Health Care Operations

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FAU-C Any of the following activities of a covered entity that relate to its covered functions:

1. Conducting Quality Assessment and Improvement activities, including the following: outcomes evaluation and development of clinical guidelines; patient safety activities, population-based activities relating to improving health or reducing health care costs, protocol development, case management and care coordination; and contacting health care providers and patients with information about treatment alternatives;
2. Reviewing the competence or qualifications of health care professionals including the following: evaluating practitioner and provider performance; conducting training programs; accreditation; certification; licensing; or credentialing activities;
3. Underwriting (except as prohibited under 45 CFR §164.502 (a)(5)(i)(e.g., involving genetic information)), enrollment, premium rating, and other activities related to the creation, renewal, or replacement of a contract of health insurance of health benefits, and ceding, securing or placing a contract for reinsurance of risk relating to claims for health care;
4. Conducting or arranging for medical review, legal services and auditing functions including fraud and abuse detection and compliance programs;
5. Business planning and development such as conducting cost-management and planningrelated analyses related to managing and operating the entity; and
6. Business management and general administrative activities including the following: management activities relating to implementation of and compliance with the requirements of the privacy regulations; customer service; resolution of internal grievances; the sale, transfer, merger, or consolidation of all or part of the covered entity; and creating deidentified health information or a limited data set; and fundraising for the benefit of the covered entity.