The section provides immunity to consultants who communicate with the Director of the Department of Managed Health Care for the purpose of determining whether health care services are being provided in accordance with the Knox-Keene Act of 1975. Nothing in the code section alters existing laws regarding the confidentiality of medical records.
A provider of health care, a health care service plan, or a contractor shall disclose medical information if the disclosure is compelled by any of the following: Court order; Order from a board, commission, or agency; Subpoena from a party before a court or agency; Arbitrator or panel; Search Warrant; Patient or Patient's representative; or, Coroner conducting an investigation
Individuals may request correction, amendment or deletion of recorded personal information held by insurance institutions, agents or insurance-support organizations. If the insurance entity changes the information, it must notify the individual, and must communicate the changes to persons specifically designated, who may have received the information within the past two years.
An insurance institution, agent, or insurance-support organization may disclose personal or privileged information about an individual to a professional peer review organization for the purpose of reviewing the service or conduct of a medical-care institution or medical professional.
An insurance institution, agent, or insurance-support organization may disclose personal or privileged information about an individual collected or received in connection with an insurance transaction to a person whose only use of the information will be in connection with the marketing of a product or service, provided: (1) no medical-record information, privileged information, or personal information relating to an individual's character, personal habits, mode of living, or general reputation is disclosed, and no classification derived from the information is disclosed; or (2) the individual
Insurance institution/agent's obligation to provide individual's requested personal information (including medical information) may be satisfied by another insurance institution or agent authorized to act on its behalf; an insurance institution, agent or insurance-support organization may make arrangements with an insurance-support organization or a consumer reporting agency to copy and disclose recorded personal information on its behalf.
Disclosure for marketing purposes of insurance related medical records is permissible as long as the subject is given an opportunity to refuse and consents with written authorization. The information's recipient must also agree to use the medical information solely for marketing purposes. Materials disclosed that include the individual's identity are to be returned or destroyed after use.
The Inspector General shall maintain records for three years after a completed audit. Records obtained in the course of an audit or investigation shall be subject to disclosure under the Public Records Act, with the exception of records covered by various California laws, including the CMIA.
Penal Code 6126.4: It is a misdemeanor for the Inspector General, staff or business associates to disclose any information obtained in the course of the audits. This prohibition is also applicable to any outside persons.
The Medical Board of California shall contract with an independent entity to conduct a comprehensive study of the peer review process. (e) The case files and other information obtained by the independent entity shall be confidential.
