Can an employer ask an employee about personal health matters (HIPAA) and COBRA decision in public? Hypothetical Scenario (in the US): Susan's employer, MoneySavers, offers COBRA to employees who separate from the company. Susan has given her two weeks' notice (she has quit her job) and will soon have her last day. She works in an open office without cubicles and little conversational privacy. Susan asks Emily, an HR representative (at Emily's desk) how/when Susan might receive COBRA paperwork. Susan expects to hear something like, &quot;You'll receive it in the mail within 4 weeks.&quot; Instead, Emily responds, &quot;Are you planning on using COBRA?&quot; Emily continues, &quot;You have to elect if you are going to use COBRA,&quot; with the implication that Susan needs to answer &quot;yes&quot; or &quot;no&quot; immediately. Several co-workers hear the conversation and add their own comments. One co-worker, Mike, the CFO, who arranged MoneySavers COBRA program, adds, &quot;Susan, no former employee would ever plan to use COBRA.&quot; Susan admittedly could have tried to make her conversation more private and her co-workers could have been more prudent in their comments. However, were any laws violated here? Specifically, was it lawful for Emily to ask Susan, before she has left MoneySavers, if she will elect to use COBRA? If it were lawful for Emily to ask, would it need to be asked in a private setting? What other legal issues are at play in this situation? Financial (Not Legal) Factors: Susan is still employed and thus could be treated differently in her last two weeks depending on how she responds because MoneySavers cuts costs whenever possible. More context: In this specific scenario, MoneySavers may incur costs if an employee elects COBRA because of a health reimbursement (HRA) program it offers. Financial question: Does anyone know if an employee elects COBRA, and then incurs a large claim while on COBRA, could increase MoneySavers health insurance renewal rate for the next year? Normally, health insurance claims made by current employees can increase MoneySavers health insurance renewal rate.
It's probably not unlawful to ask, but an answer cannot be required immediately. Per the Department of Labor, Susan has 60 days to elect COBRA coverage (the qualifying event here being the termination of Susan's employment): Your plan must give you at least 60 days to choose whether or not to elect COBRA coverage, beginning from the date the election notice is provided or the date you would otherwise lose coverage under your group health plan due to the qualifying event, whichever is later. It would be unlikely for an employer to discourage an employee from electing COBRA coverage due to costs to the employer, as you suggest: Susan is still employed and thus could be treated differently in her last two weeks depending on how she responds because the company is struggling financially and is looking for every opportunity to save money. Susan electing to use COBRA coverage is unlikely to cost the company money, because the employer is permitted to charge her the entire cost of the coverage, plus 2 percent to cover the cost of administering it (additional DoL source). As far as privacy goes, I don't think anything illegal has occurred here. The most prevalent law regarding privacy of health information, HIPAA, generally does not apply to employers. Susan could, of course, request a private discussion, and any response from Emily could not rise to the level of illegal harassment or create a hostile work environment.
We're missing a lot of information that we'd need to offer a full answer. Here are some of the things that will probably drive the analysis: the type of counselor we're talking about; the types of information the counselor disclosed; the reason she disclosed it; the job functions of the people to whom she disclosed it; the reason the client is bothered by the disclosure. Generally speaking, a mental-health counselor has a fiduciary duty to maintain the confidentiality of patient information, but my understanding is that in most cases, the counselor would be allowed to discuss a case with colleagues for the purposes of advancing the patient's treatment. So discussing the facts of a tough case with a supervisor is not going to be as problematic as idly gossiping about clients with custodial staff. Beyond the permitted disclosures, there are also situations in which counselors are required to disclose confidential information, including cases where the counselor suspects child or elder abuse or where the counselor believes the client poses a danger to herself or others. If the disclosure was truly not permitted, then it may be that the client has a claim for breach of fiduciary duty. In Georgia, proving that case requires evidence that: That the counselor had information relating to the client that she knew or should have known was confidential; That the counselor communicated the client’s confidential information to third parties; That the client did not give informed consent to the counselor’s conduct; That the confidential information was not a matter of general knowledge; and That the disclosure harmed the client. As you noted, the client could also file a complaint with the state licensing board. I don't know of any federal laws or regulations that would come into play in the situation you've described.
