Blog Post

Business Associate Agreement Under HIPPA:  Your Clients Are Protected; Are You?

Robert Haney • September 27, 2018

Representing healthcare clients is a very involved and complex task for any attorney to handle. This is especially true from a compliance perspective. The Health Insurance Portability & Accountability Act of 1996 (“ HIPAA ”) provides the requirements for the privacy and security rules regulating protected health information (“ PHI ”) of individuals and entities. Additionally, the HIPAA Privacy Rule and Security Rule (the “ Rule ”) set forth the rules for enforcing HIPAA violations and handling notifications involving any breach involving PHI (a “ Breach ”). Individuals and organizations required to comply with the Rule are called “Covered Entities.” However, the application of HIPAA does not stop at Covered Entities. HIPAA also applies to the business associates of Covered Entities, a role that is occupied by many attorneys representing Covered Entities.

What is a Business Associate?

On January 25, 2013, the final changes to the Rule were published. Under the Rule, a “business associate” of a Covered Entity can be held directly liable under HIPAA for a Breach. The Rule provides for three types of business associates working with or on behalf of Covered Entities: (1) business associate subcontractors; (2) entities routinely transmitting and accessing PHI; and (3) personal health record vendors.

Generally speaking, attorneys representing Covered Entities or business associates are business associate subcontractors if, in representing a Covered Entity or business associate, the attorney requires access to PHI in order to do their work for their client. If an attorney is a business associate, then a written Business Associate Agreement with their client is required.

Why Should I Enter Into A Business Associate Agreement?

The Rule requires business associates to enter into a written Business Associate Agreement that implements reasonable and appropriate policies in order to comply with the Rule and any Breaches thereunder. Failure to implement a written Business Associate Agreement can result in substantial fines and penalties. Amongst other things, Attorneys who are business associates can be held directly liable under the Rule, just as a Covered Entity would, for Breaches and violations of the Rule.

What is Required Under a Business Associate Agreement?

In order to avoid or reduce the chance of incurring liability for a Breach or other violation of the Rule the acts listed above, it is important to have a detailed and effective Business Associate Agreement. The template for a Business Associate Agreement should begin by incorporating the following requirements set forth under the Rule:

1)Establish the business associate’s permitted and required uses of PHI by setting forth how and when the business associate will use the PHI;

2)Provide that the business associate will only disclose PHI other than is set forth in the Business Associate Agreement or is required by law;

3)Implement appropriate safeguards to prevent the unauthorized use or disclosure of PHI;

4)Implement the requirements of the HIPAA Security Rule regarding electronic PHI;

5)Establish the situations and circumstances under which the business associate must disclose PHI to a requesting party;

6)Require the business associate to comply with all applicable requirements to the extent that the business associate is carrying out an obligation under the Rule on behalf of the covered entity;

7)Require the business associate’s internal practices, books and records in relation to the use and disclosure of PHI to be made available to the U.S. Department of Health & Human Services so that determinations regarding compliance with the Rule can be made;

8)To the extent practicable, require the business associate to return or destroy all PHI at the termination of the Business Associate Agreement;

9)Provide that any subcontractors, as defined by the Rule, business associate will engage with require the business associate to ensure that any subcontractors it may engage on its behalf that will have access to protected health information agree to the same restrictions and conditions that apply to the business associate with respect to such information; and

10)Provide for a termination of the Business Associate Agreement if the business associate violates a material term of the Agreement.

How will a Business Associate Agreement Reduce Attorney Liability?

While no Business Associate Agreement can eliminate an attorney’s liability under the Rule, it can greatly assist the attorney in limiting their liability to the extent possible.

First, while a Business Associate Agreement cannot change the statutory timeframes for providing notice or curing a Breach under the Rule, an attorney can give themselves as much leeway as possible with respect to how and when it must provide notice or cure a Breach by allowing themselves as much time as is permitted under the Rule.

Second, the Business Associate Agreement can provide greater clarity to the parties in detailing what a Breach is and when a Breach a occurs. This will help both parties reduce the probability of a Breach, recognize when a Breach occurs, and address either party’s failure to comply with the notice and cure provisions of the Rule.

Third, the Business Associate Agreement can provide essential guidance in handling a Breach by clearly stating each party’s responsibilities in the event of a Breach and the best and most efficient way to cure a Breach. Having definite and delegated plans of action for each party will provide security to each party in handling a Breach.

