Under HIPAA's privacy rule, when may a health care provider disclose PHI without client consent?

• A. For research purposes only
• B. For routine treatment, payment, and health care operations
• C. If requested by any family member
• D. When mandated by law enforcement

Answer: (B)

Disclosing Protected Health Information (PHI) without client consent is permitted under HIPAA's privacy rule in specific circumstances, and one of those key instances is related to routine treatment, payment, and health care operations. This provision allows healthcare providers to share PHI when it is necessary to provide effective medical care, process insurance claims, or manage healthcare services.

The rationale behind this allowance is that sharing information within the healthcare team or with third-party payers is essential for delivering quality care, ensuring that billing and payment processes run smoothly, and managing healthcare operations efficiently. This exception is built into HIPAA to enable continuity of care and effective healthcare administration while still protecting patient privacy.

Other choices, while they may involve specific scenarios where PHI might be disclosed, do not represent the routine permissions defined under HIPAA’s regulations in the same way. For example, research purposes may need additional safeguards and a formal process to ensure patient privacy. Requests from family members are not automatically valid without the patient’s consent unless specific criteria are met. Similarly, disclosures mandated by law enforcement come with their own rules and restrictions that do not apply to routine operational needs.