Skip to content

Your doctor might be Googling you

When we think about Google and health, we usually think about patients searching online for health information. But you may be surprised that some doctors Google you.

An Australian survey of how doctors use social media found about 16% (about one in six) had searched for online information about a patient, with roughly similar results from studies in the US and Canada.

This raises several ethical concerns. For instance, what if your doctor’s search through your Facebook, blog, or Twitter feeds revealed aspects about your lifestyle, like drug or alcohol use, you didn’t tell your doctor directly? What if that information influenced your access to surgery?

Why doctors Google patients

Some doctors say they Google their patients to gather more information about them or to discover the “truth.” Armed with that information, they say they can better care for their patients and improve their health.

For instance, a doctor may see a patient with depression’s online account of wanting to end his life as an opportunity to take action and prevent a bad outcome. Or a doctor may find out about adolescent high-risk behavior they are not likely to talk about, like drug abuse or risky sexual behavior, and see that as an opportunity to protect them from harm.

Alternatively, some doctors Google their patients out of curiosity, voyeurism, or simply habit.

This raises the issue of when a legitimate professional concern tips over into behavior that’s unnecessary and “creepy.”

To Google or not is an issue doctors admit to grappling with. In an Australian survey, when doctors were asked if it was appropriate for doctors to look up publicly available information about a patient, almost 43% said no and around 40% were unsure.

Breaching trust

When a doctor searches online for information about a patient without consent, their role changes from someone who works with the patient to someone who observes and spies on them. From a patient’s viewpoint, this is likely to destroy trust between the two, as it shows a lack of respect.

Patients can also be directly harmed when doctors act on information they find online. If a doctor sees an online photo of a patient waiting for a liver transplant drinking alcohol when they shouldn’t be, patients risk missing out on receiving a new liver.

Then there’s the issue of whether the information is recent or relevant. In the case of the liver transplant dilemma, we might not know when the photo of the liver transplant patient was taken; it is not proof the patient is drinking now.

Doctors, like the rest of us, also cannot be sure online information is accurate. For instance, more than 50% of adolescents admit posting false information on social media.

To act or not to act?

Deciding to search for information about their patients online is not the end of the matter. Doctors also need to decide whether to admit Googling and whether to act on the information they find.

Doctors are legally required under mandatory reporting laws to report information they have viewed relating to child abuse and neglect. But if they act on inaccurate information, that can harm the patient and others. If they don’t act on the information they find, they could be liable for not trying to protect the patient.

In the end, doctors need to satisfy themselves that they have good reason to take action (or not take action) based on weighing up the likely benefits and harms.

While there may be some justification for looking at patient information online when it relates to child safety, for adult patients, it’s a different matter. For adults, it would be easier and more respectful to just ask them.

What can we do?

Regardless of any ethical concerns, how realistic is it for doctors to stop Googling their patients? Using Google is so common (globally, we use it to make 3.5 billion searches a day) that it has become the default way we find out information online. Many doctors also don’t think Googling a patient is an invasion of privacy.

Patients should be aware that their doctor can see and use the information they put online. To safeguard their privacy, patients can adjust their privacy settings and be careful of what they post.

Perhaps there should be policy on the need for doctors to be open about Googling their patients. And, before they act on any information, patients should have an opportunity to refute or explain that information.

If this doesn’t happen, we will see an continual erosion of trust between doctor and patient.

This article was originally published on The Conversation. Read the original article.



Impact of New HIPAA Enforcement Leader

As the Department of Health and Human Services’ Office for Civil Rights prepares for a change in its top leadership, information security leaders are watching to see whether the strategies of the HIPAA enforcement agency might shift as well.

On July 9, OCR Director Leon Rodriguez, who held the post of the nation’s top HIPAA privacy and security rules enforcer at HHS since 2011, was sworn in as the new director of U.S. Citizenship and Immigration Services, a unit of the Department of Homeland Security.

But his successor at OCR, Jocelyn Samuels, who currently serves as the acting assistant attorney general for the Civil Rights Division at the U.S. Department of Justice, won’t be starting in her new post for a while.