Finally, in addition to entering in to a Business Associate Agreement, it is also important to remember take a step back, evaluate your practice and determine the best way to become HIPAA and Rule compliant. This can be done by assessing your current level of compliance with HIPAA, projecting potential future compliance needs as your practice changes or grows and a developing plan of action to address any gaps you may discover or anticipate.

Speak to an Attorney

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Many dentists and dental practices offer financing arrangements as a way to help patients, especially the uninsured, pay for their care and treatment. For those who utilize third-party vendors for such financing, recently enacted amendments to the Illinois Dental Practice Act impose new disclosure and transparency obligations on dentists and practices and place limits on what staff can do and say in their interactions with patients regarding the subject. The amendments became effective January 1, 2025. With other states enacting or considering similar legislation regarding external patient financing for health care providers, these changes serve as a reminder to dentists in every jurisdiction about the importance of staying up to date on changes in their state’s laws and regulations. Here is what you need to know and do about these changes in order to ensure compliance once the calendar turns to the new year. 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Mandatory Disclosure When discussing or providing applications for financing extended by a third party, a dentist, employee of a dentist, or agent of a dentist must provide the following written notice in at least 14-point font: DENTAL SERVICES THIRD-PARTY FINANCING DISCLOSURE This is an application for a CREDIT CARD, LINE OF CREDIT, OR LOAN to help you finance or pay for your dental treatment. This credit card, line of credit, or loan IS NOT A PAYMENT PLAN WITH THE DENTIST'S OFFICE. It is a credit card, line of credit, or loan from a third-party financing company. Your dentist does not work for this company. Your dentist may not complete or submit an application for third-party financing on your behalf. You do not have to apply for a credit card, line of credit, or loan. You may pay your dentist for treatment in another manner. Your dentist's office may offer its own payment plan. 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Many dentists and dental practices offer financing arrangements as a way to help patients, especially the uninsured, pay for their care and treatment. For those who utilize third-party vendors for such financing, recently enacted amendments to the Illinois Dental Practice Act impose new disclosure and transparency obligations on dentists and practices and place limits on what staff can do and say in their interactions with patients regarding the subject. The amendments became effective January 1, 2025. With other states enacting or considering similar legislation regarding external patient financing for health care providers, these changes serve as a reminder to dentists in every jurisdiction about the importance of staying up to date on changes in their state’s laws and regulations. Here is what you need to know and do about these changes in order to ensure compliance once the calendar turns to the new year. 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Anyone associated with a practice cannot do any of the following: Complete any portion of an application for financing extended by a third party for a patient or patient's guardian. Provide the patient or patient's guardian with an electronic device to apply for financing extended by a third party. Promote, advertise, or provide marketing or application materials for financing extended by a third party to a patient who has been administered or is under the influence of general anesthesia, conscious sedation, moderate sedation, or nitrous oxide; is being administered treatment; or is in a treatment area, including, but not limited to, an exam room, surgical room, or other area when medical treatment is administered, unless an area separated from the treatment area does not exist. Mandatory Disclosure When discussing or providing applications for financing extended by a third party, a dentist, employee of a dentist, or agent of a dentist must provide the following written notice in at least 14-point font: DENTAL SERVICES THIRD-PARTY FINANCING DISCLOSURE This is an application for a CREDIT CARD, LINE OF CREDIT, OR LOAN to help you finance or pay for your dental treatment. This credit card, line of credit, or loan IS NOT A PAYMENT PLAN WITH THE DENTIST'S OFFICE. It is a credit card, line of credit, or loan from a third-party financing company. Your dentist does not work for this company. Your dentist may not complete or submit an application for third-party financing on your behalf. You do not have to apply for a credit card, line of credit, or loan. You may pay your dentist for treatment in another manner. Your dentist's office may offer its own payment plan. You are encouraged to explore any public or private insurance options that may cover your dental treatment. The lender or creditor may offer a "promotional period" to pay back the credit or loan without interest. After any promotional period ends, you may be charged interest on portions of the balance that have already been paid. If you miss a payment or do not pay on time, you may have to pay a penalty and a higher interest rate. If you do not pay the money that you owe the creditor or lender, then your missed payments can appear on your credit report and could hurt your credit score. You could also be sued by the creditor or lender. If your dentist's office has completed or submitted an application for third-party financing on your behalf, you may file a complaint by contacting the Illinois Department of Financial and Professional Regulation at https://idfpr.illinois.gov/admin/dpr/dprcomplaint.html or by calling (312) 814-6910." Penalties for Non-Compliance A violation of these new rules and limitations is punishable by a fine of up to $500 for the first violation and a fine of up to $1,000 for each subsequent violation. IDFPR has the power to take additional disciplinary action as well. If you have any questions about these new requirements or third-party financing for dental services generally, please contact Jordan Uditsky at Grogan Hesse & Uditsky. We Focus on You So You Can Focus on Your Patients At Grogan Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Please call us at (630) 833-5533 or contact us online to arrange for your free initial consultation. 