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

HIPAA laws are the backbone of patient privacy and data security in the healthcare industry. But staying compliant can be challenging, and violations of HIPAA can result in significant penalties and damage to an organization’s reputation.

In this blog, we’ll cover what HIPAA does, the main rules you need to follow, what a HIPAA violation looks like, how penalties are determined (including the four penalty tiers), and how to report a violation through the U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR).

What Are HIPAA Laws?

HIPAA stands for the Health Insurance Portability and Accountability Act. Passed in 1996, it set national standards for safeguarding and handling protected health information (PHI), especially when it’s stored or transmitted electronically.

HIPAA:

• Protects patient health information from being shared without authorization
• Gives patients rights over their health information
• Requires healthcare organizations and their business associates to keep PHI private and secure
• Helps reduce healthcare fraud and abuse
• Standardizes electronic billing and transactions

What Are the 5 Main HIPAA Rules?

Before HIPAA, there wasn’t a universal standard for how to protect patient data. HIPAA created five core rules that everyone handling PHI must follow:

1. Rule 1: The Privacy Rule
2. Rule 2: The Security Rule
3. Rule 3: Transactions and Code Sets Rule
4. Rule 4: Unique Identifiers Rule
5. Rule 5: The Enforcement Rule

What Is a HIPAA Violation?

A HIPAA violation happens when a covered entity or business associate fails to comply with one or more of the HIPAA rules. That can be intentional or accidental.

Some common HIPAA violations in healthcare include:

• Unauthorized disclosure of PHI: Sharing or discussing patient information with someone who isn’t authorized to receive it.
• Failing to implement sufficient security measures: Using weak passwords, leaving charts in public view, storing PHI on an unencrypted device, or improperly disposing of paper records.
• Improper handling of data breaches: A breach occurs, but the organization fails to notify affected individuals or HHS within the required time.
• Accessing PHI without a job-related reason: Viewing a family member’s or celebrity’s medical records out of curiosity.
• Theft or loss of records/devices: Lost laptops, stolen USB drives, or paper files not secured properly.

Who Enforces HIPAA?

HIPAA is primarily enforced by the Office for Civil Rights (OCR) within the U.S. Department of Health and Human Services (HHS). OCR investigates complaints, conducts compliance reviews, issues guidance, and can impose monetary penalties or corrective action plans when it finds a violation.

In some cases, State Attorneys General can also bring civil actions related to HIPAA violations.

What Happens If You Violate HIPAA Laws?

Violating HIPAA can lead to civil and sometimes criminal penalties. OCR uses a tiered penalty structure to determine how serious the violation is and the amount of the fine.

HIPAA Civil Penalty Tiers

• Tier 1 – Lack of Knowledge: The organization didn’t know and couldn’t reasonably have known about the violation.
• Tier 2 – Reasonable Cause: The organization should have known, but it wasn’t willful neglect.
• Tier 3 – Willful Neglect (Corrected): The organization acted with willful neglect but corrected the issue within the required timeframe.
• Tier 4 – Willful Neglect (Not Corrected): The most serious category, which carries the highest fines.

OCR can also require corrective action plans, ongoing monitoring, or policy overhauls. Amounts are set by HHS and may be adjusted each year. For cases evaluated on or after August 8, 2024, the most recent update follows the penalty structure shown in the table below.

Criminal Penalties

When someone knowingly and wrongfully discloses or obtains PHI, especially for personal gain, malicious harm, or false pretenses, criminal penalties can apply.

These can include:

• Fines
• Up to 1 year in jail for basic wrongful disclosure
• Up to 5 years for violations under false pretenses
• Up to 10 years for violations for personal gain or malicious intent

Employment or Licensing Consequences

Depending on the severity of the violation and employer policy, individuals may face:

• Disciplinary action or termination
• Reporting to licensing boards
• Possible license suspension or revocation for severe or repeated violations

How Do You Report a HIPAA Violation?

You can report a suspected HIPAA violation to HHS OCR even if you’re not sure a law was broken. Patients, employees, and even the public can file.

1. File Online Through the OCR Complaint Portal

The easiest, most up-to-date method is online, through the OCR Complaint Portal.

• It’s free
• You can submit in just a few minutes
• You only need the name of the organization and a brief description of what happened to start

2. 180-Day Rule (With Flexibility)

Complaints generally must be filed within 180 days of when you knew the violation occurred. OCR can extend that deadline if there’s “good cause,” for example, you didn’t learn about the breach right away, or you were unable to report sooner.

3. You Can Report Anonymously

You don’t have to provide extensive documentation to initiate a report, and you can choose not to give your name. However, providing contact information helps OCR follow up if they need more details.

4. Other Reporting Channels

You can also report to:

• The organization’s Privacy Officer
• Senior management or compliance
• Your State Attorney General

Employees of covered entities should follow internal reporting policies first, but they can still file with OCR if the issue isn’t addressed.

When reporting, include:

• Name of the covered entity or business associate
• What happened (dates, people involved, type of PHI exposed)
• Any documents you have (emails, letters, bills)

How to Prevent HIPAA Violations

Preventing violations is always easier than responding to them. Covered entities and business associates should:

• Provide regular HIPAA training so employees understand the Privacy, Security, and Breach Notification Rules
• Conduct risk assessments to identify gaps in how PHI is stored, transmitted, or accessed
• Implement technical safeguards like encryption, access controls, and audit logs
• Use and update Business Associate Agreements (BAAs)
• Create and review policies for disposal, remote work, device use, and incident response
• Audit access to PHI to detect snooping or inappropriate access

Prevent HIPAA Violations With Training From HIPAA Exams

As a healthcare professional, staying compliant with HIPAA is part of protecting your patients. Ongoing education is key, especially as cyberattacks and reporting processes evolve.

Fortunately, HIPAA Exams by 360training offers online HIPAA courses that make it easier to understand current rules, recognize common violations, and know how to respond to breaches.

Here’s why healthcare professionals continue choosing 360training as their training provider repeatedly:

• 100% online, 24/7 access
• Take courses at your own pace
• Mobile-friendly
• Courses for healthcare workers, business associates, dental professionals, and medical office staff

Explore our HIPAA compliance training today and reduce your risk of costly violations.

Sources:

CDC. Accessed December 2025.

HHS. Accessed December 2025.