HIPAA Violations: What is a HIPAA Violation?
In the complex world of healthcare, maintaining patient confidentiality is of utmost importance. The Health Insurance Portability and Accountability Act (HIPAA) is the primary law protecting sensitive patient health information from being disclosed without their consent, providing guidelines to healthcare providers and related entities on how to safeguard patient data.
However, despite these stringent standards, misunderstandings and missteps can lead to what's known as a 'HIPAA violation.’ But what exactly constitutes a HIPAA violation? In this blog post, we will delve into all of the details, including the potential consequences and how to avoid such transgressions.
Table of Contents:
- What is HIPAA?
- Who Must Follow HIPAA?
- Common HIPPA Violation Examples
- How to Report a HIPAA Violation
- HIPAA Violation Basics
- Can a Patient Sue for a HIPAA Violation?
- Penalties for HIPAA Violations
- Categories of HIPAA Violations
- What does HIPAA Compliance Involve?
- Being Accused of a HIPAA Violation: What to Do
- When to Share PHI
- The 7 Most Common HIPPA Violations (And How to Avoid Making Them)
What Is HIPAA?
The origins of the Health Insurance Portability and Accountability Act (HIPAA) can be traced back to August 21, 1996, when it was signed into law. HIPAA's inception aimed to "improve the portability and accountability of health insurance coverage" for individuals transitioning between jobs. The act focused on reducing waste, fraud, and abuse within the healthcare sector.
HIPAA was passed with dual goals: to make healthcare delivery more efficient and to increase the number of Americans with health insurance coverage. The law required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.
In 2009, the introduction of the Health Information Technology for Economic and Clinical Health (HITECH) Act further bolstered HIPAA regulations, enabling state attorneys general to issue fines for non-compliance. The HITECH Act also expanded the scope of HIPAA to include business associates of covered entities, promoting the secure exchange of electronic health information.
Since its enactment, HIPAA has gone through several milestones involving legislative updates and enforcement actions, transforming healthcare data security and privacy standards within the United States.
The Health Insurance Portability and Accountability Act (HIPAA) consists of five main provisions or rules. Compliance with these rules is essential in order to protect patient health information and reduce the likelihood of penalties.
Implemented by the US Department of Health and Human Services (HHS), the Privacy Rule outlines the use and disclosure of individuals' health information termed "protected health information" (PHI). Covered entities and their business associates must strictly limit the release of this information. It also provides patients with the right to access their health records and request corrections.
The Privacy Rule sets limits on using PHI without patient authorization and permits disclosures for treatment, payment, and healthcare operations. Patients are granted the right to access their health information and make corrections if necessary.
This rule specifically addresses electronic PHI (e-PHI). Covered entities must ensure the confidentiality, integrity, and availability of all e-PHI. This involves protection against anticipated threats or impermissible uses or disclosures that are not permitted by the rule.
The rule stipulates three types of security measures to be observed:
- Administrative safeguards: These concern establishing policies and procedures for managing and overseeing e-PHI access or use.
- Physical safeguards: These involve physical security measures like secure facilities, workstation access limitations, and device security.
- Technical safeguards: This category deals with technologies and systems ensuring the secure transmission, access, and audit of e-PHI.
Transaction and Code Sets Rule
This rule standardizes the methods for electronic data interchange (EDI) in order to maintain the integrity and confidentiality of PHI. It includes the adoption of standard processes like healthcare claims or equivalent encounter information. These standards apply to healthcare claims, payment and remittance advice, claim status, enrollment and disenrollment in a health plan, healthcare plan premium payments, eligibility inquiries, referral authorization, and coordination of benefits.
It adopts the standard for unique identifiers for covered healthcare providers, health plans, and employers to be used in the administration and management of health information.
Under the Identifier Rule, unique identifiers are assigned to healthcare providers, health plans, and employers using standard identifiers. The purpose of this rule is to make administrative and financial processes in the healthcare system more efficient. HIPAA established three types of standard identifiers:
- National Provider Identifier (NPI): A unique 10-digit number assigned to healthcare providers.
- National Health Plan Identifier (HPID): A unique identifier assigned to health plans for use in standardized transactions.
- Standard Unique Employer Identifier (EIN): A unique identifier assigned by the IRS to employers for tax reporting and other purposes.