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But not all such gains are subject to capital gains tax. Sometimes, the IRS taxes profits as ordinary income at the taxpayer’s individual rate. Since the current individual rate is around 37 percent, sellers would rather pay the currently lower capital gains rate (the maximum of which is 20%) to the extent possible. Notably, the capital gains tax only applies to profits on assets held for more than 12 months. Unless a dental practice goes from zero to 60 or acquisition to sale in less than a year, which is rarely the case, the sale will implicate the capital gains tax. Accordingly, structuring your deal to maximize the amounts taxed as capital gains vs. ordinary income is one of the most significant considerations in minimizing your tax liabilities. This depends, to a large degree, on how you allocate and treat the assets you are selling. Asset Allocation Most sales of dental practices are structured as asset sales, meaning the purchaser is acquiring specific assets of the practice rather than its stock. Dental practices are comprised of several different kinds of assets—equipment, supplies, real property, goodwill—and separate accounting and tax rules apply to each type of asset. Tangible Assets : These include equipment, furniture, office and medical supplies, and other physical assets. Typically, tangible assets are treated as depreciated property, so gains on the sale of these assets are usually subject to recapture rules, where depreciation deductions taken in prior years may be "recaptured" and taxed as ordinary income. Accounts Receivable : Any outstanding accounts receivable can be part of the sale. For cash-basis taxpayers (the most common for dental practices), accounts receivable are taxed as ordinary income since they represent payments for services already rendered but not yet received. Goodwill and Intangible Assets : The goodwill of your dental practice, which includes the value of your brand, client base, and reputation, is generally taxed at the capital gains rate. This is advantageous because the long-term capital gains rate is often lower than the ordinary income rate. Other intangible assets may also qualify for capital gains treatment, depending on how they are classified. If you have taken depreciation deductions on your practice’s equipment or real property, the IRS requires that depreciation be "recaptured" and taxed as ordinary income up to the amount of prior depreciation. While this applies to equipment and other depreciable assets, goodwill, and certain intangibles do not face depreciation recapture. Earnouts: Deferred Purchase Price Payment or Compensation? From the IRS’ perspective, how and when you receive payment for the sale of your practice will determine its tax treatment. If those payments come in the form of earnouts, the key issue is whether the IRS views each payment as a deferred purchase price payment or the payment of compensation. Earnout provisions are often included in practice sale agreements and provide for contingent additional payments from the buyer to the seller upon the practice meeting specified financial targets or other milestones in the future. Earnout payments are generally treated as part of a deferred purchase price so long as the seller is not performing services for the buyer and the practice after the consummation of the sale. The earnout payments may be treated as compensation income if the seller provides services for the buyer or target company after the acquisition or, in some cases, if the purchase agreement includes a non-competition provision. If the IRS treats earnout payments as deferred purchase price payments (for a non-corporate seller), they will be capital gains, which, as noted, are taxed at a much lower rate than ordinary income. However, if the IRS determines that the earnout constitutes compensation to the seller, the IRS will consider it ordinary income that can be subject to tax rates as high as 37 percent, along with employment taxes (such as Social Security and Medicare taxes). Accordingly, the sale agreement should specifically refer to earnout payments as part of the purchase price to support the treatment of such payments as capital gains rather than ordinary income. However, what you call the payments in the documentation is far from determinative, as the IRS will look beyond the language of the agreement to consider several substantive factors when deciding how earnout payments should be classified. This is where careful structuring and documentation can play an outcome-determinative role in how these substantial sums will be treated for tax purposes. You put a lot into your dental practice over the years. How much you take out and whether your sale will reap the benefits you anticipate depends on how well your professional team of attorneys, accounting professionals, and financial advisors do their jobs when crafting your transaction. That is one of many reasons why you should consult with an experienced dental practice sale and acquisition attorney to discuss and understand your options. We Focus on You So You Can Focus on Your Patients At Grogan Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Please call us at (630) 833-5533 or contact us online to arrange for your free initial consultation. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices. This blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
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