How can I distinguish between activities for treatment or health care operations versus marketing activities?

Answer:

The overlap among common usages of the terms “treatment,” “healthcare operations,” and “marketing” is unavoidable. For instance, in recommending treatments, providers and health plans sometimes advise patients to purchase goods and services. Similarly, when a health plan explains to its members the benefits it provides, it too is encouraging the use or purchase of goods and services.

The HIPAA Privacy Rule defines these terms specifically, so they can be distinguished. For example, the Privacy Rule excludes treatment communications and certain health care operations activities from the definition of “marketing.” If a communication falls under one of the definition’s exceptions, the marketing rules do not apply. In these cases, covered entities may engage in the activity without first obtaining an authorization. See the fact sheet on this web site about marketing, as well as the definition of “marketing” at 45 CFR 164.501,for more information.

However, if a health care operation communication does not fall within one of these specific exceptions to the marketing definition, and the communication falls under the definition of “marketing,” the Privacy Rule’s provisions restricting the use or disclosure of protected health information for marketing purposes will apply. For these marketing communications, the individual’s authorization is required before a covered entity may use or disclose protected health information.

Created 12/20/02