This rule contains provisions related to the enforcement of HIPAA, compliance, and investigations into non-compliance, including penalties for violations. It sets the criteria for penalties, which can result from non-compliant practices or violations.
Violations can result in civil monetary penalties (CMPs) in a tiered system based on the level of knowledge or willfulness:
Tier 1: Unaware of the violation; CMP of $127-$63,973 per violation
Tier 2: Reasonable cause; CMP of $1,280-$63,973 per violation
Tier 3: Willful neglect but corrected; CMP of $12,794-$63,973 per violation
Tier 4: Willful neglect and not corrected; CMP of $63,973 per violation
In addition to CMPs, the Office for Civil Rights (OCR) investigates HIPAA violations, which can sometimes lead to criminal penalties.
Who Must Follow HIPAA?
HIPAA and HITECH regulations apply to various entities that handle protected health information (PHI). These include:
1. Covered Entities: As per the Privacy Rule implemented by HIPAA, entities that transmit any health information in an electronic format concerning transactions for which HHS has adopted standards are regarded as "covered entities.” They typically consist of:
- Healthcare Providers: These include entities that provide medical, dental, and mental health services and other healthcare services or supplies. The subset includes doctors, clinics, psychologists, dentists, chiropractors, nursing homes, and pharmacies.
- Health Plans: Health plans, which include health insurance companies, HMOs (Health Maintenance Organizations), company health plans, and government programs such as Medicare, Medicaid, and military and veterans' healthcare programs, are also considered covered entities.
- Healthcare Clearinghouses: These are entities that process non-standard health information received from another entity into a standard form or vice versa. Clearinghouses include billing services, repricing companies, community health management information systems, and value-added networks.
2. Business Associates: The HITECH Act expanded HIPAA provisions to include business associates. A business associate is a person or entity that performs or assists in a function or activity involving the use or disclosure of individually identifiable health information on behalf of a covered entity. Examples of business associates are:
- Data Transmission Providers: These are services helping to transmit PHI, such as a Health Information Exchange (HIE)
- Data Processing / Storage Firms: These could be firms offering data storage or disaster recovery services, including cloud services and other remote hosting services.
- Accounting Firms: To the extent that an accounting firm has access to PHI, they may also be considered business associates.
- Consultants, Subcontractors, Data Aggregators: These are individuals or entities that provide legal, actuarial, accounting, administrative, accreditation, or financial services involving the disclosure of PHI. It also includes subcontractors of business associates who handle PHI and entities that provide data aggregation services relating to healthcare claims and similar information for a covered entity.
These are the entities directly liable for HIPAA and HITECH Act compliance. HIPAA requires covered entities to have signed business associate agreements with their business associates, ensuring they will safeguard any PHI received, created, transmitted, or maintained in compliance with HIPAA Rules.
Common HIPAA Violation Examples
Before getting down to the gritty details, let’s cover some unfortunately not-so-uncommon examples.
One of the most frequent violations is when employees "snoop" on the healthcare records of family, friends, co-workers, and celebrities. It’s certainly tempting, especially when someone’s medical record is only a few clicks away.
But no one would notice this, right? Wrong. Don’t kid yourself; every click in EHR is tracked, dated, and stored.
When such violations are discovered, they can result not only in termination of employment but also criminal charges for the employee concerned.
A real-life example of this type of violation occurred when a former patient coordinator at the University of Pittsburgh Medical Center was found guilty of accessing and disclosing patient details of 111 people illegally and maliciously. She could have served up to 11 years in prison but received a 1-year jail term by the grace of her legal team.
Another frequent HIPAA violation is the loss or theft of devices containing PHI or protected health information (more on this later). Unsecured devices like laptops or USB drives holding sensitive data are particularly vulnerable to this type of violation. Cybersecurity and breaches are the most common way that ePHI is stolen.
In one such example, Lifespan Health System Affiliated Covered Entity (ACE) had to pay $1.04 million after an unencrypted laptop was stolen.
Failure to manage and preempt security risks is also a common reason for HIPAA violations. This can include insufficient risk analysis and management regarding the use and protection of electronic PHI (ePHI). Unfortunately, it’s becoming all too common for hackers to hold hospital systems hostage.
