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What happens when it is discovered that a prospective member or active member did not provide complete and accurate medical history or information?

User Germi
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Final answer:

Failure to provide a complete and accurate medical history may result in termination of services, denial of claims, or legal actions. Laws like HIPAA and GINA help prevent discrimination and maintain privacy, but public safety concerns can override these protections. The omission can also impact healthcare costs and quality.

Step-by-step explanation:

When it is discovered that a prospective member or active member did not provide complete and accurate medical history or information, several consequences can occur. From a legal standpoint, the Health Insurance Portability and Accountability Act (HIPAA) and the Genetic Information Nondiscrimination Act (GINA) play crucial roles in maintaining confidentiality and preventing discrimination based on medical information. However, if an individual fails to disclose important medical facts, it could lead to termination of membership or insurance, denial of claims, or legal action for fraud.

In some cases, like when a public health risk is identified, medical professionals or legal authorities may need to balance the individuals' privacy with public safety concerns. This can lead to disclosure if it's essential for the protection of the public. Misrepresentation or omission in medical disclosure can also affect the cost and quality of care, and, if the information is crucial to treatment, it can negatively impact the individual's own health outcomes.

User Sergey Avanesyan
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