“Transition demands at the Department of Justice have delayed Ms. Samuel’s arrival for a few weeks,” an OCR spokeswoman tells Information Security Media Group. “In the interim, HHS leadership are acting in her stead.”

Jocelyn Samuels

Samuels was named last week by HHS Secretary Sylvia Mathews Burwell to replace Rodriguez. He was nominated by President Obama in December and confirmed by the Senate in June 2014 as the director of U.S. Citizenship and Immigration Services, which has nearly 18,000 employees and administers the nation’s immigration and naturalization system.

DOJ Work

While Samuels has served in the civil rights division at DOJ, the agency has paid particular attention to pursuing Americans With Disabilities Act cases and enforcement actions related to the Supreme Court’s Olmstead ruling, which provides rights to individuals with disabilities to live outside of institutionalized care, notes the Boston Globe in a June 24 article about the 15th anniversary of the court’s decision. Other healthcare-related cases pursued by the DOJ during Samuel’s tenure involved rights of the hearing impaired, notes Elizabeth Hodge, a healthcare compliance attorney at the Tampa, Fla.-based office of national law firm Akerman LLP. “There were cases fining hospitals as well as smaller practices” over their lack of access to healthcare for the hearing impaired, she says.

In addition to enforcing HIPAA compliance through activities that include breach investigations and random compliance audits, OCR also enforces protection against unfair healthcare treatment or discrimination based on race, color, national origin, disability, age, gender or religion. While Samuel’s arrival to OCR will not change the mission of the agency, how its limited resources are divvied up for its various enforcement activities could potentially shift.

Challenges Ahead

The greatest challenge facing Samuels is OCR’s need for additional financial and human resources, says David Holtzman, a former senior adviser at OCR who’s now a vice president at the security consulting firm CynergisTek.

OCR’s mission and responsibility was significantly expanded through Congressional mandates in the HITECH Act and the Affordable Care Act, he notes. “For example, the HITECH Act required OCR to expand enforcement of the HIPAA rules to business associates, required investigation and imposition of penalties on HIPAA violations due to willful neglect, and established an audit program. The ACA expanded the rights of individuals to access healthcare without regard to their sexual orientation or gender identity. However, Congress did not appropriate additional funding to carry out this mission.”

Holtzman calls on Samuels to “continue the efforts begun by her predecessor to use her ‘bully-pulpit’ to raise the visibility of OCR and work with Secretary Burwell for appropriation of additional support for OCR’s mission.”

Striking a Balance

Even when it comes to OCR’s various HIPAA enforcement activities, which range from breach and complaint investigations to the planned resumption this fall of the HIPAA compliance audit program, Samuels will be faced with a delicate juggling act, says privacy and security attorney Adam Greene, a partner with Davis Wright Tremaine in Washington.

“One of the biggest challenges for Ms. Samuels will be to ensure that the agency continues to strike a reasonable balance with respect to enforcement,” says Greene, who also formerly was a member of the OCR staff. “OCR initially focused on voluntary compliance rather than seeking financial penalties and settlements, and some within healthcare complained that the lack of enforcement led to insufficient resources allocated to HIPAA. Now, we have started to see more multi-million dollar settlements, and some question whether the penalties are disproportionate to the conduct and harm.”

A challenge for Samuels, Greene says, is “to strike the balance where HIPAA is seen as having ‘teeth’ but covered entities and business associates can still count on OCR as being reasonable when there are areas of ambiguity or privacy or security issues occur despite good efforts at compliance.”

Enforcement Actions

In OCR’s latest HIPAA enforcement activity, the agency in June announced an $800,000 settlement with Indiana-based community health system Parkview Healthcare for a 2009 breach involving paper medical record dumping and affecting between 5,000 and 8,000 patients. That settlement followed a $4.8 million resolution agreement revealed in May involving two New York healthcare organizations – New York-Presbyterian Hospital and Columbia University. The OCR investigation into that incident, which involved unsecured patient data on a network and affected about 6,800 patients, uncovered other HIPAA compliance issues, including the lack of a risk analysis and failure to implement appropriate security policies.