Sixteen hospitals and over 165 other medical facilities owned by Prospect Medical Holdings had to take their national computer networks offline following a ransomware attack. It forced doctors and nurses to revert to pen and paper for patient records and caused some outpatient facilities to close temporarily.
HIPAA violations admittedly come in all shapes and sizes, including those literally breaking in. Granted, this patient did use a fake ID and got himself arrested, BUT Memorial Hermann Health System (MHHS) included the patient’s name in the press release. Uh-no. The OCR allowed MHHS to settle with a $2.4 million fine for disclosing the patient’s name.
As illustrated above, HIPAA violations can lead to substantial fines and can detrimentally impact a healthcare provider's reputation, emphasizing the crucial need for robust compliance efforts.
How to Report a HIPAA Violation
Ultimately, reporting HIPAA violations is vital for protecting patient privacy, ensuring legal compliance, and preventing negative consequences for organizations. Proactive reporting of HIPAA breaches helps bring awareness to violations and facilitates their swift resolution.
You can submit anonymous claims here directly with the Office for Civil Rights (OCR). Complaints need to be processed within 180 days of the time you become aware of the incident. However, the OCR may waive the 180-day requirement for “good cause" shown.
For information on how to file a HIPAA violation via mail, fax, or e-mail, click here.
Failing to report a HIPAA violation does not directly lead to consequences for the individual who is aware of the violation but chooses not to report it. However, the lack of reporting can have indirect effects, such as:
- Perpetuation of the Violation: Unreported HIPAA violations may continue, putting more patients' privacy at risk and exposing their sensitive health information.
- Hazards to Patient Rights: Allowing a violation to persist can result in the infringement of privacy rights for patients whose records are mishandled.
- Establishing Negative Norms: Unaddressed violations can become established "cultural norms" within the organization, making it harder to rectify the issue and transition to a compliant state.
Disturbingly, HIPAA violations often lurk in the shadows, unnoticed, jeopardizing patients' private information without the need for evident misconduct. Amid ever-evolving HIPAA regulations, a business deemed compliant just six months ago may inadvertently breach protocols today, leading to severe consequences for both the facility and its patients.
Let's uncover the most notorious examples:
Irresponsible Workplace Behavior
This prevalent HIPAA regulation breach encompasses improper disclosure of information to unauthorized parties or inadequate employee training on managing confidential data. Imagine overhearing colleagues discussing a patient's medical condition. This would be considered a violation.
Improper Records Disposal
Sensitive patient records demand secure storage—in locked desks, filing cabinets, or password-protected digital devices. When disposing of such data, ensure thorough destruction to prevent data leaks.
When dealing with digital information, encryption offers a crucial security layer, helping safeguard against database attacks and unauthorized access.
The Aftermath: Violating HIPAA Regulations
If an investigation is triggered, what follows could be a high-stakes waiting game as the Office for Civil Rights (OCR) gathers its findings.
Should the OCR discover a breach of HIPAA rules, the accused party will face significant repercussions. Their obligations include:
- Instant rectification of the violation.
- Notification to all affected patients detailing the specific exposed information.
- Developing future compliance action plans.
- Accepting ongoing monitoring and providing regular updates to the OCR.
- Proposing a fair settlement for all affected parties.
Non-compliance with the OCR's guidelines could attract stiff financial penalties. While the violating entity may seek a judicial review for the punishment, if there is substantial evidence supporting their violation, overturning the financial penalties becomes a daunting task. Anticipate that neglecting HIPAA could result in serious consequences — it pays to stay on the right side of the law.
What exactly is HIPAA? Does it serve as some form of an agreement between patients and providers? Quite so. HIPAA outlines the roadmap for:
- How medical providers utilize information
- The consent patients give for their information to be disseminated
- The consequences of violations of the standardized protocols
However, a HIPAA confidentiality breach transcends traditional contract disputes. In essence, when healthcare providers violate HIPAA, they're not merely breaking a contract but also breaching the law. The blame may fall on:
- The individual healthcare worker
- Their employer
- Or both parties
The assignment of fault shapes the response to the violation. When organizations are responsible, HIPAA breaches are generally addressed by the OCR, using their legal prerogative over the entities concerned. Individual fault could result in an OCR-administered resolution or potentially initiate a civil lawsuit and criminal charges, much like other dual-nature misdemeanors, such as:
- Assault victims claiming civil damages under suitable circumstances
- The need to establish definitive evidence about individual accountability, intent, and actions to win the case
- Victims unable to instigate criminal charges
When criminal charges are suitable, they are led by state legal systems.
