Buried within the various resolutions and corrective action plans were notices of proposed determination and final determination for ACPM Podiatry Group Ltd. and Dr. Anthony DeCeanne. The practice was hit with a $100,000 civil monetary penalty (CMP). The maximum CMP amount that could have been imposed on ACPM with regard to the violation described is $3,571,302.
One mitigating factor mentioned in the determination was the global pandemic and its effect on healthcare operations. How much of a role did that play in OCR’s CMP decision?
Following the Facts
Based on the Findings of Facts outlined by OCR, ACPM’s actions appear to have clearly violated the right of access provisions of the HIPAA Privacy Rule.
The original request for records was submitted in writing by a former ACPM patient on November 13, 2018. The patient filed a complaint with OCR in April 2019.
OCR notified the former patient by letter dated April 18, 2019, that the investigation had been informally closed by providing technical assistance to ACPM. The letter directed the Complainant to contact OCR if he continued to experience the issues described in his complaint.
On May 19, 2019, OCR received a second complaint from the Complainant alleging that ACPM still had not provided him with a copy of his medical records. Reasons given by the practice for not releasing the records included lack of time due to scheduled surgeries and non-payment for services by the patient’s insurance company.
The patient stated that he needed the requested medical records to appeal an unfavorable decision made by his health insurance company for the payment of a bill related to treatment provided by ACPM. The deadline to appeal his health insurance company’s determination was July 2, 2019.
On June 14, 2019, OCR notified ACPM in writing by certified mail of the May 19, 2019 complaint and issued a data request. The data request included a request for information from ACPM, including whether ACPM provided the Complainant with the requested medical records and a copy of ACPM’s policy regarding providing access to medical records.
OCR requested that ACPM respond to OCR’s data request letter by June 29, 2019. ACPM did not respond to the data request by June 29, 2019. The practice also did not respond to requests by OCR investigators for information and cooperation on multiple occasions.
The patient notified OCR that he had received an incomplete copy of his medical records on July 23, 2020, 618 days after the initial written request and after the deadline to appeal the insurance company’s determination.