SIIVI ?sq? e? DEPARTMENT OF HEALTH HUMAN SERVICES Of?ce Pfthe Secmlar?r Voice - (617) 565-1340, (800) 308-1019 TDD - (617') 565-1343, (800) 537-7697 Fax - 565-3809 Of?ce for Civil Rights, Region I Government Center J.F. Kennedy Federal Building, Room 1875 Boston, MA 2203-0002 JUL 2 2 2014 Coordinator, Privacy Investigations CVS Caremark One CVS Drive Woonsocket, RI 02895 Re: OCR Transaction Number: 14-18624? On July 8, 2014, the U.S. Department of Health and Human Services (HHS), Of?ce for Civil Rights (OCR) received a complaint alleging the CVS pharmacy located at 137 Federal Street, Green?eld, Massachusetts (CV5), the covered entity, has violated the Federal Standards for Privacy of Individually Identi?able Health Information 1 C.F.R. Parts 160 and 164, Subparts A and E, the Privacy Rule). Speci?cally, the complainant, alleges that on or about July 3, 2014, a CV5 pharmacy er Iscussed complainant?s prescription with him, while many people were standing in line behind him. This allegation could reflect a violation of 45 C.F.R. 164.502(a) and OCR enforces the Privacy, Security, and Breach Noti?cation Rules, and also enforces the 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 hislher 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 andfor because the minimum necessary standard was not OCR Transaction Number: 14-18624? Page 2 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 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 as part of the Health Insurance Portability and Accountability Act (HIPAA) training you provide to your workforce. You are also encouraged 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 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, please do not hesitate to contact David Corbett, Investigator, at 565-1350 (Voice), or (617) 565-1343 (800) 537-7697 (TDD). Please be advised that communication by email presents a risk of disclosure of the transmitted information to, or interception by, unintended third parties. Please keep this in mind when communicating with us by e-mail. Sincerely, . . c) i Stu. Susan M. Pezzullo Rhodes Regional Manager Enclosure: Incidental Disclosures sung-Q? ?mm DEPARTMENT OF HEALTH HUMAN SERVICES Of?ce Of the 33mm? 4ama?iimru Voice - (617] 565-1340, (800} 358-1019 Of?ce for Givil RightS, Region TDD - (617) 555?1343, (800) 531769? Government Center Fax - {617) 5656809 J.F. Kennedy Federal Building, 2 2 Room 1875 JUL Boston, MA 2203-0002 Re: OCR Transaction Number: 14-18624? Dea r. On July 8, 2014, the US. Department of Health and Human Services (HHS), Of?ce for Civil Rights (OCR) received your complaint alleging the CVS pharmacy located at 137 Federal Street, Green?eld, Massachusetts (CVS), the covered entity, has violated the Federal Standards for Privacy of Individually Identifiable Health Information (45 C.F.R. Parts 160 and 164, Subparts A and E, the Privacy Rule). Specifically, you allege that on or about July 3, 2014, a CVS pharmacy clerk discussed your prescription with you, while many people were standing in line behind you. This allegation could reflect a violation of 45 C.F.R. 164.502(a) and Thank you for bringing this matter to OCR's 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. OCR Transaction Number: 14-18624? Page 2 We have carefully reviewed your complaint against CVS and have determined to resolve this matter through the provision of technical assistance to CVS. Should OCR receive a similar allegation of noncompliance against 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, please do not hesitate to contact David Corbett, Investigator, at (617) 565-1350 (Voice), or? (617) 565-1343 (800) 537-7697 (TDD). Please be advised that communication by email presents a risk of disclosure of the transmitted information to, or interception by, unintended third parties. Please keep this in mind when communicating with us by e-mail. Sincerely, J) turns?r "k l;in Susan M. Pezzullo Rhodes Regional Manager