Moreover, remember that the handling of each HIPAA violation case can vary significantly, contingent on exact case specifics. Different degrees of liability play in. The majority stakeholder in liability will fundamentally influence how patients and other involved parties react.
Unearthing the intricacies of a HIPAA violation brings us to four potential players in the equation:
- The Covered Entity
- The Office for Civil Rights (OCR)
- State Attorney Generals
The Covered Entity takes the first step. As soon as they become privy to a violation, it’s their prerogative to report it. Their responsibilities further extend to notifying affected patients and conducting an internal investigation, key points of which can include:
- Detecting the source and reason for the violation
- Assessing whether the violator was cognizant of their wrongdoing
- Determining if there was intent behind the violation
- Evaluating the company's guidelines for potential weak points
- Enforcing corrective or disciplinary action, as needed
The outcome could show that the incident was merely an accident, requiring simple employee counseling and documenting the incident. However, deliberate rule-breaking could lead to sanctions or dismissals.
The OCR swings into action upon receiving a breach report, taking up the responsibility of probing and resolving the situation. They assess the breach's severity, assign responsibility, and dictate the penalties, all outside of court systems.
The involvement of State Attorney Generals is infrequent yet potent. Intentional and harmful breaches may lead them to levy criminal charges in favor of the affected patients. They can set in motion either criminal or civil proceedings based on the case's specific details.
For Patients, the road is two-pronged. They can request the State AG to press criminal charges or initiate a civil lawsuit. Unfortunately, not all scenarios qualify for civil suits.
What Guides the Response to a HIPAA Violation?
The reaction to a HIPAA violation is typically shaped by:
- The incident's severity
- Whether the incident was deliberate or avoidable
- The response of the covered entity
Severity: A majority of HIPAA breaches are minor, with patients often unscathed. For instance, an accidental file opening with no further action might result in a $127 fine if handled responsibly. However, severe incidents can affect many patients dramatically and could have been prevented or involved in an intentional misuse of power.
Intent: The incident involving Linda Sue Kalina, a former UPMC patient care coordinator, perfectly illustrates the role of intent. Her deliberate abuse of access to patient records and malevolent spread of confidential information about her ex-coworkers rendered her exposed to both civil and criminal liabilities. She was sentenced to 1 year in prison.
Response: The handling of violations by the employer or covered entity is another tack. Entities responding per legal standards can clear themselves of liabilities, while those who don’t can unwittingly share the liability.
Liability: HIPAA violations are unique, given the potential for multiple parties to be liable. An individual healthcare worker who accidentally accessed unauthorized data may have committed a violation, but this is small and unintentional, hence lower liability. On the flip side, an organization failing to take appropriate action post-violations could face significant liability.
Responses within organizations often involve counseling or retraining the responsible parties, reviewing and possibly revising policies, and implementing employee sanctions or terminations. When an entity is found liable, the OCR can impose fines of up to $1.9 million annually.
Can a Patient Sue for a HIPAA Violation?
Unmasking the Aftermath of a HIPAA Violation
The media often buzzes with tales of healthcare professionals illicitly breaching the medical confidentiality of renowned figures. Such instances are blatant contraventions of HIPAA law, but the underbelly of this matter, the ensuing process once a violation comes to light, remains mysterious to most. Who can patients sue? What delineates the permissible situations? What awaits the violators? Summing it up in a nutshell - it's not straightforward.
When Violations Enter the Courtroom
Only a minority of HIPAA violations end up battling it out in civil court. Reasons often include:
- The breach was unintentional or inevitable.
- It led to no provable harm.
- Establishing guilt to meet court standards is challenging.
Victims or their estates occasionally have the right to ignite civil proceedings resulting from an incident. The most probable scenarios are:
- The offense was intentional.
- The victim encountered significant or public damage.
- High-profile victims were involved, spawning cases with emblematic significance.
For expansive or particularly harsh breaches, a state's Attorney General might join the battle in favor of all victims. This is deemed the best recourse, as personal HIPAA lawsuits can be costly, time-consuming, and tough to win.