Those OCR settlements are among 21 HIPAA resolution agreements that included financial payments since 2008, plus one case that involved a civil monetary penalty, which is considered more punitive. However, since the HIPAA Omnibus Rule took effect last year, OCR has indicated that it’s ramping up HIPAA enforcement, which includes plans to resume the HIPAA compliance random audit program later this year (see HIPAA Enforcement: A Reality Check).

OCR’s enforcement strategy to date of issuing HIPAA resolution agreements and sometimes hefty financial settlements to a small number of select covered entities has been an effective compliance tool, Hodge contends.

“Given OCR’s limited resources, targeted resolution agreements that bring focus on a variety of compliance issues and breaches, and a range of different kinds of covered entities, grab attention,” she says. “The next thing we might see are resolution agreements involving business associates.”

Under HIPAA Omnibus, business associates are directly liable for HIPAA compliance.

But those cases also take up OCR resources. “I believe it is important that director Samuels work with secretary Burwell to put into place the resources needed to effectively respond to the large number of complaints being received by OCR,” Holtzman says.

“All too often, complaint investigations and compliance reviews begun by OCR drag on for many, many months because there are not enough investigators in the regional offices to keep up with the complaints filed by consumers. Almost all complaint investigations can be resolved informally through the voluntary corrective action of covered entities,” he says. “Covered entities and business associates deserve the opportunity to a prompt investigation and resolution of these agency enforcement activities.”


Social media posts can be used to detect healthcare fraud

In George Orwell’s novel Nineteen Eighty-Four, citizens of Oceania, a totalitarian state, are under surveillance at all times and constantly reminded that Big Brother is watching them.

Today, with the advancement of digital technologies – from cameras on the street and in stores, to cookies gathered from the Internet – most of us are being watched in one way or another.

For those in law enforcement, digital technology has become an increasingly important tool in the war on crime. A 2014 report by LexisNexis on social media use in law enforcement found 51 percent of those surveyed listen to or monitor social media activity for potential criminal activity and two-thirds of those surveyed found social media to be a valuable tool in anticipating crimes.

While many might think such criminal activity being monitored would be limited to identifying drug dealers, gang members, thieves and sex offenders, you might be surprised to learn that those in the healthcare arena are just as likely to be targeted and monitored.

By analyzing data from social networks, fraud detection systems can root out suspicious activity by connecting the relationship dots. For example, many times healthcare fraud is conducted by teams with a provider at the top recruiting “patients” (often friends, relatives and associates) to allow their medical records to be used to submit false claims. Investigators can use social networks, i.e. Facebook, Instagram, Twitter, etc. to link these people and put together a case.

In a number of instances, criminals have been caught and arrested for posting their own criminal activity on social media. Last September, a couple was arrested and charged with bank robbery after posting pictures of themselves on social media with stashes of cash.

Although there are some who are foolish enough to post their criminal activities on social media, it doesn’t have to be that blatant. For example, someone recruited by a healthcare provider to commit healthcare fraud might post something on their social media about how they made $100 just by allowing their medical records to be used. A simple post like that might be enough to launch an investigation – and as previously noted – get investigators to begin connecting the relationship dots.

Investigators can even infiltrate these social media networks using false names and identifications. They might pose as someone who wants to get in on the action, which in turn can help lead to the provider who was recruiting “patients” to assist in the fraudulent activity. Even if the police don’t spot such illegal activity, someone within that social network might see such a post and contact the authorities.

While we may not yet live in an Orwellian society, many of our activities are being monitored and the continued advancement of digital technologies is making it easier for fraud investigators to catch up with criminals.

The Health Law Offices of Anthony C. Vitale has been defending those charged with healthcare fraud for more than 25 years. Our team of highly skilled attorneys and consultants is here to help you before you become the focus of an investigation and will aggressively defend you should you become the target of one.


243 Charged in Medicare Fraud Schemes

Federal authorities announced their largest national Medicare fraud takedown to date, involving criminal charges against 243 individuals allegedly responsible for false billing totaling approximately $712 million.

