The way Jignesh Tanna sees it, he has a right to publish your medical records on the internet if he doesn’t get paid. The thing is, if you see a psychologist or psychiatrist in Charlotte or Gastonia, he may have copies of those records.
For two years, Tanna’s company, Vashi Transcribe, transcribed an average of 100 medical records per day for about 25 doctors in Charlotte, Kings Mountain, Shelby and Gastonia, including those of a doctor at a popular north Charlotte psychiatric practice, for a Shelby company called Accuscribe, Inc. Then he got into a spat with Accuscribe’s owner, Pam Burch. Tanna says Burch owes him $77,000. She claims his work was shoddy and cost her clients, so she refused to pay him. He says his business will go under if she doesn’t.
If Tanna chose to publish your records on the web, there’s not much you could do to remove them, since both he and the server he would upload them to are in India. Medical privacy laws like The Health Insurance Portability and Accountability Act (HIPAA) don’t apply to him, Tanna explained to me last week. Sure, he signed a confidentiality statement when he took the work from Accuscribe, but since he’s outside the US, he can do whatever he wants.
So last week he emailed a fax to Accuscribe’s doctor-clients, informing them that if he didn’t receive payment in 10 days, he’d publish their patients’ records. His words were chilling.
“We are forced to do this, as we have not received our money,” he wrote, “and money is the essence of contracts.”
Panic ensued. By the end of the week, Burch and Tanna were negotiating and Tanna sent out another fax retracting his earlier statement — for now. It’s settled, Burch told me on Friday, nothing to worry about. Of course, Burch also told me she hasn’t paid Tanna either and doesn’t plan to.
And Tanna? Well, he’s still got the patient records as well as those from other customers in Los Angeles, Menlo Park, Norwalk, Oakland, Roseville, Union City, Oklahoma City, Atlanta, Orlando and Kissimmee.
Don’t think this is an isolated incident. Many doctors make use of some form of transcription service, and those services are increasingly sending American medical records to companies in India and other countries that transcribe them at 60 percent of what it costs here. Last week, hundreds of West Coast doctors got the same rude awakening Charlotte-area doctors did. According to the San Francisco Chronicle, an Ohio company called Heartland Information Services, which outsources medical files to India for dozens of US hospitals including several in California, was the victim of an extortion attempt in October by its own employees in Bangalore, who threatened to publish Americans’ medical records unless they received a cash payoff. Those responsible were eventually arrested by Indian authorities.
In another incident three weeks before, the Chronicle reported, UCSF Medical Center received a threat from the Pakistani transcriptionist, who said she would release the hospital’s files online unless she was paid money she claimed she was owed. To emphasize her point, she included copies of patient files in her email. She was paid off by another transcription company in the chain of subcontractors that handle UCSF’s records, the paper reported.
One thing is certain in all this: the patients are always the last to know. Medical privacy laws, including HIPAA, allow healthcare providers to share your records with “business associates” with whom they have contracts, including those overseas, without informing you about it or asking your permission.
If your records wind up on the internet, you’re pretty well out of luck under US privacy laws. Although the law requires them to make a reasonable effort to check these companies out upfront, healthcare providers aren’t required to monitor what the companies do with your records after they’re transcribed.
Since the law doesn’t hold the business associates responsible, said Tena Friery, Research Director at Privacy Rights Clearinghouse, and patients can’t sue under HIPAA, they’re pretty much left with one option — suing their doctor for civil damages and hoping they can find a lawyer creative enough to make it stick. Even then, getting their medical records off the web might prove impossible.
The sad reality is this: Unless you know beyond a shadow of a doubt which company your doctor sends your records to for transcription — and where that company sends them — you can’t tell him or her anything you don’t want to come up in a Google search of your name on the web.
Unfortunately, finding out where your records go, and where they’ve been, might not be so easy. Last week, I called about half the transcription companies in the Charlotte phonebook, some of which have offices or phone numbers here and websites run out of India. Not one would give me a straight answer when asked whether they send medical records overseas for transcription.
If a 40 percent savings on their transcription costs is all the motivation some healthcare providers need to sell out their patients, it’s a sad day for the medical profession in this country.
Contact Tara Servatius at tara.servatius@cln.com
This article appears in Apr 7-13, 2004.