Potential victims might refrain from proceeding with civil cases due to the anticipated expenses overshadowing any possible rewards. Suing a healthcare worker can translate into scanty assets, making victory a hollow triumph. Organizations dole out repercussions such as revoking healthcare working rights and medical credentials or terminating the implicated employees.
Hence, civil cases generally provide financial restitution, making them redundant with no monetary compensation due to the offender's lack of assets.
When Violations Acquire a Criminal Undertone
HIPAA violations invite criminal cases when they:
- Are wilfully committed by individuals fully aware of their wrongdoing.
- Form part of an identity theft scheme.
- Involve stolen data sold or divulged for personal, social, or financial benefits of the perpetrator.
The majority of the cases see state attorneys filing criminal charges against distinct individuals instead of organizations. Any liable covered entities have their culpability addressed by the OCR sans the criminal courts. Convicted defendants can anticipate:
- Steep fines.
- Jail time spanning several years.
- Probation and additional penalties.
Additionally, individuals penalized for criminal HIPAA offenses often forfeit their capability to work in medical or related fields.
Can Patients Sue? The Final Verdict
Considering these aspects, the conclusive answer is:
- Most HIPAA violations don't permit patients to press a lawsuit.
- The onus of addressing and penalizing HIPAA violations falls on OCR and state attorneys.
- In rare instances, deliberate HIPAA contraventions could invite civil and criminal lawsuits.
- State attorneys manage all criminal suits and select civil suits.
- Exceptions may allow victims to personally pursue civil court cases.
The Provider Perspective
For providers, the essence of this understanding is the importance of rigorous HIPAA compliance for prevention not only against OCR actions but potential civil and criminal cases as well. It might be impossible to entirely avert a violation, but providers can diminish the risk and their liability by:
- Properly educating their workforce about HIPAA law, violations, and repercussions.
- Training managers and administrators to respond effectively to violations.
- Upholding robust HIPAA compliance policies and practices.
- Always acting in good faith.
Such simple strategies can shield providers from unpleasant ramifications when HIPAA violations arise and enable them to demonstrate employee liability for intentional violation of HIPAA regulations under their watch.
Penalties for HIPAA Violations
Breaking Down the Penalties for HIPAA Violations
Penalties for HIPAA violations are subject to considerable variation, contingent on the seriousness of the offense, whether it was accidental, and the response following the violation. Individuals in healthcare professions have a clear-cut responsibility to abide by HIPAA regulations; however, breaches occur, falling into four distinct categories of violations and penalties.
This group encompasses violations beyond the control of the covered entity, where preventive measures were not credible. Frequently, the entity is oblivious to the violation, lacking any feasible means to control it. The protected health information (PHI) has to be guarded by the entity with due diligence to be categorized under this tier. Any violations that could be anticipated are escalated to the next tier. Fines for this category can range from a mere $127 to an alarming $63,973 for each violation, subject to factors such as the organization's financial health and prior violation history.
Violations that a covered entity could have, but didn't foresee, fall under the second tier. Despite this, they might still be unavoidable despite adequate caution. It's worth noting that willful disregard of HIPAA rules does not qualify for this category. Adequate preventive measures should be taken to stop the violation once their potential initiation is known. However, this might pose a challenge. Consequences for infractions in this category vary from $1,280 to $63,973 per violation, similar to tier 1, where the final penalty is influenced by numerous circumstances.
Violations occurring due to intentional neglect of HIPAA norms but accompanied by corrective measures are classified under this tier. The differentiating factor here is the presence of corrective action that separates these violations from those of tier 4. Covered entities should endeavor to boost PHI security constantly. For such violations, penalties can range from $12,794 up to $63,973 per violation, with the degree of harm generated being a determinant for the exact figure.
Notably, different from tier 3, this final group encapsulates violations where there are no corrective attempts. Cases involving deliberate neglect that persist unattended would fit in here. Frequent instances might include unsecured patient records or consistent failures to log out from electronic record systems. Given these are the gravest forms of HIPAA breaches, they attract the heaviest penalties, starting at $63,973 per violation. Unlike other tiers possibly qualifying for waivers, this category is exempted. Violations under this tier may, in some cases, also carry the potential of imprisonment.
