[jastanton]

I was nodding along until this:

> They posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address,” she said.

wow. That violates HIPAA law. The counter-sue is going to be huge.

Also, I had a related issue where a doctor threatened to sue based on my yelp review. I cut the review back to verifiable facts instead of opinion and asked if that compromise was ok, he said it wasn't and started claiming it was defamation. I cut off contact and that was that. I wondered if it was possible to be dragged into court by something like this, apparently I may have dodged a bullet. Scary stuff.

[leeter]

Reviews are protected speech, this has been litigated multiple times and has precedent in the US. If you live in an area with a SLAPP law I would suggest getting an attorney to file a SLAPP motion for you. The onus is then on the plaintiff to prove they aren't suing you to stifle your speech. If they can't then they have to pay full court costs and your attorney's fees as well as a penalty in many jurisdictions.

In this case the subject is in NY state which has an Anti-SLAPP law and she should apply it and HIPAA.

https://en.wikipedia.org/wiki/Strategic_lawsuit_against_publ...

[ballenf]

That's fine but they don't have to pay until after the case and appeals. Meaning you have to be able to front the litigation costs in order to have a chance at recovering them. There is a non-zero risk of losing.

I would suggest using a pseudonym and VPN for any review written on a potentially litigious business unless you have the funds to litigate. Problem is Yelp is much more likely to mark the review as spam.

[imbur]

Many lawyers will take anti-slapp cases on contingency so you don't have to pay up front either

[TAForObvReasons]

> "They posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address,"

We are hearing one side of the story here. HIPAA violations have teeth -- potentially 10 years imprisonment for intentional leaks for personal gain -- so a vindictive public action is highly unlikely, and certainly some lawyers would take the case on spec. Especially if personal information like driver's license info and home address were leaked.

What likely happened is this quip triggered the mess:

> “I suspect that this doctor gives unnecessary procedure [sic] to a lot of people and then charges the insurance sky high prices and no one knows the difference.

Levine is accusing Song of health care and medical insurance fraud. While there's some ambiguity regarding "unnecessary procedures", insurance fraud is a crime and arguably Levine is accusing Song of criminal behavior

[Nadya]

Another user, Siphor, went through the documents in a response on another thread [0]. I think the second paragraph adds some important context, especially in regards to the accusations of Mr. Song committing insurance fraud.

>The most damning thing in there was that the Doctor tested for HHV-6 (something 100% of humans have) and then charged for it and claimed it was HHV-2 (genital herpes). Theres apparently a lab technician available to testify that the Doctor commonly tests for HHV-6. Guy seems sleazy.

[0] https://news.ycombinator.com/item?id=17182181

[ntunh43hue98]

That's not entirely correct. There are 2 different forms of HHV6. HHV6B is present in almost 100% of the population[1] (but not quite 100%). HHV6A is less frequent in Japan, North America, and Europe. It can also cause problems for infants when they first acquire it. From the same link:

>HHV-6 primary infections account for up to 20% of infant emergency room visits for fever in the United States

The test can be used to assess viral load, which may indicate other issues, I'm told. (I'm not a doctor, though.) If you have a very high viral load of HHV6, it may indicate something else is going on. However, that doesn't mean it was necessary in this patient's case. But the test exists for legitimate reasons.

[1] https://en.wikipedia.org/wiki/Human_herpesvirus_6#Epidemiolo...

[doktrin]

what's the point of ordering a nonsense lab test? Is a HHV-6 test significantly cheaper than one for HHV-2?

[matte_black]

What if you win but they immediately go bankrupt and cannot pay you back?

[leeter]

Courts have a tendency to look on this as criminal contempt and refer the lawyer and the client to the various AGs when this happens.

[jessaustin]

Physicians with their own practices might have low net worths, but they still have lots of assets to distribute in case of bankruptcy. IANAL, but a patient with a judgement would jump ahead of lots of creditors in such an event.

[joering2]

They can go bankrupt the second judge handles verdict, but this would definitely be out of scope of said person bankrupcy proceedings similar to your education loan cannot be included into bankrupcy. the judge proceeding in bankrupcy claim will clearly see whats this is about.

[wdn]

Protected or not, the defendant still have many out of pocket cost and distress for defending a lawsuit. Lawyers don’t care. They will get pay. The judge usually don’t read the case until the time of the trial but your expenses is up front and no guarantees of outcome.

