Everything You Need to Know About a HIPAA Violation
For 2022 Rules for Healthcare Workers, please click here.
For 2022 Rules for Business Associates, please click here.
Between 2005 and 2019, healthcare data breaches affected nearly 250 million people. And when data breaches like this occur, it's usually because of a HIPAA violation. HIPAA violations are not uncommon. In fact, even a competent healthcare facility will experience minor HIPAA violation cases at some point. But violations are also quite serious. They can lead to severe problems for patients and medical clinics alike. Because of this, every doctor's office needs to keep up with changing HIPAA regulations. Failing to comply with regulations can be very costly. This is because HIPAA violation fines can be in the millions. However, complying with HIPAA isn't always easy. There are countless processes that can go wrong. There are numerous problems which are often swept under the rug. Not only that, but regulations change periodically. This can make it challenging to keep track of all the rules. Fortunately, help exists online to ensure your team stays HIPAA compliant. In this article, we'll explain what a violation is and how you can avoid them. We'll also share a few HIPAA violation examples to help you predict and recognize them in the future. To learn everything you need to know about HIPAA violations, keep reading.
What is a HIPAA Violation?
HIPAA violation cases are an unfortunate everyday occurrence. The news frequently reports violations caused by hospitals, health plans, and healthcare providers. But what exactly is a violation, and what happens following HIPAA violation reporting? Simply put, a HIPAA violation is any failure to comply with an aspect of HIPAA standards and provisions. These standards and provisions are described in 45 CFR Parts 160, 162, and 164. Violations happen whenever the acquisition, access, use, or disclosure of Protected Health Information (or PHI) is done in such a way that puts a patient at significant personal risk.
What is HIPAA?
HIPAA is a landmark piece of legislation introduced in 1996. It's also called the Health Insurance Portability and Accountability Act. The HIPAA exists to simplify the administration of healthcare. It does this by eliminating wastage and preventing healthcare fraud. It also ensures employees have access to healthcare coverage between jobs. Over the years, several notable updates to HIPAA have been introduced. These updates help to increase patient privacy. These include the HIPAA Privacy Rule, HIPAA Security Rule, HIPAA Omnibus Rule, and HIPAA Breach Notification Rule. Together, these updates help ensure that professionals safeguard sensitive healthcare data appropriately. This plays a key role in protecting the identity and privacy of patients. Ultimately, a HIPAA violation puts patients' private health information at risk. If this sensitive data is compromised, it can be used to harm the patients it belongs to.
Examples of HIPAA Violations
There are many regulations and provisions in the HIPAA legislation. In fact, the combined text includes 115 pages as published by the Department of Health and Human Services Office for Civil Rights. As you can probably imagine, there are hundreds of ways people can violate the HIPAA Rules. However, the violations listed below are some of the most common examples:
- Impermissible disclosure of protected health information, or PHI
- Unauthorized access of PHI
- Inappropriate disposal of PHI
- Failure to conduct risk analyses when appropriate
- Failure to correctly manage risks to the confidentiality, integrity, and availability of patients' PHI
- Failure to create and use safeguards that ensure the confidentiality, integrity, and availability of PHI
- Failure to keep or monitor PHI access logs
- Failure to enter a HIPAA-compliant business agreement with vendors and services before giving them access to PHI
- Failure to provide patients with copies of their PHI upon request
- Failure to install and use access controls that limit who may view PHI
- Failure to revoke access rights to PHI when no longer needed
- The disclosure of more PHI than necessary for a given task
- Failure to provide appropriate HIPAA and security awareness training to staff
- Theft of patient records and PHI
- Unauthorized release of PHI to individuals
- Distribution of PHI online or through social media without authorization
- Mishandling or mismailing PHI
- Sending PHI through text message
- Failure to encrypt or otherwise adequately protect PHI from unauthorized access
- Failure to inform a patient or the Office for Civil Rights of a security breach involving their PHI within 60 days of the breach's discovery
- Failure to record and log compliance efforts
As you can see, the number of ways HIPAA violations can occur are practically limitless. This is why careful training and organization are so important. This is particularly the case in businesses related to healthcare.
How are HIPPA Violations Discovered?
HIPAA-covered entities report many violations of the HIPPA Rules through internal audits. Often employers will identify employees who have caused HIPAA violations. Employees who realize they may have violated HIPAA Rules will often self-report. They will also report potential violations made by their coworkers. The HHS Office for Civil Rights is the primary enforcer of HIPAA Rules. They investigate complaints of HIPAA violations. Patients, healthcare employees, and health plan members usually report these complaints. The OCR looks into covered entities who report security breaches involving more than 500 records. Sometimes they will conduct investigations into smaller breaches as well. Finally, the OCR conducts periodic audits of HIPAA covered entities. They will also audit the business associates of covered entities. State attorneys general also have authority to look into security breaches. These investigations are usually because of complaints about potential violations. Investigations are also made in response to official breach reports.
What Penalties Exist for HIPAA Violations?