Level of Culpability
Min. Penalty per Violation
Max. Penalty per Violation
Annual Penalty Limit
Lack of Knowledge
Willful Neglect not Corrected within 30 days
Categories of HIPAA Violations
The Health Insurance Portability and Accountability Act, or HIPAA, is a labyrinth of clauses and legislation. The Department of Health and Human Services Office for Civil Rights' published version spans an impressive 115 pages. Not surprisingly, there exist countless ways in which this complex law can be violated. However, the most common infringements include:
- Unauthorized or inappropriate disclosure of Protected Health Information (PHI).
- Unauthorized access to PHI.
- Improper disposal of PHI.
- Omitting necessary risk analyses.
- Neglecting proper management of risks to the confidentiality, integrity, and availability of patient's PHI.
- Failure to implement and maintain safeguards that ensure the confidentiality, integrity, and availability of PHI.
- Not keeping or tracking access logs for PHI.
- Not setting up a HIPAA-compliant business agreement with vendors and service providers before granting them access to PHI.
- Denying patients access to their own PHI upon their request.
- Neglecting to implement and maintain access controls that restrict PHI visibility.
- Failure to remove access rights to PHI when they're no longer required.
- Revealing more PHI than is required for a particular task.
- Neglecting to provide necessary HIPAA and security awareness training to employees.
- Theft of patient records or PHI.
- Unauthorized release of PHI to third parties.
- Sharing PHI online or on social media platforms without proper authorization.
- Mistreatment or misdirection of PHI via mail.
- Transmission of PHI via text messages.
- Not encrypting PHI or safeguarding it from unauthorized access.
- Not informing a patient or the Office for Civil Rights about a security breach involving their PHI within 60 days of discovering the breach.
- Failure in documenting and logging efforts made for compliance.
For businesses to avoid common HIPAA violations and maintain compliance, a robust strategy becomes indispensable. This begins with self-auditing to identify compliance gaps across Administrative, Technical, and Physical domains.
Filling these gaps via remediation planning with clearly noted timelines is the next step. Regular updating of policies, procedures, and staff training in accordance with HIPAA standards is also required. Meticulously documenting all compliance efforts can prove vital during potential investigations.
The management of business associates involves documenting vendors who exchange PHI, ensuring they handle it responsibly. Lastly, applying effective incident management, including documentation of breaches and appropriate patient notification under the HIPAA Breach Notification Rule, is crucial.
The Seven Pillars of an Effective Compliance Program
The Office of Inspector General at the Department of Health and Human Services has outlined the foundation of an effective program in a document known as the Seven Pillars of an Effective Compliance Program. This guidance serves as a roadmap for organizations looking to initiate or enhance their compliance mechanisms. The pillars include:
- Developing written codes of conduct and policies and procedures.
- Assigning competent individuals to form a compliance officer and compliance committee.
- Delivering effective education and training to the staff.
- Creating efficient communication channels.
- Conducting internal audits and monitoring.
- Upholding established standards through clearly communicated disciplinary guidelines.
- Swiftly responding to detected violations and undertaking corrective measures.
These seven pillars represent the basic requirements for a compliance program. An exemplary compliance program will generally implement additional measures to secure patient data. However, should a HIPAA investigation involving your organization ensue, these guidelines will be pertinent. Federal auditors will benchmark your compliance program against these pillars.
Navigating a HIPAA Violation With Our Assistance
In this discussion, we've shone a light on key elements of HIPAA compliance and violation, including common instances and the importance of maintaining compliance. Yet, HIPAA regulations are intricate and require thorough understanding to consistently prevent violations.
To aid your organization in maintaining compliance, we provide extensive HIPAA compliance training and examinations. Irrespective of whether you manage a healthcare facility or service one, our educational programs will prepare your team to safeguard sensitive patient data. Feel free to reach out to us with any queries and commence your training today.
Being Accused of a HIPAA Violation: What to Do
As a healthcare provider dedicated to offering unparalleled patient care, encountering challenges like constant rule changes and continuous technology advancements can be daunting. The administrative aspect can often overshadow the primary purpose of seeing and treating patients. The situation can get even more complex when you are faced with a HIPAA violation, making it critical to understand what steps to take next.
Role of HIPAA Training in Safeguarding Your Practice
HIPAA forms the crux of healthcare practice, and a violation could spell punitive measures, damaging publicity, and possibly lead to criminal prosecution and the incarceration of implicated employees. An urgent, thorough investigation is essential once the violation is brought to your attention. Implement a rigorous policy at your workplace to manage such complaints.