Late to the party, but I'll answer anyways. In general, providers have a lot of wiggle room when sharing information with parents, on condition that the patient hasn't explicitly objected despite having opportunity to do so. HIPAA allows the provider to make a judgment call on whether such information can be shared without explicit consent: Quoting Title 45 § 164.510 : (i) Obtains the individual's agreement; (ii) Provides the individual with the opportunity to object to the disclosure, and the individual does not express an objection; or (iii) Reasonably infers from the circumstances, based the exercise of professional judgment, that the individual does not object to the disclosure. HHS does discuss disclosure to family members in their FAQ : A covered entity is permitted to share information with a family member or other person involved in an individual’s care or payment for care as long as the individual does not object. A parent of a child who has just turned 18 is likely still somewhat involved in the child's care, so, absent either an objection or a reason to believe the child would object if asked, sharing is probably not a violation.
The primary question is whether remaining silent would constitute a breech of medical ethics. The pertinent ethical principle is AMA Opinion 2.15 One of the requirements is that the donor be assigned an advocate team whose interest is the donor, not the patient, and these should generally be distinct individuals in order to avoid conflict of interest. Assuming that the donor's team is aware of this fact, they have a duty to disclose it, since it materially affects the donor's willingness to donate the organ. The ethical opinion does not specifically address &quot;patient breaking up with a directed donor&quot;, but there is a general obligation to share information, and it would probably be found to be a breach of medical ethics to suppress relevant non-medical information. The ethics of directed donation from live donors is not well-developed. I will mention that Potential donors must be informed that they may withdraw from donation at any time before undergoing the operation and that, should this occur, the health care team is committed to protect the potential donor from pressures to reveal the reasons for withdrawal. If the potential donor withdraws, the health care team should report simply that the individual was unsuitable for donation. From the outset, all involved parties must agree that the reasons why any potential donor does not donate will remain confidential for the potential donor’s protection. In situations of paired, domino, or chain donation withdrawal must still be permitted. Physicians should make special efforts to present a clear and comprehensive description of the commitment being made by the donor and the implications for other parties to the paired donation during the informed consent process. Neither team can tell the patient that the reason the girlfriend withdrew was because they ratted him out (anyhow, we can suppose she said something to him on her own). The hospital knows this fact, and has both a duty to the patient to solve a medical problem but also to the donor to be sure that the consent is informed. The hospital would be suppressing a fact relevant to the donor's willingness to undergo the operation, which is a breach of duty. This fact is not protected by HIPAA, or any other California statute, so does not supersede the obligation to reveal relevant facts.
A NDA can only cover confidential information, that is information that is not in the public sphere, and that was transmitted to the recipient in confidence, that is it is specifically identifiable information that the recipient knew or should have known from the circumstances of the communication was confidential. For example, "marketing techniques" are not confidential information although the specific marketing strategy (pricing, promotion etc.) to be employed for a particular group may be confidential if the circumstances of the communication are such that the recipient should have known they were. Telling them "Hey, this marketing strategy is confidential" is best, however, the nature of the communication may make it implicit, for example, if it is only communicated to a subset of employees and contains information that would obviously damage the organisation if made public such as a price or client list. An NDA that states "all information given is confidential" is probably not enforceable even if exceptions are given because a) it is manifestly untrue (how can the location of the bathrooms or which day is pay day be confidential?) and b) it places an unreasonable burden on the recipient to determine what is and what is not real confidential information.
I did not write "confidential" on my letter, but I assumed a business proposal is automatically considered as a confidential material. An incorrect assumption unfortunately. Unless you have a confidentiality agreement (NDA) with the first company, they and their agents are not under any legal obligation to keep information you share with them confidential. How is the legal situation here? There is none on your side. You lied about a direct question asked and were caught in the lie. Company A had no obligation to keep what you sent confidential. Even if they did, that may not (depending on how the confidentiality agreement is worded) keep the employee of company A stating that they had received the same proposal. Chalk this one up to a lesson on confidentiality and honesty in business. There are no reasonable assumptions of confidentiality in business unless you specifically state that they are confidential or are provided as part of a confidentiality agreement.
It would merely be a &quot;jerk move&quot;. HIPAA only applies to &quot;covered entities&quot;: Healthcare Providers Health Plans Healthcare Clearing Houses (i.e. Paying for your health care) Business Associates of the Above) Source: CDC page on HIPAA
Why would this be a concern? The adults have some duty in an elementary school setting to monitor the children in the restroom in any case. Separate restrooms are an employee perk, not a liability driven decision.