In a June 18 joint announcement, officials at the Department of Health and Human Services, Department of Justice and FBI said a “nationwide sweep” led by the Medicare Fraud Strike Force in 17 districts has resulted in charging 243 individuals, including 46 physicians, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes. As of June 18, 184 defendants had been taken into custody, a DOJ spokesman says.

Officials called “the coordinated takedown” the largest in strike force history, both in terms of the number of defendants charged and the loss amount.

The sweep also resulted the Centers for Medicare and Medicaid Services using its authority under the Affordable Care Act to suspend a number of healthcare providers from participating in the Medicare program.

Variety of Charges

The defendants in the takedown are charged with various healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The charges are based on a variety of alleged fraud schemes involving various medical treatments and services, including home healthcare, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy fraud.

More than 44 of the defendants are charged with fraud related to the Medicare prescription drug benefit program known as Part D, which regulators say is the fastest-growing component of the Medicare program.

“This takedown adds to the hundreds of millions we have saved through fraud prevention since the Affordable Care Act was passed,” said HHS Secretary Sylvia Mathews Burwell. “With increased resources that have allowed the Strike Force to expand and new tools, like enhanced screening and enrollment requirements, tough new rules and sentences for criminals, and advanced predictive modeling technology, we have managed to better find and fight fraud as well as stop it before it starts.”

The Medicare Fraud Strike Force, a multi-agency team of federal, state and local investigators and prosecutors designed to combat Medicare fraud through the use of Medicare data analysis techniques, coordinated the investigation. Since the program’s inception in March 2007, Strike Force operations in nine locations have charged more than 2,300 defendants who collectively are alleged to have falsely billed the Medicare program for more than $7 billion, according to federal authorities.

Among the large Medicare busts was the May 2014 arrest of 90 individuals in six states who were allegedly tied to Medicare fraud schemes responsible for $260 million worth of false billings. Also, in October 2012, federal authorities announced a Medicare fraud crackdown that involved charges against 91 individuals in fraud schemes allegedly involving approximately $492 million in false billing.

A Wake-Up Call

Security expert Mac McMillan, CEO of the consultancy CynergisTek, says the magnitude of the most recent Medicare takedown is significant. “This should be a wake-up call to those healthcare professionals who think it is OK to fudge around the edges, or in some cases just outright steal from the system, that their days are numbered and the feds are serious about curbing this very important problem,” he says. “Hopefully it will have some impact, but frankly, right now, it seems like someone declared open season on healthcare between this [type of fraud] and the hacks we’ve seen lately.”

Healthcare entities can help in the battle against fraud by monitoring for criminal behavior within their own organizations, he says. “One of the simplest ways is to perform periodic audits of what workforce members involved in preparing or handling claims are doing, as well as audits of patients receiving discharge summaries and bills.”

Additionally, more commercial health insurers should follow CMS’s lead and implement analytical tools that can help detect suspicious activities, he says. “They are the only really effective tools for proactive monitoring and detection,” he says. “Those committing fraud may not cause a compliance trigger to be activated, but generally fraud requires an abnormal event to occur. Monitor for those, and you have a better chance of detecting inappropriate behavior.”

Fraud Scams Busted

Among those charged in the latest Medicare fraud takedown were individuals in six states:

