Computer and Information Systems

Health care organizations are important in a society /country which gives emphasis on its citizens ' health so that the latter may contribute in the improving of the society as a whole

However , as these health care organizations are indispensable and start to flourish in the present time , threats to these organizations materialized or emerged . These threats cause in the disruption of the normal processes of these organizations , and eventually hamper in the providing of the needed service and health care to individuals covered by these heath organizations

Some of these sources

of threats are 1 ) frauds in claiming health care benefits , 2 ) health care abuse by individuals , 3 ) difficulty in the inquiry of claims status due to system inefficiency , 4 ) misinformation and 5 ) financial instability

However , financial instability and the problem on the fraudulent claims stand out as primary threats to these health care organizations

At one point , failure on the part of collection of premium payments leads to financial instability because a situation would arise wherein the existing finances or capital of a particular health care provider cannot compensate as against a usually high claims benefit payments

On the other hand , fraudulent claims wreak havoc on health care organizations by depleting the latter 's resources through overly stated claims amount , non-existent claiming patients sometimes called as ghost patients , filing of multiple claims , and the use of illegal modus operandi to receive money through benefit payments from the health care provider

The enactment of the Health Insurance Portability and Accountability Act (HIPAA ) in 1996 provided health care organizations with protection needed to forestall or defer the effects of these threats

Wikipedia .org (2006 ) says that title II of HIPAA defines numerous offenses relating to health care and sets civil and criminal penalties for them . It also creates several programs to control fraud and abuse within the health care system . However , the most significant provisions of Title II are its administrative Simplification rules . Title II requires the Department of Health Human Services (HHS ) to draft rules aimed at increasing the efficiency of the health care system by creating standards for the use and dissemination of health care information

HIPAA provided for a Security Rule to help prevent the commission of fraud in stepping up the efficiency and effectiveness of health care organization operations systems

Wikipedia .org (2006 ) added that the final rule on Security standards was issued on February 20 , 2003 . It took effect on April 21 , 2003 with a compliance date of April 21 , 2005 for covered entities and April 21 2006 for small plans . The Security Rule complements the Privacy Rule . It lays out three types of security safeguards required for compliance administrative , physical , and technical . For each of these types , the Rule identifies various security standards , and for each standard , it names both required and addressable implementation specifications

The Administrative Safeguards are policies and procedures designed to clearly show how the entity will comply with the act , while the Physical Safeguards control physical access to protect against inappropriate...