A HIPAA violation is noncompliance on the part of a HIPAA-covered entity with the standards set by the Health Insurance Portability and Accountability Act of 1996. Examples of HIPAA violations include:
The U.S. Department of Health and Human Services (HHS Office of Civil Rights) enforces HIPAA compliance and determines the appropriate penalties in cases where violations occur.
Here are 10 of the most common HIPAA violations. We’ll divide these violations into two categories:
These are HIPAA violations that incur financial penalties when discovered. Penalties depend on factors such as the gravity of the breach, how long the violation persisted, and the organization’s finances involved, and are usually imposed on a penalty per violation basis.
The Office of Civil Rights (OCR) may impose penalties on a single healthcare professional or the entire healthcare facility for up to $250,000, depending on the gravity of the violation. These violations include:
Non-Performance of an Organization-Wide Risk Analysis ($100,000 – $6,500,000)
HIPAA expects covered healthcare providers to perform a risk analysis to determine the weak spots that may leave their patient information open to compromise. Failure to do this leaves patients’ Protected Health Information (PHI) vulnerable to actions that may undermine its integrity, confidentiality, and availability.
Lack of a Risk Management Process ($150,000 – $1,700,000)
After performing a risk analysis, organizations must have risk management processes where they find themselves vulnerable. This measure is to ensure direct action is taken immediately after the discovery of a breach.
Unauthorized Access to PHI
Access to PHI, permitted under HIPAA following its privacy regulations, includes healthcare operations, treatments, and payments. Accessing PHI for any other reason besides these without the patient’s permission is deemed unauthorized and will attract a financial penalty when discovered.
The law expects covered entities to make reasonable efforts to prevent such incidents.
Inadequate Access Control for the Electronic Form of PHI (ePHI) ($111,400 – $5,500,000)
HIPAA expects covered entities to limit access to PHI on a need-to-know basis to reduce the risk of compromise. It imposes a financial penalty on organizations found in violation of this.
Failure to Use Encryption or its Equivalent ($650,000 – $3,200,000)
Encryption is the safest way to handle data in storage or transport. When data is encrypted, it remains inaccessible even when stolen (unless the decryption key is stolen, too), rendering such data useless for any malicious purpose.
Though HIPAA does not mandate encryption, organizations should still implement such measures or their equivalent to secure their data.
Reporting Breaches Past the 60-Day Deadline ($130,000 – $875,000)
HIPAA security regulations allow organizations to report a security breach up to 60 days after it. Failure to report a violation within the deadline could result in a financial penalty.
Failure to Enter HIPAA-Compliant Business Associate Agreement
HIPAA expects covered entities to enter HIPAA-compliant business associate agreements with all PHI vendors. This measure can be considered compliance for vendors and ensures that such vendors handle health information as stipulated by HIPAA, even when they’re not covered entities.
Lack of Employee Training
HIPAA mandates that covered entities provide privacy and security training for their employees and document the activity. If the government deems the compliance training of their employees inadequate, covered entities can be penalized.
However, if the covered entity can prove that it did train its employees by providing the necessary documentation, the court could decide that the specific employee in question should incur the penalties.
Improper Disposal of PHI
Covered entities must ensure that PHI is disposed of appropriately to prevent it from falling into the wrong hands. Businesses need to dispose of physical (paper) records and ensure that digital records are deleted without a possibility of a copy existing.
Reckless Use of Social Media
The use of social media in a way that may disclose a patient’s private information is considered a HIPAA violation. Covered entities should take care to limit the use of social media in places that may compromise the organization.
Here are a few violations that do not result in any financial penalty but a corrective action plan. These include:
● Discussing a patient’s PHI where other parties can hear it.
● Charging a patient unreasonably for a copy of their PHI.
HIPAA violations come with penalties that may be monetary (for civil violations) and can result in jail time (for criminal offenses). The fines from these penalties mostly compensate the unfortunate victims of these violations.
These are penalties imposed when a covered entity, unknowingly or by carelessness, fails to comply with HIPAA standards. Civil penalties are divided into four tiers of increasing levels of guilt, including:
Lack of Knowledge (Tier 1)
These violations result from genuine ignorance, where the organization could prove they (or their employees) did not know of the violation.
Want to get your employees trained in HIPAA compliance? Check out our list of the top HIPAA certification programs.
Reasonable Cause without Willful Negligence (Tier 2)
In Tier 2, the covered entity is or should have been aware that its actions violate HIPAA but didn’t do it out of carelessness.
Willful Negligence, Corrected in 30 Days
Here, the violation results from neglect on the part of a covered entity but is discovered and corrected within 30 days.
Willful Negligence But Not Corrected in 30 Days
The violation results from carelessness, and the covered entity did not take corrective action within 30 days.
Criminal penalties are imposed on individual health practitioners who knowingly violate HIPAA. These violations result in criminal charges, and penalties may include monetary fines, jail time, or both.
There are three tiers of criminal violations:
Wrongful Disclosure of PHI (Tier 1)
Here, the individual was unaware or should’ve known that their action violated HIPAA.
Wrongful Disclosure of PHI Under False Pretences (Tier 2)
Here, the individual or organization obtained PHI under pretenses and went ahead and disclosed it, knowing that such action violates the provisions of HIPAA.
