What Is Considered a HIPAA Violation?

HIPAA violations can be costly, damaging, and, more often than not, completely preventable. Whether you’re a seasoned healthcare provider or new to the field, it’s important to understand what counts as a violation and what doesn’t. In this blog, we’ll break down the most common types of HIPAA breaches, explore who’s at risk, and explain what happens when patient privacy is compromised.

What Is HIPAA? 

The Health Insurance Portability and Accountability Act, better known as HIPAA,  originated on August 21, 1996, when it became law. Its enactment pursued two primary objectives: enhancing the efficiency of healthcare delivery and expanding the number of Americans with health insurance. 

HIPAA mandated the establishment of nationwide standards to safeguard sensitive patient health information, ensuring it wasn't disclosed without the patient's consent or awareness.

In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) Act further strengthened HIPAA's regulations. This act authorized state attorneys general to levy fines for non-compliance and broadened HIPAA's reach to encompass business associates of covered entities. 

Additionally, the HITECH Act encouraged the secure transfer of electronic health information. 

What Is PHI (Protected Health Information)?

Protected Health Information, or PHI, refers to any health data that can identify an individual and is created, received, or maintained by a covered entity or business associate. This includes medical records, billing details, lab results, appointment dates, and even demographic information like names, addresses, and birthdates. HIPAA strictly regulates how this data is used and disclosed to safeguard patient privacy.

Who Must Follow HIPAA?

HIPAA and HITECH regulations apply to entities handling (PHI), mainly:

• Covered Entities: Defined by HIPAA, these include:
  • Healthcare Providers: Doctors, clinics, psychologists, dentists, chiropractors, nursing homes, pharmacies, etc.
  • Health Plans: Health insurance companies, HMOs, company health plans, and government programs (Medicare, Medicaid, military, and veterans' healthcare).
  • Healthcare Clearinghouses: Entities processing health information into a standard format (billing services, repricing companies, etc.).
• Business Associates: Expanded under HITECH to include:
  • Data Transmission Providers: Services facilitating PHI transmission, like Health Information Exchanges.
  • Data Storage Firms: Companies offering data storage or recovery services, including cloud-based solutions.
  • Accounting Firms: Those accessing PHI in their services.
  • Consultants, Subcontractors, and Data Aggregators: Legal, actuarial, accounting, administrative, accreditation, or financial service providers handling PHI.

These entities are directly responsible for HIPAA and HITECH Act compliance. Covered entities must ensure business associates agree to protect any PHI they handle under HIPAA Rules.

Categories of HIPAA Violations

HIPAA is made up of a complex array of provisions and legal details. The version published by the Department of Health and Human Services Office for Civil Rights extends to a remarkable 115 pages, offering ample scope for potential violations. 

Among these, certain types of infringements occur more frequently than others, such as: 

• Unauthorized or inappropriate disclosure of PHI.
• Unauthorized access to PHI.
• Improper disposal of PHI.
• Omitting necessary risk analyses.
• Neglecting proper management of risks to the confidentiality, integrity, and availability of patient's PHI.
• Failure to implement and maintain safeguards that ensure the confidentiality, integrity, and availability of PHI.
• Not keeping or tracking access logs for PHI.
• Not setting up a HIPAA-compliant business agreement with vendors and service providers before granting them access to PHI.
• Denying patients access to their own PHI upon their request.
• Neglecting to implement and maintain access controls that restrict PHI visibility.
• Failure to remove access rights to PHI when they're no longer required.
• Revealing more PHI than is required for a particular task.
• Neglecting to provide necessary HIPAA and security awareness training to employees.
• Theft of patient records or PHI.
• Unauthorized release of PHI to third parties.
• Sharing PHI online or on social media platforms without proper authorization.
• Mistreatment or misdirection of PHI via mail.
• Transmission of PHI via text messages.
• Not encrypting PHI or safeguarding it from unauthorized access.
• Not informing a patient or the Office for Civil Rights about a security breach involving their PHI within 60 days of discovering the breach.
• Failure in documenting and logging efforts made for compliance.

Common Types of HIPAA Violations

Alarmingly, HIPAA violations can often occur subtly, endangering patient privacy without obvious wrongdoing. With the constant evolution of HIPAA rules, a business deemed compliant just a few months ago might unknowingly violate current standards, resulting in serious repercussions for both the organization and its patients.

Here are some key examples of common breaches:

• Irresponsible Workplace Behavior: This includes sharing patient information with unauthorized individuals or failing to train employees adequately in handling confidential data. For instance, employees discussing a patient's health details openly would constitute a violation.
• Improper Records Disposal: Patient records, whether on paper or digital, require secure storage methods like locked cabinets or password-protected devices. Disposal of this information necessitates destruction to avoid data breaches.
• Vulnerable Data Security: In the digital realm, encryption is essential for protecting data against hacking and unauthorized access, providing an important defense for sensitive information.

The 7 Most Common HIPAA Violations 

As of 2024, the Office for Civil Rights (OCR) has received over 374,000 HIPAA complaints since enforcement began in 2003, with more than 370,000 cases resolved. Each year, the same types of violations account for the majority of complaints and penalties, many of which are preventable with proper safeguards and training.