A rise has been observed in the legal prosecution of HIPAA violations, with imprisonment taking precedence over financial penalties. Another disturbing trend is the framing of healthcare workers, often nurses, out of spite, leading to court cases that can disrupt your practice. Protecting your employees and practicing against such scams requires meticulous HIPAA training to comprehensively understand the complex policies.
Effective Management of HIPAA Violations
Establishing policies to tackle potential HIPAA violations is key. An improvised strategy post-violation can negatively influence your position if you face legal proceedings. Documentation supporting your practice's operations is indispensable to counter unjust allegations. Upon receipt of a potential violation notification, immediate action is required. Quick response and remedial measures within 30 days can limit or even avoid penalties. Delays can complicate denying responsibility, and once the Office of Civil Rights (OCR) is engaged, outcomes can vary from mere problem resolution to incurring heavy fines or even criminal charges.
Investigation and Mitigation
Prompt investigation should be initiated on detecting a suspected violation. Document all findings to shield yourself in case the situation escalates. If your employees are found guilty, identify gaps in your internal policy and take preventive measures. Enhancing compliance training or modifying office policies could effectively mitigate damage.
Combatting False Accusations
In case of no proof of breach, remember it's not uncommon for false HIPAA violation claims to emerge as a retaliation tool. The increased legal prosecution of such violations may result in employees being targeted by fraudulent schemes. Regardless of the nature of these accusations or where they originate from (internally or externally), treat them like any other potential HIPAA violation. Cooperate with any investigation and gather evidence to defend your case.
Ensuring Employee Protection
Regular HIPAA training keeps your staff updated and assures them of their ability to resist false claims. Understanding common HIPAA violations and prevention strategies is essential in safeguarding your practice from possible breaches.
Most Common HIPAA Violations
Several aspects of this policy are commonly violated, including denying patients access to health records, failing to protect a patient's privacy, neglecting to evaluate vendors for compliance, and lax security measures toward electronic health records (EHRs). Bypassing deadlines for investigations and failing to report breaches within 60 days are also frequent breaches.
Collaborating with the Office for Civil Rights
Regardless of the legitimacy of a HIPAA violation allegation, OCR has a responsibility to investigate such claims. If you are confident about your HIPAA training and documentation processes, any inquiry should hardly be a cause for concern. Remember, lodging false complaints is also an offense, and the complainant might have infringed upon HIPAA policies. Hence, regular staff training is the most potent tool in insulating your practice and staff from fraudulent HIPAA infringement allegations.
When to Share PHI
Understanding When to Share Protected Health Information (PHI)
Certain situations under HIPAA legislation may require the sharing of PHI or Protected Health Information. It's crucial for your healthcare practice to understand such instances. This will prevent accidental information breaches and unrequired withholding of vital information. Proper knowledge of HIPAA compliance among your staff members should not be underestimated.
Information sharing typically becomes necessary under several circumstances, such as:
- Research related to specific diseases
- Public health investigations, especially for communicable diseases
- Workplace safety and workers' compensation
- Public health emergencies like food contamination
- Cases involving victims of abuse or neglect
- Law enforcement demands
- Identification of a deceased individual
- Organ donation procedures
- Legal proceedings
- Essential government activities
HIPAA Compliance: A Continuous Journey
As technology evolves, so does HIPAA compliance. Modern healthcare practices need to know how to securely store patient data, adapting to evolving software and technological innovations. Being HIPAA compliant is not a one-time achievement; it's an ongoing process. Rather than viewing it as a box to be checked after an external audit or training, consider it an ongoing safety measure.
Non-compliance with HIPAA can lead to serious consequences. The Department of Health and Human Services (HHS) can impose hefty fines, even jail time, depending on the magnitude of the violation. Constant attention to updates and changes in HIPAA regulations is essential.
HIPAA in the Age of Electronics
In today's digital age, secure handling of electronic patient data is a pivotal aspect of healthcare practices. While technology has streamlined healthcare operations, it has also introduced new data security threats. Protecting your practice from potential threats requires a proactiveness that goes beyond the installation of sophisticated software or physical security measures.
Engaging experienced IT professionals to ensure your system is impervious to security breaches is recommended. This investment could greatly reduce the chance of a costly security breach happening in the future.