I was sued and I pro-se to defend myself. Although the plaintiffs know the lawsuit is frivolous but that doesn’t matter. He said if I don’t apologize and I win the case, he will just spend more money appeal the case and make my life miserable. I apologized and he dismissed the case.

It probably caused him some money, but it had caused me a lot of distress and time reading up the laws.

[Nadya]

>Wow. That violates HIPAA law. The counter-sue is going to be huge.

Basically an open and shut case too. Assuming they were smart enough to "correct" the mistake it may not be a Tier 4 ($50,000+) violation, but instead a Tier 3 violation ($10,000 - $50,000 per violation) of willful neglect. I'm not sure if each violation above would be considered a single large violation or multiple small violations ( 1 violation vs 7 violations is a major difference in penalty cost). There's also SLAPP.

If litigation has gone on long enough to cost her $20,000 in legal fees I can't help but feel there is a lot more to this story or my understanding of the legal system is completely out of touch...

[SolarNet]

The quote is taken out of context I think (this is a tabloid) the doctor probably posted the information to the court docket under seal at the request of the judge or at least probably in accordance with the law.

[siphor]

I just went through the documents and that doesn't seem to be the case... Doc #43 is a request to the judge to remove Doc #24 due to HIPPA violations. Doc #24s not there anymore. Pretty interesting, and the tabloid seems to be accurate.

The most damning thing in there was that the Doctor tested for HHV-6 (something 100% of humans have) and then charged for it and claimed it was HHV-2 (genital herpes). Theres apparently a lab technician available to testify that the Doctor commonly tests for HHV-6. Guy seems sleazy

[coding123]

haha, that's really interesting to hear. I'm almost certain a Judge is also not allowed access to medical records. He most likely is not a covered entity. Beyond that while it might make sense to request medical records in a criminal trial, there's no place for that in a civil suit.

[Nadya]

HIPAA allows health care providers to disclose medical records in response to a court order as long as the order specifies the scope of the records required to be disclosed and is signed by a judge.

[CodeWriter23]

Court order != Filing Suit

[albedoa]

The docket persists beyond the filing and can have records attached to it under seal by order. Nadya did not draw the equivalence you are correcting.

[phonon]

If the civil suit is about medical treatment, do you really think posting responsive documents to the court docket is a HIPAA violation?

[fencepost]

If the civil suit is about medical treatment, do you really think posting responsive documents to the court docket is a HIPAA violation?

If it's not posted under seal, then yes. Particularly if it's posted as part of the initial filing and not as a response.

[titanomachy]

This is the only interpretation that remotely makes sense.

[alexbanks]

You seem like you know what you're talking about. A few years ago, I got a Facebook message from a girl that lived in my town. She said something like "This is really weird, but did you have shoulder surgery by X doctor last October? If so, that surgeon just did my knee and after my rehab told me that she thought you and I would be a good match. Would you want to grab dinner sometime?"

I was really confused. Wasn't this a HIPAA violation? If yes, what do you even do about it? Feels like a cause for concern if your doctor is also trying to play cupid? What should I do/have done?

[Nadya]

I work in a tech-related healthcare field where I'm required to undergo HIPAA training and (often) end up needing to educate clients on potential violation risks. Nowhere as good as a lawyer but I deal with it on a daily basis at least. So take this as the typical "I am not your lawyer or pretending to be a lawyer - go speak with an actual lawyer" disclaimer.

>Wasn't this a HIPAA violation?

100% yes that was a HIPAA violation and honestly anything shy of giving your information to people who actually need it (aka: any hospital/practitioner you visit who should be aware of your medical history) is a violation with very few exceptions (mostly legal ones). Gossiping about patients is probably one of the most common violations.

>If yes, what do you even do about it?

Depends how much you care and how long it has been since the event happened and you became aware of the violation. If it happened within the last 6 months you can report it online through the process xapata linked you. If it's been over 6 months it's too late to report. I'm not sure if "it happened but I didn't know it was a violation until recently" counts as a start date for the "aware of the occurrence" limitation. Would be a great question for an actual lawyer.

You also don't know what else could possibly have been said about you or your medical history - so I'd keep that in mind when deciding if this violation is a "big deal" to you personally or not.

[xapata]

https://www.hhs.gov/hipaa/filing-a-complaint/index.html

[robocat]

Did you pick a nice restaurant?

[Camillo]

Loneliness is a serious health risk, rivaling smoking or obesity. Perhaps your doctor was simply prescribing treatment.

[avn2109]

Twenty grand in legal fees in Manhattan is about four days of attorney time, if you're lucky.

