Posted On: January 2, 2025

HIPAA Violations: What Are HIPAA Laws and Who Enforces Them?

Healthcare data breaches affect millions of people nationwide every year. During these incidents, confidential information about a patient can be exposed and shared without their consent.

These data compromises are just one kind of HIPAA violation, all of which can lead to severe consequences. Below, we’ll talk about HIPAA enforcement, the potential penalties for violations, and how to ensure HIPAA compliance to protect yourself and your organization.

What Are HIPAA Laws?

HIPAA stands for the Health Insurance Portability and Accountability Act. This comprehensive federal law – originally passed in 1996 – sets the national standard for safeguarding and handling Protected Health Information.

HIPAA law includes five main rules, including the Privacy Rule and Security Rule. These rules ensure that patients have control over their health information, establish requirements for keeping health data secure, and set the requirements that healthcare professionals must follow in order to keep private information from being accessed.

These rules specifically apply to Covered Entities (CEs), Business Associates (BAs), and Private Health Information (PHI), so let’s define each of those concepts.

What Is Protected Health Information (PHI)?

PHI stands for Protected Health Information. PHI includes:

Patient names
Contact information
Appointment information
Geographic data
Full-face photos and similar images
Diagnoses, treatment plans, test results, or medical histories
Communication records, including email, phone calls, and texts
Medical record numbers or health plan numbers
Biometric identifiers
IP addresses
Device IDs or serial numbers
Any unique identifying numbers, characteristics, or codes

What Is a Covered Entity?

HIPAA applies to Covered Entities and their Business Associates.

Covered Entities are the organizations and individuals that are the primary target of HIPAA compliance. A covered entity is an entity that directly handles PHI. Examples include:

Healthcare Providers, like doctors, hospitals, dentists, nursing homes, pharmacies, and many others
Health Plans, like insurance companies, HMOs, company health plans, and government healthcare programs
Healthcare Clearinghouses, which process non-standard health information from another entity into a standard format

Business Associates of Covered Entities are also affected by HIPAA. This includes any individual or organization that performs a service involving the use and disclosure of PHI. Examples include billing companies, IT service providers, and many others.

What Is a HIPAA Violation?

The Health Insurance Portability and Accountability Act has many provisions, including technical administrative rules, but the goal of HIPAA enforcement is to protect the privacy and security of patients’ private health information across the country.

As a result, when we say “HIPAA violation,” we’re usually talking about a violation of the Privacy or Security Rules.

There are many different types of HIPAA violations, but most can be broken down into four main categories.

Unauthorized Disclosure of PHI

It’s a direct violation of HIPAA law to share or disclose PHI to someone who does not have the right and the need to access it. That means that doctors can share PHI for treatment, consulting, and other legitimate reasons, but not for gossip.

Even when the sharing of information happens accidentally, it is still considered a violation.

An example of a PHI disclosure violation is when a nurse is discussing a patient’s diagnosis with their friend or family member without the patient’s consent.

Failing to Implement Sufficient Security Measures

Having insufficient security measures in place to protect PHI from being improperly accessed is another type of HIPAA violation. This can happen with inadequate data encryption, weak passwords, or poor disposal of sensitive information.

An example of this type of HIPAA violation is a hospital manager throwing away whole physical pages of PHI in an unsecured dumpster.

Improper Handling of Data Breaches

If a security incident like a data breach happens, it is important to act quickly to stay in compliance with HIPAA.

Failing to quickly and adequately respond to and report data breaches is considered a violation. This can include not notifying affected individuals of a data breach.

Theft of Patient Records

This one might be obvious, but stealing the private health information of a patient is a HIPAA violation. When someone steals a patient’s records, they’re illegally gaining access to someone else’s sensitive information, which can include their medical history, diagnoses, treatment plans, and other data.

Who Enforces HIPAA?

The Office for Civil Rights (OCR) under the United States Department of Health and Human Services (HHS) is responsible for enforcing HIPAA regulations in non-criminal cases. The OCR can impose penalties for those found to be in violation of the law.

When HIPAA violations cross the line into criminal acts, the OCR refers those cases to the HHS Office of the Inspector General (OIG). The attorney general of each state also has the power to examine HIPAA grievances and take necessary measures in response; this is typically reserved for intentional and harmful breaches of HIPAA.

What Happens if You Violate HIPAA?

Violating HIPAA isn’t just an ethical issue. In fact, it can result in both legal and administrative consequences. The severity of the penalty will depend on the type, extent, and intent of the violation, as well as the response when discovery of a HIPAA violation occurs.

The official penalties for a HIPAA violation include civil penalties, criminal penalties, termination of employment, and license suspension or revocation. Consequences may also include civil lawsuits and bad PR.