Considering HIPAA Certification
While HHS does not offer official HIPAA certification, having a third party certify your practice can be beneficial. A third party audits your systems to ensure they meet stringent HHS requirements and can provide solutions if they fall short. This certification may need regular reassessment due to evolving compliance requirements.
In the event of a compliance failure, reputational damage could result in patients opting for other healthcare providers. This highlights the importance of maintaining patient trust by following best privacy practices and ensuring that their information is diligently safeguarded.
The Importance of Training in HIPAA Compliance
Keeping your staff up-to-date about HIPAA laws and regulations is an integral part of compliance. Medical professionals cannot be expected to know all the ins and outs of HIPAA without proper training. HIPAA training sessions are instrumental in ensuring that the employees follow compliant practices and stay informed about changes or new laws.
Training done in-house or online by a third party can provide employees with the necessary knowledge to be HIPAA-compliant in their daily tasks. The training would also help them leverage digital tools responsibly with respect to sensitive information storage, thus minimizing theft risk. Although compliance cannot be guaranteed solely by employee training, it remains a crucial preventive measure against potential breaches.
The 7 Most Common HIPPA Violations (And How to Avoid Making Them)
The Office for Civil Rights (OCR) reported more than 28,000 complaints of potential HIPAA violations in 2019, resulting in upwards of $15 million in penalties. Surprisingly, most of these violations are recurrent, with the same seven infringements accounting for a majority of them each year.
1. Failure to Secure and Encrypt Data
Securing and encrypting data is often overlooked, leading to widespread HIPAA violations. This happens due to a misconception that encryption is not mandatory since it's classified as "addressable" rather than "required." Sometimes, breaches occur from simple staff errors such as leaving physical files exposed to other patients, neglecting to secure computer screens when stepping away, sharing unsecured patient data via text, or downloading records onto unencrypted mobile devices.
Training staff on what constitutes a breach, preventive measures, and what to do in case of a suspected breach can help avoid this violation. Moreover, encryption can act as a powerful protector. If encrypted data gets stolen, but the encryption key remains secure, it is not considered a HIPAA breach.
2. Device Theft
Occurrences of lost or stolen devices add to HIPAA violation cases. According to the OCR, almost half of Americans have had their Protected Health Information (PHI) compromised since 2009, mostly due to stolen, unsecured, and unencrypted devices like laptops, cell phones, portable drives, etc.
Encrypting all PHI across all devices can safeguard your information, even if a device gets stolen. Additionally, training your staff on proper device handling practices can minimize risks.
3. Employee Misconduct
Employee misconduct ranges from accidental breaches (like answering questions from patients' relatives, violating privacy, or leaving files where others can see them) to deliberate misuse of access to PHI.
Restricting access to PHI and providing comprehensive HIPAA training to staff can help prevent both accidental and deliberate breaches.
4. Improper Records Disposal
Accidentally discarding documents containing PHI or failing to wipe or destroy devices carrying PHI is another common violation. Clear policies regarding document and device handling, coupled with effective staff training on possible HIPAA violations, can mitigate these risks.
5. Non-Compliant Partnership Agreements
Working with non-compliant partners can lead to significant HIPAA violations. Rapid changes in partners' organizational structures and urgent facility needs can cause non-compliant agreements. Training staff handling partner contracts in HIPAA compliance can help avoid these issues.
6. Failure to Perform an Organization-Wide Risk Analysis
Performing a comprehensive risk analysis is mandated under HIPAA regulations. Failing to do so can trigger violation penalties in itself and can allow other violations to go unchecked.
7. Inadequate Staff Training
Given that almost all other common violations on this list can be prevented by proper staff training, it's unsurprising that inadequate training is one of the most recurrent HIPAA violations. Effective and comprehensive training can be challenging to conduct, especially as the healthcare environment evolves rapidly.
Online training providers, such as HIPAA Exams, offer valuable resources for HIPAA training. Their courses explain the requirements, the nature of breaches and their avoidance, penalties for violations, and the application of this information in daily work routines. The training concludes with tests for comprehension and provides printable completion certificates for easy tracking.
Investing in robust training, applying strong and clear data and device policies, and maintaining compliant partnerships should protect healthcare practices from falling victim to these common violations. Head to our website and check out our extensive catalog of HIPAA training courses today.