Health Care Operations

Health care operations are any of the following activities:

1. quality assessment and improvement activities, including case management and care coordination;
2. competency assurance activities, including provider or health plan performance evaluation, credentialing, and accreditation;
3. conducting or arranging for medical reviews, audits, or legal services, including fraud and abuse detection and compliance programs;
4. specified insurance functions, such as underwriting, risk rating, and reinsuring risk;
5. business planning, development, management, and administration; and
6. business management and general administrative activities of the entity, including but not limited to: de-identifying protected health information, creating a limited data set, and certain fundraising for the benefit of the covered entity.