Penalties for HIPAA violations can be very severe. Judges have even issued fines costing millions of dollars. Besides healthcare providers, plans, and clinics, individuals can receive fines as well. Some individuals who violate HIPAA Rules can go to jail for up to 10 years. There are two separate types of HIPAA violations: civil violations and criminal violations.
Civil penalties are for individuals who commit violations without any malicious intent. This is usually the case when the violation is the result of forgetfulness. It can also apply when the offender didn't know that what they were doing was wrong. In such a case, the penalties may be as follows:
- If an individual was unaware that they were violating HIPAA Rules, they will be fined $100 for each violation
- If an individual had reasonable cause for their actions and were not willfully neglectful, they will be fined a minimum of $1,000
- Even if the individual was acting with willful neglect, as long as they fixed the issue afterward, they will be fined a minimum of $10,000 per violation
- If an individual acted with willful neglect and failed to fix the issue, they will be fined a minimum of $50,000 per issue
The penalties for civil violations may seem severe, but they're just the beginning. It gets worse if violators know what they're doing and have malicious intent. In those cases, violations will lead to criminal penalties.
These penalties are significantly harsher than those for civil HIPAA violations. They can be as follows:
- If an individual deliberately obtains and discloses PHI without authorization, they may be fined up to $50,000 and put in jail for up to one year
- If an individual commits violations under false pretenses, they may be fined up to $100,000 and put in jail for up to five years
- If an individual commits the violation for personal gain (such as by selling PHI or using it to harm the patient), they may be fined up to $250,000 and jailed for up to 10 years
With such harsh penalties, you definitely don't want to find your business on the wrong side of HIPAA law. Thankfully, the sternest penalties aren't usually applied in all situations. These are only applied where violators acted willfully and knowingly. Minor and accidental violations typically invoke a lesser penalty.
What Does HIPAA Compliance Involve?
Knowing what the most common HIPAA violations are is only the beginning. To avoid causing these violations within your own business, you must know how to obey HIPAA Rules. A business will need to have a strategy in place to maintain HIPAA compliance. A compliance strategy will often begin with self-auditing. These audits should involve the entirety of their organizations. They should assess Administrative, Technical, and Physical gaps in compliance that may exist. Next after self-auditing is remediation planning. A remediation plan needs to resolve any gaps in compliance discovered during auditing. These plans must be fully recorded and include deadlines for when gaps will be remedied. The next part of a compliance strategy involves policies, procedures, and employee training. Covered entities and associates will need to develop new policies and procedures. In turn, these policies need to correspond to HIPAA regulatory standards. They must also update these self-imposed rules regularly as the organization evolves. Documentation is another critical part of any compliance strategy. HIPAA-beholden organizations must document all efforts taken to become compliant. Careful documentation will become critical in the event that a HIPAA investigation takes place. Next on the list is business associate management. All business associates and covered entities must carefully record all vendors that they share PHI with. This documentation ensures that PHI is handled responsibly and securely, thus mitigating liability. Last but not least, no HIPAA compliance strategy is complete without incident management. If a covered entity or business associate experiences a data breach, they will need a process for documenting it. There must also be a protocol in place for notifying patients when a data breach occurs. This protocol must work according to the HIPAA Breach Notification Rule.
The Seven Elements of an Effective Compliance Program
The HHS Office of Inspector General created a document defining an effective program. It's called the Seven Elements of an Effective Compliance Program. This list guides organizations looking to establish or improve their compliance solutions. They include the following:
- Establishing written policies, procedures, and codes of conduct
- Designating qualified individuals as a compliance officer and compliance committee
- Providing staff with effective training and education
- Establishing effective lines of communication
- Performing internal auditing and monitoring
- Enforcing established standards through well-promoted disciplinary guidelines
- Responding quickly to detected offenses and performing corrective action
The Seven Elements of an Effective Compliance Program are bare minimum requirements. An ideal compliance program will usually take additional measures to safeguard patient information. However, in the event that the OCR conducts a HIPAA investigation involving your business, these guidelines will apply. Federal auditors will compare any compliance program you have against these seven elements.
Avoid a HIPAA Violation With Our Resources
In this article, we've explored nearly every major aspect of HIPAA violation and compliance. We've covered the most common examples of HIPAA violations, as well as what it means to be HIPAA-compliant. By now, you should understand everything you need to know about HIPAA violations. That doesn't mean your business is completely safe from committing violations, however. Like many subjects in healthcare and law, HIPAA regulations are complicated. You can't simply read a few articles online. You have to know the regulations in-depth to avoid violations every time. That's why we offer HIPAA compliance training and exams to businesses like yours. If you're ready to help your staff become more knowledgeable in HIPAA compliance, our exams are just what you need. It doesn't matter whether you run a healthcare facility or a business that serves healthcare facilities. Our trainings will teach your staff everything they need to know to keep patients' sensitive information safe. Don't delay contact us with any questions you might have, and start your training today.
For 2022 Rules for Healthcare Workers, please click here.
For 2022 Rules for Business Associates, please click here.