Understanding criminal penalties for HIPAA violations

Written by Tshedimoso Makhene | Jan 6, 2025 11:03:28 PM

While the civil penalties for HIPAA violations often get the spotlight, the law also enforces serious criminal penalties for individuals or entities that intentionally misuse or mishandle protected health information (PHI). Criminal penalties, which can result in fines or jail time, reinforce the importance of HIPAA compliance and the consequences of willful negligence or malfeasance.

What constitutes a criminal HIPAA violation?

Criminal penalties are typically reserved for violations involving intentional misconduct. These include:

Knowingly accessing or disclosing PHI without authorization.
Obtaining PHI under false pretenses, such as impersonating an authorized individual.
Using PHI for malicious purposes, including financial gain, personal benefit, or to cause harm.

The Department of Justice (DOJ) enforces criminal penalties for HIPAA violations, often focusing on cases involving clear intent to exploit sensitive information.

See also: Who enforces HIPAA regulations?

Criminal penalty tiers

Criminal penalties are divided into three tiers based on the nature and severity of the violation:

Violation type	Definition	Penalty
Knowingly obtaining or disclosing PHI	Unauthorized access to or disclosure of PHI without malicious intent	Fines of up to $50,000 and imprisonment for up to 1 year
Offenses committed under false pretenses	Accessing PHI using deception, such as falsifying credentials or pretending to have authority	Fines of up to $100,000 and imprisonment for up to 5 years
Offenses with intent to sell, transfer, or use PHI for harmful purposes	Exploiting PHI for financial gain, commercial advantage, or to harm an individual	Fines of up to $250,000 and imprisonment for up to 10 years

Real-world example

According to Abrams Fensterman Law’s media publication, a US cardiothoracic surgeon, Huping Zhou, was sentenced to four months in jail and a $2,000 fine for unauthorized access to patient records. Zhou, a researcher at UCLA School of Medicine, accessed patient records 323 times after being fired and accessed the medical files of his supervisor and co-workers. Despite pleading guilty, Zhou claimed he did not know it was a federal offense and that UCLA did not offer adequate training for employees.

Consequences beyond legal penalties

Criminal penalties often lead to:

Permanent criminal records, affecting future employment opportunities.
Loss of professional licenses, especially for healthcare professionals.
Reputational damage to individuals and their employers, eroding public trust.
Civil lawsuits from affected individuals, compounding financial losses.

Mitigating risks

Organizations and individuals can take proactive steps to avoid criminal violations:

Training and education: Regular HIPAA training ensures employees understand the rules and their responsibilities.
Access controls: Implement role-based access to PHI, ensuring only authorized personnel can view sensitive data.
Audit trails: Use monitoring tools to track access to and usage of PHI.
Incident response plans: Establish protocols for responding to breaches or unauthorized access swiftly and effectively.

FAQs

Who enforces criminal HIPAA penalties?

The Department of Justice (DOJ) enforces criminal penalties for HIPAA violations

What is the difference between civil and criminal HIPAA penalties?

Civil penalties typically involve monetary fines for violations caused by negligence or lack of compliance. Criminal penalties, on the other hand, apply to intentional misconduct and may result in imprisonment and higher fines.

Can patients sue for HIPAA violations?

While HIPAA does not provide a private right of action for patients, they can file complaints with the Department of Health and Human Services (HHS). Additionally, patients may pursue lawsuits under state privacy laws if they have suffered harm from a violation.

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