacy, Security, and Breach Notification Rules.
There are three main types of covered entities:
1) Health Care Providers
These include medical professionals and facilities that transmit health information electronically. Examples of these include hospitals, pharmacies, nursing homes, doctors and physician groups, chiropractors and dentists.
2) Health Plans
Health plans include companies that pay for medical care. These include HMO’s, health insurance companies, Medicare & Medicaid, and employee sponsored health plans.
3) Health Care Clearinghouses
Clearinghouses process health information into standard formats often between providers and insurers. An example of a clearinghouse would be a billing services company.
What is not a “covered entity”?
Many companies handle health-related information but are not considered covered entities under HIPAA. These include employers, life insurance companies, work compensation carriers, and schools.
At McShane & Brady, we receive calls daily from people who believe they have been subjected to a HIPAA violation. HIPAA law is complex and complicated. It may not always be a HIPAA violation, but it is always wise to error on the side of caution and to call us to discuss your matter.
If your sensitive health information has been compromised, determining whether the organization is a covered entity — and whether they followed HIPAA’s requirements — is often the first step toward accountability.
If your personal health information has been exposed, time matters. Contact McShane & Brady, LLC today to speak with a HIPAA attorney who will fight for your privacy and hold negligent companies accountable.
📞 Call us at (816) 888-8010
🌐 Visit mcshanebradylaw.com
Let us protect your rights. Your information is personal, and we are here to keep it that way.
