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. However, 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 dive into the purpose of HIPAA, what it takes to stay compliant, and the government agencies responsible for enforcing HIPAA regulations to protect patient data across the healthcare sector.

What Are HIPAA Laws?

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

By creating laws, HIPAA safeguards patient-provided health information (PHI). Additionally, it creates national standards for the security of electronic PHI. HIPAA regulates health insurance policies and benefits for preexisting conditions.

One of the primary goals of HIPAA is to lessen healthcare misuse and fraud. HIPAA also requires industry-wide electronic billing standards, which promote accountability and openness in the medical field. HIPAA's overall goal is to protect patient security and privacy.

These laws ensure that patients can have control over their health information, establish rules and guidelines for keeping health data secure, and establish certain requirements that healthcare professionals must follow in order to protect private information from being accessed.

What Are the 3 Main HIPAA Rules?

There was a lack of agreement on PHI best practices prior to HIPAA’s creation. Organizations were given direction by HIPAA's Privacy, Security, and Breach Notification Rules when it was enacted into law back in 1996. This set industry standards for addressing PHI and improving patient care experiences.

HIPAA has three main rules: the Privacy Rule, the Security Rule, and the Breach Notification Rule. We'll break down what they mean further:

• Privacy Rule -  The HIPAA privacy rule protects patient health information, restricts sharing information without consent, and allows access to medical records for patients and their representatives.
• Security Rule - The HIPAA Security Rule requires electronic safeguards for patient health information. They also require healthcare practitioners and business associates to identify risks, develop management plans, get training, analyze risks, and complete yearly evaluations.
• Breach Notification Rule - The Breach Notification Rule outlines the steps to take in case of a breach of patient health information (PHI). This requires organizations to notify affected persons, HHS, and the media, depending on the number of people affected.

HIPAA streamlines healthcare services, protects client information, and promotes health insurance portability by reducing paperwork and enhancing workflows. It also protects against fraud, identity theft, and privacy violations, with failure resulting in civil and criminal penalties.

Who Enforces HIPAA?

The Office for Civil Rights (OCR), which is part of the United States Department of Health and Human Services, is responsible for enforcing HIPAA regulations. The OCR can impose penalties for those found to be in violation of the law.

What Is a HIPAA Violation?

So, what exactly is considered a HIPAA violation? A HIPAA violation is when a person or entity wrongfully accesses, obtains, or transmits PHI without their knowledge or consent. There are several different types of HIPAA violations, including:

1. Unauthorized Disclosure of PHI - Sharing or disclosing PHI without the patient's consent is a direct violation of HIPAA law, whether intentional or accidental. An example is a nurse discussing a patient's information with a friend or family member without consent.
2. Failing to Implement Sufficient Security Measures - HIPAA violations can occur due to inadequate security measures, such as weak passwords, weak data encryption, or poor disposal of sensitive information. An example would be a hospital manager discarding physical PHI in an unsecured dumpster.
3. Improper Handling of Data Breaches - If an unfortunate incident such as 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.
4. Theft of Patient Records - Stealing a patient's private health information is a HIPAA violation, as it illegally accesses their sensitive data, including medical history, diagnoses, treatment plans, and other data, thereby violating the privacy of patients.

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 and extent of the violation. Some potential outcomes of violating HIPAA include:

1. Civil Penalties - HIPAA violations can result in civil penalties, with individuals who were unaware of their actions being fined $100 for each violation, and those who believed they had reasonable cause for their actions fined $1,000. Individuals who acted with willful neglect can face a minimum fine of $10,000 per violation if they fix the issue afterward, or $50,000 if they fail to fix the issue.
2. Criminal Penalties - Unauthorized and deliberate PHI disclosure can result in fines of $50,000 and one year in jail. Violations committed under false pretenses can result in a fine of up to $100,000 and imprisonment for up to five years. If an individual violates a law for personal gain, they may face a fine of up to $250,000 and a 10-year jail sentence.
3. Termination of Employment - Depending on the type and nature of the incident, a healthcare professional can get fired for a HIPAA violation. This will depend on a variety of factors, such as the way the information was obtained or whether or not the individual is a repeat offender.
4. Medical License Revocation - HIPAA violations can also put someone’s medical license at risk of being temporarily suspended, or worse, permanently revoked.

How Do You Report a HIPAA Violation?

Reporting a HIPAA violation is determined by the type of violation and your status as a public member, a covered entity's workforce member, or a covered entity. There are several reporting channels available, including the Privacy Officer, the State Attorney General, and the HHS Office for Civil Rights.

To report a HIPAA violation as a covered entity, contact the Privacy Officer at the organization where the violation occurred, file a complaint with the Office for Civil Rights (OCR) online or in writing, or call, or report to your state Attorney General. The Privacy Officer's contact information can be found in the organization's Notice of Privacy Practices.

You can also report a HIPAA violation by contacting senior management or filing an incident report with the Privacy Officer. File a complaint within 180 days of the infraction. However, the OCR may extend the period if "good cause" is demonstrated. Include the name of the covered entity or business associate, a description of the alleged violations, and any supporting documents, such as medical records or bills.

How Can We Ensure HIPAA Compliance?

There are a few steps healthcare professionals can take to make sure they are complying with HIPAA laws. The first would be to educate themselves on all HIPAA regulations. This includes learning about and familiarizing themselves with HIPAA requirements and guidelines.

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.

Administrative staff can also help reduce violations by properly training their employees. How to properly access or dispose of confidential records, incident reporting, and security protocols are just some of the many topics that can be covered in training sessions for healthcare professionals.

Lastly, conducting regular workplace audits can help avoid HIPAA violations. Constantly monitoring a hospital's system and access logs can not only help detect any unauthorized activities or breaches but could also identify possible areas for improvement.

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As a healthcare professional, ensuring you are complying with HIPAA laws is crucial. With our compliance training and tests, 360training Healthcare makes it easier to understand HIPAA rules and regulations. Our curriculum is designed to help you understand how to protect the privacy of patients’ private medical information.

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