WW 0 a: 3 Voice (617) 565-1340, {300) 353-1019, Top (617) 555- 1343, FAX (617) 565-3809, Of?ce for can Rights, Region 1 JFK Fallen! Blending, Room 1315 2.5 2013 Re: OCR Transaction Number: 13-155656 Dear On January 11, 2013, the U.S. Department of Health and Human Services (HHS), Of?ce for Civil Rights (OCR), received your complaint alleging that Carolina Primary Care, the covered entity, has violated the Federal Standards for Privacy of Individually Identifiable Health Information (45 C.F.R. Parts 160 and 164). Specifically, you allege that a cashier at the Winston-Salem CV5 discussed your medical insurance in a loud voice that allowed other customers in the line and in the waiting area to overhear what she was saying about your insurance status. This allegation could reflect a violation of 45 C.F.R. 164.502(a) and Thank you for bringing this matter to attention. Your complaint plays an integral part in OCR's enforcement efforts. OCR enforces the Privacy, Security, and Breach Noti?cation Rules, and also enforces Federal civil rights laws which prohibit discrimination in the delivery of health and human services because of race, color, national origin, disability, age, and under certain circumstances, sex and religion. The Privacy Rule permits certain incidental uses and disclosures of protected health information (PHI) that occur as a by-product of another permissible or required use or disclosure of PHI, as long as the covered entity has applied reasonable safeguards and implemented the minimum necessary standard, where applicable, with respect to the primary use or disclosure. See 45 C.F.R. For example, the Privacy Rule permits covered health care providers to share PHI for treatment purposes without patient authorization as long as they use reasonable safeguards when doing so. These safeguards may vary depending on the mode of communication used. For example, when discussing patient health information orally with another provider in proximity of others, a doctor may be able to reasonably safeguard the information by lowering his/her voice. Page 2- 13-155656 We have carefully reviewed your complaint against the Winston-Salem CVS and have determined to resolve this matter informally through the provision of technical assistance to CVS. Should OCR receive a similar allegation of noncompliance against the Winston Salem CVS in the future, OCR may initiate a formal investigation of that matter. Based on the foregoing, OCR is closing this case without further action, effective the date of this letter. OCR's determination as stated in this letter applies only to the allegations in this complaint that were reviewed by OCR. Under the Freedom of Information Act, we may be required to release this letter and other information about this case upon request by the public. In the event OCR receives such a request, we will make every effort, as permitted by law, to protect information that identifies individuals or that, if released, could constitute a clearly unwarranted invasion of personal privacy. If you have any questions regarding this matter, please contact Vicki Kaufman, Investigator, at (617) 565-1344 (Voice) or (617) 565-1343 (TDD). Sincerely, MWL Peter K. Chan Regional Manager Voice (617') 565-1340, (300} 368-1019, TDD 565- 1343, (800) 53?-769? FAX (617) 565-3309, We: for Chi Rith, Region I JFK Federal Building. Room 1815 AUG 2 .5 2013 Government Center Boston, MA 02103-0002 ?it. DEPARTMENT OF HEALTH 3.: HUMAN SERVICES OFFICE OF THE I In {bll?llbl?llcl Coordinator Privacy Investigations CVS Caremark One CVS Drive Woonsocket, RI 02895 Re: OCRTransaction Number: 01-13-155656 Dear {momma} On January 11, 2013, the U.S. Department of Health and Human Services (HHS), Of?ce for Civil Rights (OCR), received a complaint alleging that the CVS Caremark (CV5), the covered entity, has violated the Federal Standards for Privacy of Individually Identi?able Health Information (45 C.F.R. Parts 160 and 164, Subparts A and E, the Privacy Rule). Speci?cally, the complainant alleges that, on December 22, 2012, her protected health information (PHI) was disclosed when a staff person at the CVS at 855 Hanes Mall Boulevard, Winston Salem, NC discussed the complainant's health insurance coverage in a manner that could be heard by other customers in the line behind her and in the waiting area. This allegation could re?ect a violation of 45 C.F.R. 164.502(a) and OCR enforces the Privacy, Security, and Breach Noti?cation Rules, and also enforces Federal civil rights laws which prohibit discrimination in the delivery of health and human services because of race, color, national origin, disability, age, and under certain circumstances, sex and religion. The Privacy Rule permits certain incidental uses and disclosures of protected health information (PHI) that occur as a by-product of another permissible or required use or disclosure of PHI, as long as the covered entity has applied reasonable safeguards and implemented the minimum necessary standard, where applicable, with respect to the primary use or disclosure. See 45 C.F.R. For example, the Privacy Rule permits covered health care providers to share PHI for treatment purposes without patient authorization as long as they use reasonable safeguards when doing so. These safeguards may vary depending on the mode of communication used. For example, when discussing patient health informatlon orally with another provider in proximity of others, a doctor may be able to reasonably safeguard the information by lowering his/ her voice. In this matter, the complainant alleges the incidental use or disclosure of PHI was not permissible, either because reasonable safeguards were not in place to prevent the use or disclosure and/or because the minimum necessary standard was not implemented when it should have been. Pursuant to its authority under 45 C.F.R. 160.304(a) and OCR has determined to resolve this matter informally through the provision of technical assistance to CVS. To that end, OCR has enclosed material explaining the Privacy Rule provisions related to Incidental Uses and Disclosures, Reasonable Safeguards, and the Minimum Necessary requirement. You are encouraged to review these materials closely and to share them with your staff at the CVS in Winston Salem, NC as part of the Health Insurance Portability and Accountability Act (HIPAA) training you provide to your workforce. You are also encoumged to assess and determine whether there may have been an incident of noncompliance as alleged by the complainant in this matter, and, if so, to take the steps necessary to ensure such noncompliance does not occur in the future. Please contact OCR if you need further information regarding the allegations in this matter. Should OCR receive a similar allegation of noncompliance against CVS at 355 Hanes Boulevard, Winston Salem, NC, OCR may initiate a formal Investigation of that matter. Based on the foregoing, OCR is closing this case without further action, effective the date of this letter. determination as stated in this letter applies only to the allegations in this complaint that were reviewed by OCR. Under the Freedom of Information Act, we may be required to release this letter and other information about this case upon request by the public. In the event OCR receives such a request, we will make every effort, as permitted by law, to protect information that identifies individuals or that, if released, could constitute a clearly unwarranted invasion of personal privacy. If you have any questions regarding this matter, please contact Vicki Kaufman, Investigator, at 565-1344 (Voice) or (617) 565-1343 (TDD). Sincerely/m Peter Chan Q1 Regional Manager Enclosures: Incidental Disclosures Reasonable Safeguards Minimum Necessary