  • Seventy-three defendants in Miami were charged with offenses relating to their alleged participation in various fraud schemes involving approximately $263 million in false billings for home healthcare, mental health services and pharmacy fraud. In one case, administrators in a mental health center billed close to $64 million between 2006 and 2012 for purported intensive mental health treatment to beneficiaries and allegedly paid kickbacks to patient recruiters and assisted living facility owners. Medicare paid approximately half of the claimed amount.
  • Twenty-two individuals in Houston and McAllen, Texas, were charged in cases involving more than $38 million in alleged fraud. One of these defendants allegedly coached beneficiaries on what to tell doctors to make them appear eligible for Medicare services and treatments and then received payment for those who qualified. The company that paid the defendant for recruiting patients to bill for medically unnecessary services submitted close to $16 million in claims to Medicare, more than $4 million of which was paid.
  • Seven people in Dallas were charged in connection with home healthcare schemes. In one scheme, six owners and operators of a physician house call company allegedly submitted nearly $43 million in billings under the name of a single doctor, regardless of who actually provided the service. The company also allegedly significantly exaggerated the length of physician visits, often billing for 90 minutes or more for an appointment that lasted only 15 or 20 minutes.
  • Eight individuals in Los Angeles were charged for their alleged roles in schemes to defraud Medicare of approximately $66 million. For example, a physician is charged with causing almost $23 million in losses to Medicare through his own fraudulent billing and referrals for durable medical equipment, including more than 1,000 power wheelchairs and home health services that were not medically necessary and often not provided.
  • Sixteen defendants in Detroit were charged for their alleged roles in fraud, kickback and money laundering schemes involving approximately $122 million in false claims for services that were medically unnecessary or never rendered, including home healthcare, physician visits and psychotherapy, as well as pharmaceuticals that were billed but not dispensed. Among those charged are three owners of a hospice service who allegedly paid kickbacks for referrals made by two doctors who defrauded Medicare Part D by issuing medically unnecessary prescriptions.
  • Five individuals in Tampa were charged with participating in a variety of alleged scams, ranging from fraudulent physical therapy billings to a scheme involving millions of dollars worth of clams for physician services and tests that never were provided. In one case, a licensed pain management physician sought reimbursement for nerve conduction studies and other services that he allegedly never performed. Medicare paid the defendant more than $1 million for these purported services.
  • Nine individuals in Brooklyn, N.Y., were charged in two separate criminal schemes allegedly involving physical and occupational therapy. Three of those defendants face charges for their roles in a previously charged $50 million physical therapy scheme.
  • Eleven people in New Orleans were charged in connection with $110 million worth of alleged home healthcare and psychotherapy schemes. In one case, four individuals who operated two companies – one in Louisiana and one in California – that mass-marketed talking glucose monitors across the country allegedly sent the devices to Medicare beneficiaries regardless of whether they were needed or requested. The companies billed Medicare approximately $38 million for the devices, and Medicare paid the companies more than $22 million.


White Men Have Less Life Stress, But Are More Prone To Depression Because of It

When people talk about the black-white health gap, they usually mean that black people have worse health outcomes than white people. And generally, that’s true. On basically every measure, from childbirth to hypertension to HIV transmission rates, the black community fares worse. 

But there’s one area where this gap doesn’t hold up: men’s mental health. White men are more likely to face depression associated with stressful life events than black men or women of any race, according to a recently published study in the Journal of Racial and Ethnic Health Disparities.

This is an especially interesting finding because, as might be expected, white men reported having fewer stressful life events than black men. These events were defined as poor health, financial stress, issues with employment, marital or family problems, problematic gambling behavior, police harassment and being the victim of a crime or discrimination.

“White men were experiencing the least stress in their lives,” lead study author Dr. Shervin Assari, a research investigator at the University of Michigan Department of Psychiatry, told The Huffington Post. “They don’t get a lot of it and they are not used to it, so they are more prone to its harmful effects.”

Logically, people who haven’t dealt with stressful life events, or who have encountered them infrequently, lack the coping mechanisms and support systems that develop when overcoming hardship. Social support and religion, for example, are proven and effective coping mechanisms for dealing with stress. 

“They don’t learn how they should mobilize their resources from previous stressful experiences,” Assari said. “Whom should they talk to? How should they act? They have not learned to respond to stress to the same level as black men.”

In a way, the study hits on a sticky subject. Depression is a serious and often debilitating mental health condition, and white men who are suffering from depression should be supported, not stigmatized.

On the other hand, the strong association between a small number of stressful life events and depression among white men speaks volumes about white privilege. The world treats white men well — so well, in fact, that infrequent negative life circumstances mentally harm them.  

Resilience in the wake of stress 

The study, which included almost 6,000 adults from around the country, controlled for income, education, employment and marital status. It did not find the same stress-depression correlation among women that it did among men.

When comparing stressful life events along gender and racial lines, women had more exposure to stress than men, and black participants had more exposure to stress than white participants. Black women reported the highest number of stressful life events while white men reported the least exposure to stress.   

