Being Framed for a HIPAA Violation: What to Do

When a team member is accused of a HIPAA violation, the stakes are high for both the individual and their place of work. Even baseless allegations can tarnish reputations and strain trust among staff and patients. This article provides actionable steps for navigating such situations, safeguarding all parties, and ensuring compliance with HIPAA regulations.

HIPAA Violation Statistics

With the rising rate of HIPAA violation claims, it is not uncommon to receive a HIPAA violation claim. According to the HIPAA journal, there were about 725 data breaches reported to the Office of Civil Rights, with more than 133 million exposed records in 2023. The OCR has a meticulous process for investigating violation claims. Depending on the scope of the breach, noncompliance penalties can be quite hefty for employers. 

Types of HIPAA Violation Claims

Violation claims take many forms. Some common examples include:

• Failure to guard a patient's privacy
• Failure to check compliance from vendors and other third-party agents
• Denying patients access to their health records. This also includes charging above-market rates for copies of the documents or dragging your feet at providing the documentation.

How to Handle a HIPAA Violation Claim

There are a few different steps to take when you’re dealing with a HIPAA violation allegation. Let’s take a closer look at some of them so you can address the situation effectively, mitigate potential risks, and ensure compliance moving forward.

Investigate the Issue

Employers must start a full investigation into all claims of HIPAA violation. Timely investigation can mitigate the risks of noncompliance charges and bad press. The investigation must be thorough and objective and done by a trained professional. If the investigation reveals a fraudulent claim, you must escalate to the appropriate authorities for legal action for HIPAA legal defense. If a violation claim proves true, you should take immediate steps to mitigate the risk of the violation.

For example, if a health worker unwittingly posts an image of a patient on the internet, the health worker must swiftly take the post down. Depending on the scale of violation, the health worker may receive a form of sanction. You should report all verified violation claims to the Office of Civil Rights within 30 days of discovery. An early report reduces the risk of penalties. The OCR commences its investigation and penalizes according to the scale of violation.

A claim investigation is also an ideal time for a risk assessment. Conduct a risk assessment of all systems and processes involved in storing, transferring, and processing PHI. A risk assessment greatly reduces the chances of a repeat violation. Another way to reduce a repeat occurrence is to update existing policies. You can also add additional compliance training for staff, or switch to new training providers with richer and current content.

HIPAA exams offer a range of HIPAA courses to suit diverse staff needs. For example, our courses, HIPAA for healthcare workers, HIPAA for medical staff, and HIPAA for dental offices train care providers on how to protect patient privacy when performing clinical tasks. This training reduces the likelihood of HIPAA compliance mistakes.

Documentation

Document every process of the investigation. Good documentation is useful evidence in a

legal battle with a fraudulent whistleblower. The document must contain the nature and scale of the violation claims, the investigation process, and mitigation measures. It should also contain the results from the risk assessment and measures taken to prevent a recurrence.

Have a Fail-Proof Policy

A claims investigation policy covers the above processes and more. Ideally, you should have different processes for different contexts. For example, what to do if accused of HIPAA violation by a patient, or a business associate. In our course, HIPAA for business associates, we discuss how business associate agreements can protect covered entities from liabilities incurred by business associates and their contractors.

Fraudulent HIPAA Violation Claims

The law does not take fraudulent HIPAA violation claims lightly, and neither should you. In 2019, a Georgia resident fraudulently accused a nurse of violating the Privacy Rule. The man alleged that the nurse emailed graphic images of patients’ injuries to him. A thorough investigation revealed that this man conceived and enacted an elaborate scheme where he created emails using the names of the said nurse and other staff members, and sent the images to the hospital’s email address, the DOJ, and the FBI.  In the end, he was sentenced to 6 months of jail time.

With the rising prevalence of AI-generated images and deepfakes, the rate of fraudulent HIPAA violation claims will increase. As an employer, you must be thorough in all claims investigation, and be thorough in taking legal action against fraudulent claims.

Consequences of Legitimate HIPAA Violations

Penalty fees from the OCR can be hefty. In February 2024, the OCR fined Montefiore Medical Center over 4 million dollars for violating the HIPAA Security Rule. Unfortunately, the costs of HIPAA compliance violations aren’t only monetary. Noncompliance charges from the OCR can cost you your clients’ trust and loyalty. It can hurt your brand and trigger bad publicity. There is also the possibility of jail. Nowadays, it is not uncommon for law enforcement agents to criminally prosecute HIPAA violations.

How To Protect Your Staff and Your Business From False Accusations

Aggrieved patients can frame or falsely accuse nurses and other health workers. While you can't control the actions of such people, you can however protect your staff from these events. The best protection you can give your staff is regular, updated HIPAA training. A well-trained staff is confident in their record-keeping and compliance standards. Staff members are also in a better position to defend themselves when falsely accused of violating HIPAA regulations.

Our HIPAA courses are not only affordable, but they also provide the latest information on HIPAA regulations and policies. Our courses are also accredited to provide Continuing Education Units. To learn more about these courses, visit our website and check out our full course catalog here.