Complying with privacy regulations in health plan operations

There is significant documentation of fraud and abuses of consumer privacy through telemarketing activities. This led to a proliferation of legislative efforts to protect consumer privacy rights in the USA. Two such federal laws, the Health Plan Portability and Accountability Act of 1996 and the Telemarketing and Consumer Protection Act of 1994 significantly improve consumer privacy protections. However, they have a negative impact on the legitimate research and customer outreach efforts of ethical firms. It is especially challenging for health care firms as personal health information is among the most highly guarded areas of privacy concern. This article describes key provisions of these laws as they relate to health care organizations. Two program examples show how one firm successfully balances effectively administering health plan operations that support customer‐focused initiatives while complying with consumer privacy regulations.