Rehab Confidentiality: Does Rehab or Drug Abuse Go on Record?

Confidentiality is an important aspect of medical care for all patients. It is why the U.S. Department of Health and Human Services (HHS) established the Health Insurance Portability and Accountability Act of 1996—otherwise known as HIPAA.¹ A sweeping legislation, HIPAA updated medical privacy laws, allowing for patients to attend treatment with peace of mind in the 21^st century.

Veterans especially may be concerned with privacy. When they come back from service, they sometimes face a multitude of medical and mental health challenges, including substance use disorder. Due to the nature of VA benefits, many veterans fear that rehab will go on their record and jeopardize VA coverage. However, most forms of substance abuse treatment are covered by the VA and kept confidential under the provision of HIPAA.

HIPAA, Medical Records & Laws

HIPAA is a federal law that protects the privacy of people’s health information by ensuring that sensitive information is not disclosed without the person’s permission.¹ The HIPAA Privacy Rule addresses the disclosure of a person’s health information by various entities, referred to as “covered entities.”¹

Under the Privacy Rule there are standards for your rights and how you can control the way your health information is used.¹ Some covered entities may need access to certain medical information. For example, if you are receiving emergency medical treatment, the acting physician needs to know what prescriptions you are taking to ensure you don’t receive treatment that would cause a negative interaction. The physician in this example would likely not be bound by the HIPAA Privacy Rule. However, the Privacy Rule strives to maintain a balance between sharing vital information and your right to privacy, and will hold in most situations.

In 2002, the Department of Veterans Affairs (VA) founded the VA Privacy Services (PS) to maintain and protect veterans’ right to confidentiality.² As a part of this goal, the VA focuses on two acts: ²

• Privacy Act of 1974.
• HIPAA.

The VA Privacy Services’ central department oversees the information flowing to and from these entities, making sure that veterans have access to and control over their medical information.² Veterans are allowed to:²

• Access their own health information.
• Receive copies of information about their medical health.
• Ask for corrections to any incorrect information.

A veteran has the right to request that their information not be disclosed to others.² The Veteran Health Administration must request permission from veterans in writing to disclose health information, except in limited situations.²

HIPAA ensures the protected health information (PHI) of people in the Armed Forces personnel is disclosed only under special circumstances.³ This provision is referred to as the Military Command Exception.³

The Confidentiality of Alcohol and Drug Abuse Patient Records regulations were issued in 1975. These provisions ensure confidentiality to anyone seeking treatment for substance use.⁴ The only time that rehab and other treatment can be disclosed is in cases of medical emergency, suspected child abuse, criminal investigations, and program audits.⁴ When it comes to HIPAA and substance abuse, you can have peace of mind knowing your privacy is protected.

Doctor-Patient Confidentiality & Drug Use

Whether a veteran meets with a primary care physician or a substance abuse rehab provider, they want to know that their personal information is protected. According to federal law, patients have special rights when it comes to their substance use history.⁵ Under Title 42 of the Code of Federal Regulations (CFR) Part 2, patients can expect privacy concerning any substance use disorder.⁵ Doctors and providers can’t give out information about a patient’s drug use without that person’s written consent.⁵

Past or current substance use can’t be used against you in determining employment, divorce cases, or custody battles.⁵ You can be assured of doctor-patient confidentiality for illegal drug use, too.

Will Prior Rehab or Drug Use Show Up On a Background Check?

Some people may be worried about whether drug rehab shows up on their medical records, and how that might affect their future. This could cause them to hold back on seeking treatment, which is detrimental to their well-being. This is a real concern when a veteran is looking for a new career or job. Sometimes prospective employers will run a background check on people they might hire. However, employers must abide by all the laws and rules set forth by HIPAA and the Privacy Act if they do run a check.⁵ They can’t get around the law and try to extract information about your past drug or alcohol use.

Can Drug Use or Rehab Impact VA & Veteran Benefits?

A service-related injury or illness can be compensated with VA benefits. Even if a pre-existing condition was made worse through service, you might be able to collect disability through the VA. There are other conditions that may apply, so it’s best to check directly with the Department of Veterans Affairs for clarification.⁶

You won’t be disqualified for benefits except in cases of “willful misconduct.”⁸ Willful misconduct applies when a veteran purposely engages in conduct that is specifically prohibited without regard for the consequences and includes using alcohol or drugs for enjoyment.⁹

However, the VA recognizes substance use disorders as a disability.⁷ The VA considers substance use an issue that warrants treatment, and can make exceptions for drug or alcohol use related to pre-existing mental health or physical conditions.⁷ It’s important to reach out to your VA representative to determine the extent of your benefits.

Under What Circumstances Could Information be Disclosed?

Health information is normally protected, and veterans can be assured that even information about drug or alcohol rehab will remain confidential. However, there are always exceptions to every rule. If you need emergency medical care, doctors may be required to provide limited information about your medical history.¹ Outside of an emergency, you can always give written consent for your medical information to be given to select individuals.⁵

There are some situations in which a veteran might decide to disclose personal information. They may want to have their health history shared with a close relative or spouse in case of an emergency. Some veterans may wish to share medical information between different medical facilities to make care smoother.

Penalties for Disclosing Information

It’s a serious infraction when a medical provider discloses your information without permission. If any covered entities do so knowingly, they can face a fine of up to $50,000, as well as imprisonment of up to 1 year.⁹

Finding Treatment

It’s important to remember that HIPAA and its provisions provide a great deal of confidentiality for veterans seeking substance abuse treatment. While there are a few exceptions, veterans should still feel confident in the confidentiality HIPAA provides and seek treatment for substance abuse. Contacting the VA is often a great starting point for veterans to begin finding treatment. If the VA can’t meet a veteran’s treatment needs, a confidential facility in the VA’s Community Care Network (VACCN) may be able to provide treatment.