93? 1immune?; DEPARTMENT OF HEALTH 3: HUMAN SERVICES Of?ce of the Secretary ?is . . . m" Voice - (404) 562-7386, (800) 368-1019 Of?ce for Civil Rights, TDD - (404} 562-7334, (300) 537-7697 Region yet] Fax - {404) 562-2881 61.7091'3' Centers 61 Street. SW. Atlanta. GA 30303 July 3, 2012 Chief Privacy Of?cer CVS Caremark P.O. Box 52072 Phoenix, AZ 85072-2072 Re: vs. CVS Caremark OCR Transaction Number: 11-135023 Dear {blistibimici On August 23, 2011, the US. Department of Health and Human Serv, Of?ce for Civil Rights (OCR), Region IV, received a complaint ?led by (?Emma Ileging that the CVS Caremark Pharmacy the covered entity (CE), located on 38?? Avenue in Beach, South Carolina 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 alleged that on August 8, 2011, a employee impermissiny disclosed the protected health information (PHI) of patients by using the patients? full names and discussing the name and type of medication being prescribed for the patients. 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 iong 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. 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 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 Caremark Pharmacy. 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 Caremark Pharmacy 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. 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 identi?es individuals or that, if released, could constitute a clearly unwarranted invasion of personal privacy. If you have any questions regarding this matter, please contact Ms. Ingrid Dove, Investigator, at (404) 562-7877(Voice) or (404) Sincerely,_ - sev?lt ?gs) Regional Manager Enclosures: Incidental Disclosures Reasonable Safeguards Minimum Necessary DEPARTMENT OF HEALTH 3. HUMAN SERVICES Of?ces the Secretary '5 Voice - {404) 562-7886, (80(1) 368-1019 Of?ce for Civil Rights. Region IV TDD - {404) 562-?384, [800) sat-?res? Atlanta Federal Center, Suite Fax - (404) 5624881 16TTO 31 Forsy?'l Street? s_w_ Atlanta, GA 30303 July 3, 2012 Re: vs. gammark OCR Transaction Number: 11-135023 {mimth Dear On August 23, 2011, the U.S. Department of Heaith and Human Services (HHS), Of?ce for Civil Rights (OCR), Region IV, received your complaint alleging that CVS Caremark Pharmacy the covered entity, located on 38th Avenue in Beach, South Carolina, 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, you allege that on August 8, 2011, a employee impermissiny disclosed the protected health information (PHI) of patients by using the patients? full names and discussing the name and type of medication being prescribed for the patients. This allegation could re?ect 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 Notification 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. We have carefully reviewed your complaint against CVS Caremark Pharmacy and have determined to resolve this matter informally through the provision of technical assistance to CVS Caremark Pharmacy. Should OCR receive a similar allegation of noncompliance against CVS Caremark Pharmacy 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 Ms. Ingrid Dove, Investigator, at (404) 562-7877(Voice) or (404) Sincerely, - kw .2 "Bl?Roosevelt ll/=reema Regional Manager