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In New York, all medical records are the property of the physician or the hospital that created the records. The law provides that patients and qualified persons have access to the patient’s medical records with the proper HIPAA authorization release. Qualified people are patients, guardians of incapacitate persons, conservators of an incompetent, administrators or executors of deceased patients, parents of infant patients, distributors f deceased patient’s estate, and lawyers who represent patients or patients’ estates.
In some cases, normally, during a billing audit or an investigation, an insurance company or its representative will make a demand on a physician (or another practitioner) to produce patients records for the insurer’s review. I have represented numerous clients in such cases. What is important to realize is that in some situations production of medical records could violate HIPAA. In cases where no HIPAA violation exists, the records are most likely be examined in order for the insurer to support a determination that fraud has been committed. The information in the files will be extrapolated to the other cases the practitioner has had with the insurer. If there is any irregularity found in what has been provider, the insurer will often assume that these irregularities occur across the board in all other cases. In some situation, this may even expose the physician to criminal liabilities.
Always consult an attorney when any agency demands medical records from your practice before complying. If you have any questions and want to discuss your case, call our NYC defense attorneys at (212) 577 6677.