Civil Penalties

Civil penalties are for organizations or individuals who violate HIPAA without any malicious intent.

The minimum civil penalty varies based on intent and response. There’s a minimum of:

$100 per violation if someone was unaware that they were violating HIPAA Rules.
$1,000 per violation If they thought they had reasonable cause for their actions and were not willfully neglectful.
$10,000 per violation if there was willful neglect but they fixed the issue afterward.
$50,000 per violation when there’s willful neglect and no attempt at corrective action.

Criminal Penalties

To warrant a criminal penalty, HIPAA violations need to be intentional.

Again, the severity of the penalty will depend on the circumstances. You can be:

Fined up to $50,000 and jailed for up to one year if you deliberately obtain or disclose PHI without authorization.
Fined up to $100,000 and jailed for up to five years if you commit a HIPAA violation under false pretenses.
Fined up to $250,000 or jailed for up to 10 years if you commit the violation for personal gain.

Termination of Employment

Healthcare professionals can be fired for a HIPAA violation, though not in every case. The question of termination will depend on a variety of factors, including how the information was obtained and whether the individual is a repeat offender.

Medical License Suspension or Revocation

HIPAA violations can also put someone’s medical license at risk of being temporarily suspended or, in more serious cases, permanently revoked.

Personal Lawsuits

Patients can bring a civil lawsuit against an organization or individual for a HIPAA violation, though most cases don’t make it to court.

Civil cases are most successful when the breach is deliberate, the victim suffered significant tangible harm, and the case is high-profile.

Damage to Reputation

Headlines are a far more likely outcome of a HIPAA violation than a civil lawsuit, and public awareness can damage a business’s reputation and bottom line. If HIPAA breaches are not dealt with properly, they result in a loss of confidence and customers.

The Highest HIPAA Penalties

Organizations and individuals are rarely punished for HIPAA violations one at a time, and since fines are levied on a per-violation basis, the more violations there are, the more expensive it can become.

In 2015, Anthem received the biggest HIPAA penalty on record at $16 million after a cybersecurity breach that resulted in PHI theft for 78.8 million individuals. Between official fines and lawsuit settlements, they paid a total of $48.2 million through the courts. That doesn’t include the corrective actions they were required to take to improve data security practices.

The same year, Premera Blue Cross was also hacked, resulting in a $74 million lawsuit to the individuals whose PHI was exposed, a $10 million lawsuit over the breach, and $6.85 million in OCR penalties.

These were some of the most expensive HIPAA violations to date.

But lest you think cyberattacks are the only way to get in hot water, Advocate Health Care was fined $5.5 million in 2013 after four desktop computers were stolen from an administrative building.

Ensuring HIPAA Compliance

Full HIPAA compliance requires multiple approaches and constant vigilance for organizations and individuals.

For Individuals

Individuals can be charged with violations of the Health Insurance Portability and Accountability Act separately from their employers or organizations, so it’s prudent for healthcare professionals and their associates to take measures that ensure HIPAA compliance.

The most important thing is to educate yourself on HIPAA regulations. This includes learning about HIPAA requirements and familiarizing yourself with best practices. Avoid free courses – they just won’t cut it for professionals.

Even if you’ve received official HIPAA training at work, you need to keep up with how new technologies affect HIPAA compliance. How do you text patients in compliance with HIPAA? What are the social media guidelines you need to follow? Can using AI get you in hot water with HIPAA enforcement?

For Organizations

Organizations need to take even broader measures to avoid dealing with HIPAA enforcement.

First, organizations can help reduce violations by choosing effective HIPAA training for their employees. The workforce needs to be trained appropriately for the situations they will encounter in their roles, whether that includes paper record disposal, talking to patients’ families, or dealing with the press. General information security training can also be beneficial for HIPAA compliance.

Another way to ensure compliance is by conducting risk assessments. Performing thorough risk assessments can help identify potential vulnerabilities and risks to the confidentiality of patient’s protected health information.

Last but not least, conducting regular workplace audits can help you catch HIPAA violations before they become an enforcement issue. Constantly monitoring a hospital’s system and access logs not only allows you to detect unauthorized activities or breaches, but it could also identify possible areas for improvement.

Avoid HIPAA Violations With Online HIPAA Training

As a trusted provider of workplace compliance training, we offer role-specific HIPAA courses to protect both individuals and organizations. Students will learn the regulations and real-life scenarios that apply to them online and at their own pace for maximum retention and recall.

Our HIPAA compliance training options include HIPAA for Healthcare Workers, HIPAA for Medical Office Staff, HIPAA for Dental Offices, and HIPAA for Business Associates. In addition, we offer other healthcare training topics like bloodborne pathogens and infection control techniques, as well as general HR topics that healthcare professionals need.

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