The Health Insurance Portability and Accountability Act (HIPAA) is fundamental in protecting patient information across U.S. healthcare. Since its establishment in 1996, HIPAA has focused on simplifying healthcare management, reducing fraud, and safeguarding personal health information (PHI). Yet, compliance with HIPAA can be challenging, and violations can lead to breaches and penalties.
What counts as a HIPAA violation?
A HIPAA violation happens when a healthcare organization or individual doesn’t follow the rules set out by HIPAA, either intentionally or accidentally. Even unintentional mistakes can lead to violations, so understanding HIPAA’s core requirements is necessary:
- Security rule: Requires physical, technical, and administrative safeguards to protect health data.
- Privacy rule: Ensures personal health information isn’t shared without consent.
- Breach notification rule: Mandates that organizations notify affected individuals within 60 days if there’s a data breach.
- Omnibus rule: Gives patients the right to access and share their medical records.
- Enforcement rule: Outlines how complaints are investigated and the penalties for violations.
Read more: Understanding and implementing HIPAA rules
Common HIPAA violations and how to avoid them
Understanding common HIPAA violations is a big step toward maintaining compliance. Here are some of the most frequent infractions and practical ways to prevent them:
- Unauthorized access to health records: Employees sometimes access patient records without permission, either out of curiosity or by mistake. Limiting access to only those directly involved in patient care or operations is one way to curb this issue.
- Lack of a thorough risk assessment: Many organizations skip regular risk assessments, leaving vulnerabilities unchecked. Conducting routine assessments can help identify and fix gaps in data protection practices.
- Delayed breach notifications: HIPAA requires breaches to be reported within 60 days, but sometimes organizations miss this deadline. Setting up a clear breach notification process can help ensure timely reporting.
- Insufficient employee training: Employees who aren’t trained on HIPAA can unintentionally make mistakes that lead to breaches. Regular, focused training sessions help staff understand the imperativeness of safeguarding PHI.
- Improper disposal of PHI: Discarding sensitive documents without secure disposal methods can lead to unauthorized access. Shredding paper records and securely deleting electronic files are effective ways to handle PHI disposal.
Read also: Common HIPAA compliance issues and concerns
How HIPAA violations are discovered
HIPAA violations can be uncovered in various ways, often through self-reporting, audits, or external investigations:
- Internal audits: Organizations often perform their audits to check for compliance issues. These audits can help uncover areas that need immediate attention.
- Employee reporting: Sometimes, employees notice potential violations and report them, either internally or directly to the Department of Health and Human Services (HHS). Fostering a transparent culture where staff feel comfortable reporting issues can be helpful in catching mistakes early.
- HHS investigations: The Office for Civil Rights (OCR) within the HHS regularly investigates complaints and breaches, especially those involving major data exposure.
Penalties for HIPAA violations
HIPAA penalties can be severe, with both civil and criminal consequences depending on the nature and intent behind the violation. Here’s a breakdown of the types of penalties:
- Civil penalties: For unintentional violations, civil penalties may apply, with fines that vary based on the level of negligence. Fines can range from $100 for minor oversights to $1.5 million per violation for severe cases of willful neglect.
- Criminal penalties: For intentional violations, criminal charges may apply. This could include up to one year in prison and a $50,000 fine for unauthorized access, with harsher penalties if PHI was accessed for false pretenses or personal gain.
Related: What are the penalties for HIPAA violations?
Real-world examples of HIPAA violations
Learning from past violations can provide valuable insights. Here are a few notable cases that show the consequences of non-compliance:
- Health insurance provider data breach: In 2020, a major breach exposed the PHI of 10.5 million people after a phishing attack went undetected for nine months. The company faced a $6.85 million fine, with an investigation revealing poor risk assessments and inadequate security.
- Imaging company’s public data exposure: A medical imaging company in Tennessee was fined $3 million after it was discovered that their server, containing PHI of over 300,000 people, was publicly accessible. Delivering delayed breach notifications added to the penalties.
- Unauthorized disclosure in a press release: In 2015, a health system paid a $2.4 million fine for disclosing a patient’s name in a press release related to a police matter, proving the necessity of patient consent before releasing any PHI.
- Nonprofit health system’s ongoing violations: A nonprofit academic health system was fined $2.15 million for multiple HIPAA violations over several years, including unauthorized record access and failure to report lost records.
Strategies to avoid HIPAA violations
A proactive approach to compliance is beneficial to preventing HIPAA violations. Here are some practical strategies:
- Employee training: Consistent training sessions help employees stay informed about HIPAA and reinforce protecting PHI. Training should cover everything from safe data handling practices to procedures for reporting potential violations.
- Regular risk assessments: Regularly assessing risks helps organizations identify vulnerabilities, whether in physical security, technical safeguards, or administrative policies.
- Secure disposal of PHI: Ensure PHI is securely disposed of by shredding documents and permanently deleting electronic records no longer in use.
- Strong access controls: Only authorized staff should access PHI. Assign unique login credentials, regularly review permissions, and remove access for employees who leave the organization.
- Establish a breach response plan: Having a response plan ensures that a team knows exactly what to do in case of a breach, including notifying affected individuals and conducting an internal investigation.
See more: Preventing HIPAA violations
How technology can help with HIPAA compliance
Technology offers many tools that can support HIPAA compliance. Here are a few helpful options:
- Encryption solutions: Encrypting PHI—both in storage and during transmission—adds a layer of security, reducing the risk of unauthorized access.
- Compliance management software: Many organizations use software to streamline HIPAA compliance, offering features like automated risk assessments, training modules, and incident reporting.
- Secure communication channels: Encrypted email services and communication software ensure that PHI is safely shared, reducing the risk of exposure.
Learn more: HIPAA Compliant Email: The Definitive Guide
FAQs
Does HIPAA apply to my organization?
HIPAA applies to all covered entities, which include health plans, healthcare clearinghouses, and healthcare providers who transmit any health information in electronic form. If your organization falls into one of these categories, you are subject to HIPAA compliance requirements.
Do I need patient consent to share their protected health information (PHI)?
Generally, you need to obtain patient consent before sharing their PHI, with some exceptions. These exceptions include sharing PHI for treatment, payment, or healthcare operations, as well as certain public health and safety activities. Familiarize yourself with the specific consent requirements outlined in the HIPAA privacy rule.
What tools or resources can I use to ensure HIPAA compliance?
There are various tools and resources available to help healthcare providers maintain HIPAA compliance, such as:
- HIPAA compliant software and cloud storage solutions
- HIPAA training programs for employees
- Policies and procedures templates for HIPAA-related processes
- Guidance from industry organizations and regulatory bodies
Learn more: FAQs: All about HIPAA breaches