Everything You Need to Know About a HIPAA Violation

Between 2005 and 2019, healthcare data breaches affected nearly 250 million people due to HIPAA violations. Such violations are common; even the most competent healthcare facilities may encounter minor cases. However, these violations can lead to severe issues for patients and clinics. Doctors' offices must stay updated with changing HIPAA regulations to avoid costly fines that can be in the millions. Complying with HIPAA can be challenging due to various potential processes going wrong and evolving regulations. Fortunately, online resources exist to help ensure HIPAA compliance.

In this article, we'll explain violations, how to avoid them and provide examples. Keep reading to learn more about HIPAA violations.

What is HIPAA?

The Health Insurance Portability and Accountability Act, more commonly referred to as HIPAA, is a landmark piece of legislation. Enacted in 1996, HIPAA simplifies healthcare administration by eliminating wastage, preventing fraud, and ensuring healthcare coverage between jobs. Notable updates, such as the HIPAA Privacy Rule, Security Rule, Omnibus Rule, and Breach Notification Rule, enhance patient privacy and safeguard sensitive healthcare data. A HIPAA violation jeopardizes patients' private health information, potentially causing harm if compromised.

What is a HIPAA Violation?

Unfortunately, HIPAA violations are a common occurrence in today's world. They can be caused by hospitals, health plans, and healthcare providers. But what exactly constitutes a violation, and what are the consequences of reporting such incidents? In simple terms, a HIPAA violation occurs when there is a failure to comply with any aspect of the HIPAA standards and provisions outlined in 45 CFR Parts 160, 162, and 164. These violations occur when the acquisition, access, use, or disclosure of Protected Health Information (PHI) puts a patient at significant personal risk.

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 is 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 often report violations through internal audits. Employers identify employees responsible, and employees may self-report or report their coworkers' potential violations. The HHS Office for Civil Rights (OCR) enforces HIPAA Rules and investigates complaints, including security breaches involving 500 or more records. They also audit covered entities and their business associates. State attorneys general can investigate breaches based on complaints or official reports.

What Penalties Exist for HIPAA Violations?

Penalties for HIPAA violations can be very severe. In the past, judges have issued fines costing millions of dollars. Healthcare providers, plans, clinics, and individuals can be faced with fines or even jail time for violating HIPAA. There are two separate types of HIPAA violations: civil violations and criminal violations. Let’s go over them both.

Civil Penalties

Civil penalties are for individuals who commit violations unintentionally. This is usually the case when the offense is the result of forgetfulness. It can also apply when the offender doesn't know what they are doing is 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 was 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 have malicious intent. In those cases, violations will lead to criminal penalties.

Criminal Penalties

Criminal 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?

To maintain HIPAA compliance and avoid common violations, businesses must follow a comprehensive strategy. This strategy begins with self-auditing, assessing Administrative, Technical, and Physical compliance gaps. Next comes remediation planning to address these gaps with recorded timelines. Policies, procedures, and employee training should align with HIPAA standards and be regularly updated. Documentation of compliance efforts is crucial for potential investigations. Business associate management involves recording vendors with whom PHI is shared, ensuring responsible handling. Finally, incident management is vital, including documenting breaches and notifying patients as per 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:

  1. Establishing written policies, procedures, and codes of conduct
  2. Designating qualified individuals as a compliance officer and compliance committee
  3. Providing staff with effective training and education
  4. Establishing effective lines of communication
  5. Performing internal auditing and monitoring
  6. Enforcing established standards through well-promoted disciplinary guidelines
  7. 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 covered major aspects of HIPAA violation and compliance, including common examples and the significance of being HIPAA compliant. However, HIPAA regulations are complex, requiring in-depth knowledge to avoid violations consistently.

To help your business stay compliant, we offer comprehensive HIPAA compliance training and exams. Whether you run a healthcare facility or serve healthcare facilities, our training will equip your staff to protect patients' sensitive information. Don't hesitate to contact us with any questions and start your training today.


For 2022 Rules for Healthcare Workers, please click here.

For 2022 Rules for Business Associates, please click here.