[dataviz1000]

Interesting. My next door neighbor ten years ago was a lawyer a couple years out of law school. He discovered that he could pour through hundreds of medical charts a day and find cases where the doctor under billed the insurance company. He would then sue the insurance company, settle, and split the profits with the doctor. More or less he was mining the charts.

He would sometimes pull up next door with a half dozen tote boxes overflowing with medical records. He would say "hey, dataviz1000, can you help me get these into the house?" He once asked me if I wanted a new job helping him go through all the charts. I don't get involved with illegal activities and I was earning more not breaking the law elsewhere. He did hire a young woman who graduated law school and was still working on passing the bar. Since they have married and started a family.

Yes, HIPAA laws got broken! Yes, this guy made 10s of millions in a few short years.

There are no good guys in this story.

Probably would make a good start up using LLM and bringing the process into compliance with HIPAA. There is probably several billion dollars in insurance companies that have been under billed.

[nradov]

You have garbled that story. When a provider under bills an insurer that is not grounds for a lawsuit. At most the provider can submit a revised claim if it's still within the time limit.

And it's not necessarily a HIPAA violation to outsource medical billing and chart review as long as there is a proper BAA in place, and everyone follows the Security/Privacy Rules. Many small provider organizations pay outside services to ensure they bill at the highest allowable level.

[ec109685]

Are you sure it was illegal?

HIPPA carves out this exception for using your health records:

“To pay doctors and hospitals for your health care and to help run their businesses”

[dataviz1000]

With HIPAA you have to track and store the information every person who touches or reads the medical chart. The issue was more to do with random people reading medical charts.

It isn't difficult to bring the process into compliance. I offered to make an app which would have been easy because there was a predefined workflow that can be diagrammed on a sequence chart in about 10 steps. There were a couple interactions between the lawyer and the doctor. Then a step where the insurance company is notified. Then a lawsuit filed if not paid. At one point, I was researching how to store data in HIPAA compliance in the cloud. It was about 2 years later when AWS provided HIPAA compliant EC2 instances. I offered to build the app for $10,000. Having random people pour over private medical charts and undocumented and haphazard communication between the lawyers, insurance company, and doctors through email and text messages was a mess.

[griomnib]

This almost definitely falls under Business Associate in hipaa and is totally fine.

https://www.hhs.gov/hipaa/for-professionals/privacy/guidance...

[thayne]

The lawyer looking over the records was probably fine. Him paying his neighbor to help him look through them is more questionable.

[lelanthran]

> The lawyer looking over the records was probably fine. Him paying his neighbor to help him look through them is more questionable.

I don't think so. The "paying" part is important - the neighbour becomes an employee for the duration of the work, which is fine, as then there's a contract between the employer and employee which includes, even if only implicitly, that the employers data is not to be exfiltrated.

If he were simply sharing it with his neighbour for shits and giggles that would be a different story.

[dataviz1000]

If there is anything true in this article "What Are The Requirements For Storing Physical HIPAA Documents"[0], laws were broken. But, I'm not a lawyer, what do I know?

[0 https://www.medicaltranscriptionservicecompany.com/blog/what...]

[griomnib]

There was one case where the HHS levied a fine on somebody leaving a stack of boxes on the street. If they are under lock and key it isn’t an issue.

And yes, I think the lawyer does know more than you.

[ec109685]

Yup: “An attorney whose legal services to a health plan involve access to protected health information.”

[lotsofpulp]

So many parts of this story makes no sense.

[refulgentis]

Honestly no piece of this makes any sense, from the thinking this is illegal somehow, to the lawyer jumping to sue because a doctor underbilled (judges would tired of this very quickly, court isn't an automated process to use to threaten people after youve made a mistake)

Checked with a doctor and they said the same and couldn't puzzle out a benign misunderstanding that was right - they pointed out that even if you meant the lawyer sued if the insurance company refused to pay, the economics would be all fucky on the splitting, because now the lawyer does have to go to court, no automated easy money, much less millions.

[dataviz1000]

There was a discrepancy in medical coding. The lawyer was looking for something very specific in the medical charts.

I searched for "how long does a doctor have to bill you in florida" and the a top result was this gem, "A doctor in Fort Lauderdale I saw in 2020 contacted me to tell me that there was a /"billing error/" 3 years ago that they now want paid. What can I do?" That sounds about right.

I don't know the specific details about the lawyer was doing.