Why would an employer want to receive PHI?
A. There are many reasons. First, it may want to use the information to shop for new insurance coverage, or for re-insurance. It may want to audit claims to make sure that no fraud is taking place, or may simply want to control large claims to try to minimize plan expenses. It may have a committee which decides claims appeals, or it may want to help its employees who have questions about their claims or are having trouble getting their claims paid. There are many legitimate reasons an employer may seek PHI from its health plan, but if it does so, it may subject the plan to the more complicated compliance burdens discussed above.
