HIPAA Feedback Form

The HIPAA Compliance Program of Fairfax County Government investigates and responds to complaints on behalf of residents who have received physical and mental health care services from Fairfax County Government agencies and complaints on behalf of Fairfax County Government employees and retirees participating in the Health Plan administered by Fairfax County Government's Department of Human Resources' Benefits Division.

Complaints must be submitted within 180 days from the alleged date of infraction. At this time, complaints are being accepted for violations related to the privacy of patient's protected health information and for violations related to the incorrect submission of transactions and incorrect use of proper codes.

The Fairfax County Government HIPAA Compliance Program does not provide legal advice or medical advice. The Fairfax County Government HIPAA Compliance Program does not regulate health insurance premiums, health-care provider service charges, or quality of care issues.

Health Insurance Complaints

If you are a participant in a Fairfax County Government Health Plan, please indicate your status by checking the appropriate box below. All other complaints related to Health Insurance must be directed to your Health Insurance Company's Privacy Officer or Virginia's State Corporation Commission, Bureau of Insurance for Life and Health, 804-371-9691, 1-800-552-7945, TDD 804-371-9206.

Health Care Provider Complaints

If you have recently received physical or mental health care services from a Fairfax County Government agency or affiliated program (such as the Fairfax County Health Department, the Fairfax County Fire and Rescue Department, or the Fairfax/Falls Church Community Services Board), please indicate your status by checking the appropriate box below. All other complaints related to health care providers must be directed to the health care provider's Privacy Officer as identified on your health care provider's Notice of Privacy Practices or to the Office for Civil Rights, U.S. Department of Health and Human Services, 215-861-4441, 1-800-368-1019, FAX 215-861-4431, TDD 215-861-4440, http://www.hhs.gov/ocr/privacyhowtofile.htm.

Please select one category before you submit the feedback form:
I am a Fairfax County Government employee.
I am a Fairfax County Government retiree.
I have received health care services from Fairfax County Government.
I am a parent of a minor child or a legally authorized representative submitting a complaint.
   
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