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Medical Informatics Engineering, Concentra, Employers, Data Sharing, And Privacy

Medical Informatics Engineering logo After receiving the breach notice from Medical Informatics Engineering (MIE) via postal mail, my wife and I wondered how MIE acquired her information. MIE's breach notice mentioned Concentra, a healthcare company we haven't and don't do business with. Today's blog post describes what we learned during our search for answers, and how consumers aren't in control of our sensitive personal information.

Background

The breach was massive. The Journal Gazette reported 3.1 million breach notices sent to affected consumers nationwide. The U.S. Department of Health & Human Services listed 3.9 million consumers affected.  Readers of this blog have reported breach notices received via postal mail in Alabama, California, Colorado, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Maryland, Massachusetts, New Hampshire, Tennessee, Texas, and the District of Columbia. Concentra was one of many health care providers involved.

During our search for answers, my wife contacted her employer and a local clinic. Neither does business with No More Clipboard (MIE's cloud-based service) or with Concentra. On her behalf I contacted Concentra's nearest office in Wilmington, Massachusetts. The office's administrative person searched for information about my wife in Concentra's database. No record. The administrator referred me to regional human resources representative, who confirmed the breach and suggested that Concentra may have obtained my wife's information from data-sharing during a sales pitch with employers. We continued to look for firmer answers.

Select Medical logo The HR representative referred me to Edwin Bodensiek, the Vice President of Public Relations at Select Medical, the corporation that acquired Concentra in May, 2015. Select Medical's First Quarter 2015 10-Q Filing (Adobe PDF) explained:

"[Select Medical Holdings] announced on March 23, 2015 that MJ Acquisition Corporation, a joint venture that the Company has created with Welsh, Carson, Anderson & Stowe XII, L.P. (“WCAS”), has entered into a stock purchase agreement, dated as of March 22, 2015 (the “Purchase Agreement”), as buyer with Concentra Inc. (“Concentra”) and Humana Inc. (“Humana”) to acquire all of the issued and outstanding equity securities of Concentra from Humana. Concentra, a subsidiary of Humana, is a national health care company that delivers a wide range of medical services to employers and patients, including urgent care, occupational medicine, physical therapy, primary care, and wellness programs... For all of the outstanding stock of Concentra, MJ Acquisition Corporation has agreed to pay a purchase price of $1.055 billion..."

Humana had acquired Concentra in 2010. Now, Concentra is part of Select Medical. i contacted Mr. Bodensiek asking when, why, and how Concentra obtained my wife's sensitive personal information. My wife and I weren't sure we'd get any answers, and if so how long it would take.

What We Learned

After about a month, Mr. Bodensiek called with some answers. My wife had taken a temporary part-time job in February 2014 and that second employer used the Humana Wellness (e.g., Concentra) health care services. Mr. Bodensiek explained that the second employer sent an "eligibility file" to Concentra with data about its employees that were eligible for the employer-sponsored health care plan. That's when my wife's name, address, phone, and Social Security Number were transmitted to Concentra; and then to MIE, the electronic medical records vendor for Humana Wellness. Mr. Bodensiek described this as standard business practice.

My wife and I have health care coverage elsewhere, so she never had any intentions nor did not register for health care through this second employer. My wife's situation is not unique since five percent of the U.S. workforce works two or more jobs. (Vermont, South Dakota, Nebraska, Kansas, and Maine lead the nation with people working two or more jobs.) It's great that this second employer offered health care to its employees, but not so great that employees' sensitive information was shared regardless of whether or not the employees expressed an interest in coverage.

I'd like to publicly thank Mr. Bodensiek for his hard work and diligence. He didn't have to help, but he did. It gave us a good first impression of Select Medical. Hopefully, other breach victims have had success getting answers.

Implications And Consequences

Our experience highlights a business practice consumers should know: your employer may share your information with their health care provider whether you subscribe or not, and maybe without your knowledge. Maybe this sharing was for employees' convenience (e.g., faster, easier sign-up for health care), or for the employer's convenience (e.g., minimize processing effort and expense) by sending one, massive eligibility file. Regardless, the business practice has implications and consequences.