[leesalminen]

$20,000 is nothing for litigation these days. Most advise planning for a minimum of $50,000 or $100,000 to fight something out with a judge.

[gamblor956]

Former trial attorney here...Would really like to know the source of those claims. $20k would cover most civil litigation cases not involving serious injury or death. $100k would cover pretty much any civil or criminal action. Beyond that, you'd have to be employing some extremely expensive specialists.

And that assumes that the lawyer isn't handling the case on contingency.

Generally, the reason people overestimate the costs of trials is because standard contingency fees are 30%-40% of judgements.

[poulsbohemian]

My divorce should have been an open/shut deal and never went to trial - still cost me > $12,000. I have another pending business lawsuit that I fully expect to cost ~$10,000 for what should be open/shut contract dispute. Lawyers are really good at wasting time while pretending to be doing something meaningful, and as a lay-person I have little recourse other than to play "Go fish!" and try to find another lawyer. So, $20K for anything of any substance doesn't surprise me.

[xapata]

If lawyers are like programmers, the fees can easily be 10x different from one to another. I'll bet there are some $50/hr lawyers and some $5,000/hr lawyers.

[simonbarker87]

Serious question that I feel I already know the answer to but, how do people afford to defend themselves if the costs are that high?!

[dmitrygr]

Serious, and depressing, answer. They don't. This is why plea bargaining is rampant in America. It isn't necessarily very fair, because for many people this ends up ruining their lives. But facing the choice of POTENTIALLY going to prison for a number of years, and to jail for weeks awaiting trial, or pleading guilty to something that does not put them jail at all, they choose the latter (since a few weeks of absence from the world messes your life up quite a bit if you didn't prepare - you'd lose your job, maybe apartment). Even if that plea forever taints them in the eyes of employers

[coding123]

This is a civil case obviously, so all that jail stuff won't apply to this, but just curious... If cheap litigation is 20K, and "battling out with a judge" is 100K how come the first time I'm hearing about this is in a HN comment? Seems like no one is going up to bat against this stuff until it affects them.

Reminds me of that famous poem "First they came for the ..."

[Jach]

Peter Thiel got a lot of flak for this comment: "If you’re middle class, if you’re upper middle class, if you’re a single digit millionaire like Hulk Hogan, you have no effective access to our legal system. It costs too much. This was the modus operandi of Gawker in large part, to go after people who had no chance of fighting back."

It's somewhat hard to square with "litigious culture" criticisms of some parts of the country. But the details matter. Filing & defending in small-claims court is pretty cheap without a lawyer (and even with one is "only" in the small thousands) and person-vs-person cases won't be too terrible compared to companies-vs-individuals...

[dmitrygr]

Good point. In civil cases the equivalent is a "settlement offer". Made famous my the RIAA. Pay us $5000/song you downloaded or we'll sue you for $5 million, and you cannot afford that. We might not win, but if we do, you're boned!

[simonbarker87]

Ok thanks, kind of what I guessed but as I’m not in the US I wasn’t certain.

[amelius]

And another question: why is the market failing here?

[wyldfire]

One (modest) force that coerces the market: you nearly always must attend law school. Unlike Lincoln, John Adams, Marshall, et al, you have to get a degree from a law school in order to become an attorney. Apprenticeship is peanuts compared to getting a degree (provided you can find a sponsor). There's a handful of US states that still permit apprenticeship, but most do not.

[amelius]

Ok, then why is law school so expensive? It seems to me that classes could be offered online without practical problems, and exams could be organized on a national level.

[HeyLaughingBoy]

The market isn't failing; that's the market rate!

[MereInterest]

The market is not failing to determine a market rate. The market is certainly failing to provide equal access to the legal system.

[jumelles]

This is the market working; the market itself is thus a problem too.

[unethical_ban]

That is awful, and they should be punished severely for that.

This reveals a predicament for businesses that have to protect customer privacy. If a restaurant owner thinks a customer is lying, they can call the person out on all kinds of media and say they're a liar. Alamo Drafthouse made a set of videos to play before movies making fun of a customer complaint call, telling her to eff off.

If a doctor believe a patient is lying or doing a detriment to their business, they can't call them back out on social media. Their only remediation, if they think the statements are false, is a lawsuit to have the force of law take lies down.

[dm319]

This is why, at least in the UK, there are several pathways to resolve disputes - both in the hospital trust and above it, which is in part to avoid this kind of scenario. If that doesn't resolve it the patient usually approaches a lawyer to seek compensation, and most times this is settled out of court and in private. When patients and family hit social media, the hospital/doctors are not able to publicly talk about the grievances, or can only put out a very limited public statement with permission (like the recent Alfie case).