Unlike men, however, black and white women had similar stress-related susceptibility to depression. Assari thinks this may be a product of habituation, or when the body stops responding to a stress or stimulus it is repeatedly exposed to. 

“You start developing a type of resistance to it,” he said. “After some types of very severe stressors, people transform.”

This is what’s known as post-traumatic growth, when a person shows resilience or emerges stronger in the wake of a traumatic experience. While such stressors are clearly a net negative, the results of a heartening 2013 study of low-income mothers in the years following Hurricane Katrina found that 30 percent of survivors felt the storm had given them an improved sense of personal strength, enhanced spirituality and improved relationships.

They are not used to stress, so they are more prone to its harmful effects.

Not all coping mechanisms are healthy

Learning to cope with repeated exposure to stress can have a dark side, too. Chronic stress has been linked to anxiety, depression, digestive problems, heart disease, sleep problems, weight gain and memory and concentration impairment, according to the Mayo Clinic. 

And all too often, people’s behavioral strategies for dealing with stress are far from healthy. Smoking, drinking alcohol, overeating and using drugs are all coping methods, albeit unhealthy ones.

Coping with stress by drinking alcohol or overeating creates a physical health burden even as it dispels a mental one. Drinking too much can lead to heart disease, liver disease and digestive problems, while being overweight is associated with Type 2 diabetes, high blood pressure and cancer, according to the Centers for Disease Control and Prevention. As the authors of a study on race, chronic stress and health disparities published in the American Journal of Public Health in 2010 wrote: 

For many individuals, especially among materially disadvantaged ethnic groups, the short-term benefits of reducing states such as anxiety, depression, and frustration may psychologically outweigh the risk of poor long-term physical health from behaviors such as overeating, consuming alcohol, using tobacco, and using over-the-counter or illicit drugs. 

Dispelling the myth that men don’t get depressed 

Perhaps the most important takeaways from Assari’s study are the fact that men do suffer from depression, and that the study dispels the highly damaging belief that mental health and emotions aren’t something men need to worry about. In fact, it’s just the opposite. While white men certainly enjoy privileges that come with their gender and skin color, they are especially vulnerable the debilitating effects of stress-related depression. 

White men are also at a high risk for suicide. The Centers for Disease Control and Prevention report that white men have the highest suicide rates of any demographic, accounting for 70 percent of all suicides committed in the United States in 2013.

Of course, depression isn’t always linked to stressful life events. Moreover, a strong association between stress and depression doesn’t mean that white men as a group are more likely to suffer from depression than women. According to the National Comorbidity Survey, the lifetime prevalence of major depressive disorder among men is 13 percent. Among women, that number rises to a full 20 percent who will suffer from the disorder over the course of their lifetimes.


This post is part of ShameOver: It’s Time To Talk About Men’s Mental Health, a HuffPost Healthy Living editorial initiative that aims reclaim what it means to “be strong” by addressing the stigma men face in disclosing and seeking support for mental health issues. Each week we’ll share features and personal stories about men and their caregivers as it relates to suicide, mental illness and emotional well-being. If you have a story you’d like to share, email us at 

If you — or someone you know — need help, please call  1-800-273-8255 for the National Suicide Prevention Lifeline. If you are outside of the U.S., please visit the International Association for Suicide Prevention for a database of international resources.


Also on HuffPost:

— This feed and its contents are the property of The Huffington Post, and use is subject to our terms. It may be used for personal consumption, but may not be distributed on a website.


Medical Shoes Market Analysis By Product Type, End User, Distribution Channel, Region, Country, Opportunities and Forecast (2017-2022)

Global Medical Shoes Market analyzed the potential of Medical Shoes Industry and provides statistics and information on market size, shares and growth factors. The report intends to provide cutting-edge market intelligence and help decision makers take sound investment evaluation. Besides, the report also identifies and analyses the emerging trends along with major drivers, challenges and opportunities in the global Medical Shoes market.


Easy to understand info about dyslexia

Parents have been booking time with me to ask me if their child has dyslexia.