Civil Laws vs. HIPAA: Which one dominates?

Rather than one dominating the other, civil laws and HIPAA complement each other. HIPAA sets the standards for healthcare privacy and security, while civil laws provide avenues for individuals to seek justice and compensation. In healthcare-related disputes, the interplay between these frameworks ensures that both regulatory compliance and individual rights are upheld.

What are civil laws?

Civil laws govern disputes between individuals, organizations, or entities. These laws cover areas like contract breaches, personal injury claims, and medical malpractice cases. The purpose is to resolve conflicts and compensate the aggrieved party for the damages suffered.

Features of civil laws:

• Scope: Broad, encompassing various legal areas such as property disputes, tort law, and contract law.
• Enforcement: Handled by civil courts, with judgments typically resulting in monetary damages, injunctions, or specific performance.

Examples

• A patient suing a hospital for medical negligence.
• A business dispute over contract violations.

Understanding HIPAA

HIPAA, enacted in 1996, focuses specifically on protecting the privacy and security of patients' health information. “HIPAA applies to health plans, health care clearinghouses, and those health care providers that conduct certain health care transactions electronically (e.g., billing a health plan). These are known as covered entities,” says the HHS. “In addition, HIPAA protects PHI

held by business associates, such as billing services and others, hired by covered entities to perform services or functions that involve access to PHI.”

Features of HIPAA

• Scope: Limited to healthcare entities and their associates, targeting privacy, security, and breach notifications related to PHI.
• Enforcement: Overseen by the U.S. Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR).
• Penalties: Includes civil fines ranging from $141 to $71,162 per violation (capped annually at $2,134,831 for identical violations) and criminal penalties, including imprisonment.

Go deeper: Understanding and implementing HIPAA rules

Civil laws vs. HIPAA: When conflicts arise

While HIPAA is a specialized law, civil laws provide a broader framework. In healthcare disputes, both can intersect, leading to complex legal dynamics. For instance, a patient’s medical malpractice lawsuit may involve allegations of a HIPAA violation, but HIPAA itself does not grant individuals the right to sue for violations. Instead, individuals must rely on civil laws to seek remedies.

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Which one dominates?

The dominance of civil laws or HIPAA depends on the context:

• Privacy violations: HIPAA takes precedence in cases involving breaches of PHI. For example, if a healthcare provider improperly discloses patient information, the OCR will investigate and impose penalties. However, individuals cannot directly sue under HIPAA; they must file a complaint with HHS or seek recourse under state privacy laws, which are part of the civil law framework.
• Medical malpractice: In medical malpractice cases, civil laws dominate. HIPAA may influence the case by providing standards for handling patient information, but the resolution is driven by civil courts.
• Data breaches: HIPAA governs healthcare data breaches and outlines specific penalties. Civil laws, on the other hand, may allow affected individuals to file lawsuits for damages caused by the breach, such as identity theft.

Intersection of civil laws and HIPAA

Although HIPAA and civil laws operate independently, they often intersect. For example:

• A HIPAA breach could trigger a civil lawsuit under state laws.
• Evidence of a HIPAA violation might strengthen a plaintiff’s case in a malpractice suit.

See also: HIPAA Compliant Email: The Definitive Guide

FAQs

What is the difference between civil law penalties and HIPAA penalties?

Civil law penalties typically involve monetary compensation or specific performance, while HIPAA penalties are regulatory fines and sanctions imposed by the OCR.

Can a HIPAA breach trigger a civil lawsuit?

Yes, a breach may lead to lawsuits under state laws for damages, even though HIPAA violations themselves are handled by the OCR.

Can state laws override HIPAA?

State laws that provide greater protections for patient information can complement HIPAA but cannot reduce its requirements.