I had a friend of mine who refused a request by a patient out of the country, while on-call one weekend. I'll leave out the details apart from it involved shipping a large quantity of a very expensive medication to another country - as the hospital did not have this medication available. He had already sent enough of this medication to cover for at least a week (at huge cost to the NHS, as the medication had to be couriered by plane) when a second request was received 2 days later. A huge internet hate-mob appeared on Facebook saying all sorts of things about this doctor by name, to which he had no ability to respond.

I'm for making healthcare more transparent, but I wonder if, as a doctor, we'd be pressurised into pleasing the patient more than treating the patients correctly, with the threat of negative yelp reviews, though that's obviously a risk with any sort of profession and review system.

[SOLAR_FIELDS]

Not to discount your point, because it's mostly relevant, but in the Alamo Drafthouse case I don't ever think they reveal the name of the girl who makes the call.

Though I guess if a phone call had protected HIPAA information and you could tell who it was through their voice it might be a violation?

[heisenbit]

Deliberately writing bills for services not performed is fraud. Of course there can be billing mistakes and corner cases where it is not clear what exactly has been performed. Excessive billing that goes beyond what insurance pay can motivate people to fight back...

There are so many things wrong in how the doctor behaved it is mind-boggling and a big red flag. Fighting angry and stupid people in court is best avoided but one does not always have a choice.

[conanbatt]

You've heard only one side so far.

[brightball]

My question around reviews in medical is always around how a physician is supposed to be able to respond because of HIPAA? It almost seems unfair to be able to review them since there is very little they can do to refute anything without violating it.

It seems like there should be some special set of rules around medical reviews, in my opinion at least.

[b_t_s]

If it's BS, call them on it with something along the lines of "We dispute the veracity of this claim. Further, the alleged conduct is a felony, so if the client genuinely believes their allegations, we encourage them to file a criminal complaint at their local police station." This conveys "client is a nut, we are professionals, and we can prove it" whereas arguing the details of a case with confidential info in a public forum is wildly unprofessional and sometimes illegal.

[ballenf]

You can explain just that in the response and not much more.

Even if the patient reveals PHI you should avoid confirming or acknowledging it as the "covered entity" under HIPAA. A confirmation of a diagnosis is different than a person discussing symptoms. I would argue that you probably should avoid even acknowledging that the person is a patient or has been seen in the office. The approach will reinforce to others how seriously you take privacy and you can taut your customer service policies, etc.

I wouldn't call this unfair since all providers are in the same situation.

(This isn't legal advice, obviously.)

[SilasX]

It's not unfair in the sense of "advantage over competitors", but it definitely seems unfair in the sense of "not being allowed to publicly refute public allegations against you".

[lazyasciiart]

Reviews are opinions. Some of them are lies. Some of them are fake. It is almost never a good idea for a business to try a detailed rebuttal to a negative review, no different for doctors.

[danieltillett]

You are assuming this is true. I have read through the case records and I am not confident that anything the defendant says is true. If it is false then the defendant will have just increased their loss - judges tend not to look to favourably on running a PR campaign outside of the court process.

[conanbatt]

It cant be understated how a bad review on yelp can tear your practice down and put you on the street. Figure a physician sees 16 to 22 patients a day, and if one of them tanks you you can lose everything.

Review wars are real in all retail businesses, its pretty sad.

-----

I cannot imagine a lawyer would condone the HIPAA violation, I wonder if there are exceptions when the patient has made that information public before you (patient said she had x, and you say "We did not diagnose x") or smth.

[dawnerd]

I've been threatened with a lawsuit over a review before. Even though I know I'd be in the right, just the processes of going to court and defending yourself is a huge pain. Not sure why a company would risk trying to sue someone over a review when it would undoubtedly backfire and be really bad pr for them.

Definitely recommend checking out libel insurance. Shouldn't cost much to get and will help protect against companies trying to go after you.

[fencepost]

Revision: "This review removed under threat of a lawsuit."

And to be scrupulously neutral, 3 stars if that's an option.

[ikeboy]

>I cut the review back to verifiable facts instead of opinion

Opinion is allowed, verifiable facts are allowed. False statements of facts are not.

[xapata]

If you like to write reviews, buy umbrella insurance. It's cheap and covers all sorts of random stuff for millions.

[rokhayakebe]

Detailed anonymous review, no one can sue you.