First, when an employer's administrative process sends to their health care vendor data about all employees (without an opt-out mechanism), then more data is shared than otherwise, and the process is arguably less private. Why? The health care provider receives and archives information about both subscribers and non-subscribers; patients and non-patients. A process based upon opt-in would be better and more private, since the data shared includes employees who want to sign up for their employer's health care plan. Simply, fewer employee records with sensitive data (e.g., name, address, phone, Social Security Number) are shared, and less data for the health care provider to archive and protect (and further share with a cloud vendor).

Regarding the MIE breach, eligibility-file-sourced data about my wife was archived by MIE. That means MIE archived eligibility-file data about many other employees. So, MIE's database includes data about health-care subscribers and non-subscribers; patients and non-patients. When data breaches happen, the stolen archived data about non-subscribers opens those non-subscribers to identity theft and fraud risks. How long will this data about non-subscribers be archived? When will data about non-subscribers be deleted? Select Media didn't say. I can only assume the archiving will continue as long as they decide, either solely or in combination with their employer clients.

Second, costs matter. The more data shared, the more records the health care provider and electronic records vendor must archive and protect. When data breaches happen, more data is lost and data breach costs (e.g., investigation, breach notification, identity protection services) are greater. A 2015 study by IBM found that the average total cost of a data breach was $3.8 million, up 23 percent from 2013. Given this high cost, you'd think that employers and health care providers would work together to minimize data sharing. Probably not as long as consumers bear the risks.

Third, if my wife had signed up for health care services with Concentra, then much more sensitive information would have been stolen in the MIE breach. One may argue who is to blame for the data security failure (e.g., breach), but at the end of the day: the employer hired Concentra, and Concentra hired MIE. There is enough blame to go around.

Fourth, the MIE breach highlights some of the places employees' sensitive information can be shared without their knowledge (or consent). If the MIE breach hadn't happened, would employees know their medical records were stored in the cloud? Would employees know about the eligibility-file sharing? One wonders. Employees deserve to know upfront.

Your sensitive personal information also moves when companies (e.g., health care providers, employers, cloud vendors) buy, sell, and merge with other companies. that includes your medical records. Since eligibility-file sourced data is archived, you don't have to be a health care plan subscriber or patient.

Fifth, for information to be private there must be control. The eligibility-file sharing suggests that employers have the control and not employees. Consumers like my wife have been taken steps to protect themselves and their sensitive information by locking down their credit reports with Security Freezes. That data protection is largely undone by eligibility-file sharing with health care providers. Not good.

Consumers need a comparable mechanism to lock down their medical records and prevent eligibility-file sharing. Without a mechanism, then consumers have no control over both their medical and personal information. Without control, consumers lack privacy. You lack privacy.

It will be interesting to watch how Select Medical manages its new acquisition. The Select Medical website lists these core values:

"We deliver superior quality in all that we do. At Select Medical, we set high standards of performance for ourselves and for others. We provide superior services to our patients. We continually strive to uphold and improve our reputation for excellence.

We treat others as they would like to be treated. At Select Medical, we treat each other with respect and promote a positive environment where people feel valued. We are honest and open in our relationships and straightforward in our communications.

We are results-oriented and achieve our objectives. At Select Medical, we are focused and decisive in achieving our objectives and helping others achieve theirs. We accept responsibility for our decisions and actions. We are accountable for using our time, talents and resources effectively."

My wife and I know how we want to be treated. We wanted to be treated with respect. We know how we want our sensitive personal and health information treated:

  • Don't collect it unless we're patients,
  • Don't archive it unless we're patients,
  • Don't share it without notice and consent. Consent must be explicit, specific, for a stated duration, and for specific purposes,
  • Don't collect and archive it if you can't protect it,
  • Be transparent. Provide clear, honest answers about breach investigations and data-sharing practices,
  • Don't try to trick us with promises of convenience,
  • Hold your outsourcing vendors to the same standards,
  • Don't make consumers assume the risk. You benefited from data sharing, so you pay the costs, and
  • Two years of credit monitoring is insufficient since the risk is far longer.

What are your opinions? Does the data sharing by employers bother you?

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