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May 1, 2012 - April 30, 2013
The Office of Administration's Bureau of Program Integrity (BPI) requires that all employees maintain strict confidentiality concerning the facts of the cases to which they are assigned. No information obtained in the course of conducting reviews may be used for purposes other than the official administration of the Medical Assistance (MA) Program. The overall guiding principle is to provide for the minimum necessary use and disclosure of protected health information required to accomplish the objectives of BPI.
Medical records and claims information are used to determine the necessity, quality and appropriateness of services billed, the accuracy of the coding/billing, resolution of patient complaints, recipient restriction, and for evaluation of the MA Program.
Information may be provided for purposes of treatment, payment, and health care operations. Assisting in investigations, prosecutions, and civil or criminal proceedings related to the administration of the MA Program are all considered health care operations for which necessary disclosure is appropriate. The medical assistance application signed by recipients includes an authorization for release of personal, financial, and medical information for the purpose of determining eligibility and for review of the MA Program.
BPI closely monitors disclosures of personal health information. Any information shared by BPI with other government agencies/medical professionals/contracted associates must be subject to the same applicable rules and regulations regarding protected health information.