IN THIS ARTICLE
- What HIPAA Regulations Actually Represent
- The Most Common Types of HIPAA Violations
- How Can HIPAA Violations Hurt Healthcare Providers?
- How can HIPAA Violations Hurt Patients?
- How are HIPAA Violations Discovered?
- Tips for Preventing HIPAA Violations
- Final Thoughts
What HIPAA Regulations Actually Represent
HIPAA, or the Health Insurance Portability and Accountability Act of 1996, is a federal law that requires the creation of national standards to protect sensitive patient health information from being disclosed without the patient’s consent or knowledge. HIPAA regulations represent a set of guidelines and standards that covered entities and business associates must follow to protect the privacy and security of protected health information (PHI). These regulations include the Privacy Rule, which protects the privacy of individually identifiable health information, and the Security Rule, which sets national standards to protect electronic protected health information (e-PHI). The HIPAA Privacy Rule pertains to all PHI, including paper and electronic, while the Security Rule deals specifically with e-PHI. HIPAA Rules and Regulations lay out three types of security safeguards required for compliance: administrative, physical, and technical. For each of these types, the HIPAA Privacy Rule identifies security standards, and for each standard, it names both required and addressable implementation specifications. There is obviously a litany of information out there and too much to digest in a single sitting. So, in an effort to remain succinct, here’s a short roundup of some of the regulations and what they mean to your practice.Standardize Your Coding and Electronic Transmissions
HIPAA wants to make sure that everyone is communicating about healthcare issues in a unified way, and regulations in its “Transactions and Code Sets” rule accomplish this. To comply, simply use a compliant electronic health record (EHR). Easy peasy.Get Unique Identifiers for You (and Your Organization)
In the “Identifier Standards” rule, HIPAA mandates that every individual or organization that renders healthcare have a unique 10-digit National Provider Identifier (NPI). To comply, make sure that all HIPAA-covered entities in your practice have an NPI.Protect Your Patients’ Privacy
The HIPAA Privacy Rule, in conjunction with the HIPAA Security Rule, constitutes the most important part of HIPAA for most providers. The rule spells out how healthcare entities may use PHI, and it also delineates patients’ rights to be informed of and control those uses. In a nutshell, you can comply by designating a privacy official, understanding PHI and keeping a record of all uses, and understanding the concept of “minimum necessary” to guide your uses. There’s more on these points in this article.Secure Your Electronic Medical Information
Perform a risk analysis for electronic PHI in your organization, and then implement safeguards to address security gaps identified by the risk analysis. Make sure everything is documented appropriately, and repeat those steps on a periodic basis. There’s a lot that goes into doing this correctly and thoroughly, but this is the necessary high-level approach. The final pieces are understanding the penalties associated with violations and how to handle information breaches.The Most Common Types of HIPAA Violations
The most common types of violations include:Improper Disposal of Records
Failing to secure electronic records and not properly disposing of paper records.Unauthorized Access
Failing to limit access to patient records to only authorized personnel.Device Theft
The theft or loss of devices containing patient information, such as laptops or smartphones.Unencrypted Data
Failing to encrypt electronic patient information and not properly securing physical records.Disclosure of Information
Failing to train employees on HIPAA compliance and not having policies and procedures in place to ensure compliance.Failure to Conduct Risk Analysis
Implementing safeguards to address security gaps identified by the risk analysis. It’s critical for medical practices to not just be aware of these common violations (and take the appropriate steps to prevent them), but to comply to avoid financial penalties and ultimately the loss of patient trust—a significant penalty in its own right.How Can HIPAA Violations Hurt Healthcare Providers?
Financial Penalties
There can be both civil and criminal penalties for violating HIPAA. The consequences of violating HIPAA depend on the nature of the violation and the classification of the violator (e.g., covered entity, business associate, or workforce member). This is probably a good time to point you to the HIPAA Enforcement Rule, the actual section of HIPAA that imposes the penalties and serves as the source of truth. The following are some of the potential consequences of a HIPAA violation. Civil Penalties:- Unknowing violation: Minimum penalty of $100 per violation, with an annual maximum of $25,000 for repeat violations.
- Reasonable cause: Penalty range of $1,000 – $50,000 per violation, with an annual maximum of $100,000 for repeat violations.
- Willful neglect but violation is corrected within the required time period: Penalty range of $10,000 – $50,000 per violation, with an annual maximum of $250,000 for repeat violations.
- Willful neglect and violation is not corrected: Minimum penalty of $50,000 per violation, with an annual maximum of $1.5 million.
- Maximum penalty caps of up to $1.5 million for all violations of an identical provision during a calendar year.
- Offenses committed under false pretenses: Penalty of up to $100,000 fine, with up to 5 years in prison.
- Willful or malicious intent: Up to 10 years in prison.