These are the seven most common HIPAA violations reported:

1. Impermissible Uses or Disclosures of Protected Health Information (PHI)
2. Failure to Secure and Safeguard Data
3. Denied or Delayed Patient Access to Records
4. Theft or Loss of Devices or Paper Records Containing PHI
5. Disclosure of More Information Than Necessary
6. Failure to Perform an Organization-Wide Risk Analysis
7. Inadequate Staff Training on HIPAA Policies and Procedures

Together, these violations continue to represent the bulk of enforcement actions taken by the OCR each year.

When to Share PHI

There are situations where sharing PHI may not be considered a HIPAA violation. HIPAA includes certain exceptions and situations where the disclosure of PHI is allowed without the individual's authorization, including: 

• Research related to specific diseases
• Public health investigations, especially for communicable diseases
• Workplace safety and workers' compensation
• Public health emergencies like food contamination
• Cases involving victims of abuse or neglect
• Law enforcement demands
• Identification of a deceased individual
• Organ donation procedures
• Legal proceedings
• Essential government activities 

The Aftermath: Violating HIPAA Regulations 

In the event of an investigation, the involved parties often face a tense period of anticipation while the Office for Civil Rights (OCR) conducts its investigation. If the OCR uncovers a HIPAA violation, the entity in question is met with significant consequences. 

Their responsibilities include:

• Immediate correction of the violation.
• Informing affected patients about the specifics of the compromised information.
• Creating and implementing plans to ensure future compliance.
• Undergoing continuous monitoring and regularly reporting back to the OCR.
• Offering an appropriate settlement to those impacted.

Failure to adhere to OCR's directives can lead to severe financial penalties. Although the entity can seek a judicial review of the imposed sanctions, challenging them successfully is difficult if there's strong evidence of the violation. 

It's crucial to understand the gravity of neglecting HIPAA compliance, as it can have serious ramifications. Ensuring adherence to the law is not just advisable but essential.

Civil Court Proceedings for HIPAA Breaches

Not all HIPAA breaches reach civil court due to various reasons, such as unintentional breaches, lack of tangible harm, or difficulty in proving guilt. Civil cases typically arise when:

• The breach was deliberate.
• The victim suffered significant or public harm.
• The case involves a high-profile individual, creating a precedent.

State Attorneys General might intervene in severe cases, which is often preferable over personal lawsuits due to the high costs and low likelihood of success. 

Financial constraints and the limited assets of healthcare workers can also dissuade victims from pursuing civil action. Employers often respond to breaches by terminating or penalizing the involved employees. 

Criminal Implications of HIPAA Violations

Criminal charges in HIPAA cases occur when breaches are intentional, linked to identity theft, or involve selling or disclosing stolen data for personal gain. 

Typically, state attorneys file these charges against individuals, not organizations. Convictions can lead to fines, jail time, probation, and loss of employment eligibility in healthcare.

Patient's Right to Sue and Provider Responsibilities

Most HIPAA violations don't allow for patient lawsuits. The OCR and state attorneys handle penalties and enforcement. Civil and criminal lawsuits are rare and typically managed by state attorneys. Providers must prioritize HIPAA compliance to prevent both OCR actions and legal cases. 

Effective strategies include thorough HIPAA training, robust compliance policies, and proactive management responses to violations. This approach not only reduces risk but also helps providers demonstrate due diligence in preventing intentional breaches.

Penalties for HIPAA Violations

HIPAA violation penalties vary significantly, depending on the severity of the breach, whether it was accidental, and the entity's response. 

Healthcare professionals must adhere to HIPAA, but violations, categorized into four tiers, do occur:

1. Tier 1: Involves violations beyond the entity's control with no reasonable prevention measures. Often, the entity is unaware of the breach. Fines range from $141 to $71,162 per violation, influenced by factors like financial status and past violations.
2. Tier 2: Covers unforeseen violations despite possible avoidance with sufficient caution. Willful neglect of HIPAA is not included here. Penalties range from $1,424 to $71,162 per violation, depending on various factors.
3. Tier 3: Pertains to violations due to intentional neglect but followed by corrective actions. The key here is the implementation of corrective measures. Fines vary from $14,232 to $71,162 per violation, influenced by the harm caused.
4. Tier 4: Represents the most serious violations involving deliberate neglect without any corrective actions. Examples include unsecured patient records or consistently failing to log out of electronic systems. Penalties start at $71,162 per violation and can lead to imprisonment, with no waivers available for these severe breaches.

Provide Adequate Staff Training With 360training 

Considering that proper staff training can prevent most of the usual violations on this list, it's not surprising that lack of adequate training is a frequent HIPAA violation. Delivering effective training can be difficult, particularly in the fast-evolving healthcare sector.

Providers like 360training offer essential online HIPAA training resources. Their courses cover the essentials of HIPAA, breach prevention, violation penalties, and practical application in everyday tasks, concluding with comprehension tests and providing certificates for record-keeping.

By investing in thorough training, enforcing robust data and device policies, and ensuring compliance in partnerships, healthcare practices can safeguard against these prevalent violations.

Head to our website and sign up for  HIPAA training today!