HIPAA does not prohibit sending PHI offshore, but it does not stop applying at the border. What the BAA chain, the Security Rule risk analysis and the CMS offshore subcontractor attestation actually require, which RCM work really moves, and the access controls that break first.
Why Accounting Firms Offshore Work, and What It Really Costs
The honest economics of offshoring accounting work: the AICPA pipeline numbers driving it, why year one usually costs more than it saves, which tasks travel and which never do, the review burden seniors absorb, and what an accountant whose department is being offshored can actually do.