Wrongful Disclosure of PHI under False Pretenses with Malicious Intent (Tier 3)
A third-tier violation occurs when an organization obtains PHI under pretenses but does so with the plan to transfer data for personal gain or malicious purposes.
We’ve covered all the different classifications and types of violations, but let’s talk specifics. Here are some concrete examples of HIPAA violations and their consequences.
Preserving patient privacy necessitates strict adherence to policies. Employees must refrain from discussing patient information with unauthorized individuals, including coworkers, friends, family members, or external vendors. Employees should only discuss such details in private with authorized medical personnel.
Mishandling patient records poses a significant risk of HIPAA violations, particularly in clinics that still rely on paper-based systems. To prevent unauthorized access, patient records should always be securely stored in locked spaces and not left carelessly around the office.
Loss or theft of devices containing Protected Health Information (PHI) is a serious HIPAA violation. Proper precautions, such as password protection and timely device locking, should be implemented. Negligence, like leaving a laptop open and logged in, can render password protection ineffective. It is crucial to power down and secure all devices when not in use.
Texting patient information may seem convenient, but it exposes sensitive data to potential hackers. Sharing patient names or information via text can lead to significant fines ($5k per text) and legal consequences.
Risks of Unsecured Communication Platforms: Skype and other similar platforms pose similar risks as texting when discussing patient information. Hackers can exploit vulnerabilities, compromising the security of patient data. Opting for HIPAA-compliant video software is crucial to safeguard sensitive communication.
It’s against HIPAA to discuss private information with a patient over the phone in a public area. All phone conversations need to take place in a private area.
Sending PHI through email is a common HIPAA violation, as it exposes patient information to potential unauthorized access. Encryption programs and HIPAA-compliant communication platforms should be used to maintain the security and integrity of sensitive data.
Posting patient photos on social media violates HIPAA regulations, even without accompanying names or information. Such actions may inadvertently expose patient identities and health-related information. Strict policies and training should emphasize the prohibition of posting patient-related content on personal or professional social media accounts.
Using personal computers for accessing patient information after working hours is permissible, but precautions must be taken. Screens should be turned off and passwords applied to protect patient data from unauthorized access by family members or others. Regular policy training should reiterate these measures.
Another pervasive violation is accessing patient information without proper authorization, regardless of the reason. Employees must only access patient data when necessary for their assigned responsibilities. Curiosity or assisting colleagues should not justify unauthorized access.
The University of California Los Angeles Health System was fined $865,500 after a doctor gained unauthorized access to celebrities’ health information.
Using or selling PHI for personal gain is illegal and subject to significant penalties, including potential imprisonment. Employee training sessions and regular reminders should highlight the severe consequences associated with such actions.
Before disclosing PHI for purposes beyond treatment, payment, or healthcare operations, written consent is mandatory. When in doubt, healthcare professionals should err on caution and ensure written consent is obtained to comply with HIPAA regulations.
Patient authorizations may have expiration dates, and releasing confidential records after the specified date is a HIPAA violation. Healthcare providers must exercise diligence to adhere to authorization timelines and avoid unauthorized disclosures.
Patient consent forms, including HIPAA, must be signed to be considered valid. Releasing information without obtaining proper signatures violates HIPAA regulations, so ensure everything is signed correctly.
Nurses should access patient information strictly for the patients under their care. Accessing PHI for patients assigned to other nurses is a HIPAA violation. Following the “need to know” principle ensures that patient information is only accessed by authorized individuals responsible for their care.
Health insurance companies require essential patient information, such as the number of clinic visits but not the complete medical history. It is crucial to adhere to the “minimum necessary” principle, sharing only the required information to fulfill operational needs to avoid unnecessary HIPAA violations.
Releasing information about minors without proper parental consent is a HIPAA violation. Ensuring appropriate consent is obtained for all patients, including minors, is vital to avoid legal complications and maintain compliance.
Even by mistake, releasing the wrong patient information constitutes a HIPAA violation. Implementing verification processes and training staff to double-check information minimizes the risk of such errors. And when you release the information, it should go to the person authorized on the form.
All patient forms, including consent forms, should contain a “right to revoke” clause. Omitting this clause invalidates the forms, and any subsequent release of information to third parties violates HIPAA regulations. Ensuring the presence of this clause is essential for maintaining compliance.
This applies more to facilities that still use paper records. Paper records should be unrecognizable when disposed of, so shredding is one option. For digital records, companies could use disintegration, pulverization, melting, or incinerating.
Carrying out actions designated as HIPAA violations results in one thing: wrongful disclosure of Protected Health Information. Not only does that violate patient privacy, but it may also result in many consequences, depending on the actors involved. Common examples of these consequences include blackmailing the patient, identity theft, cyber-attacks, and the like.
A covered entity’s interest is in avoiding HIPAA violations, considering the penalties involved and the dangers they may expose patients to. Here are tips on how to do that.
HIPAA compliance for covered entities means being audit-ready at all times and entails the following:
Healthcare employees can be as liable for HIPAA violations as covered entities and should be mindful of the following:
Perimeter81 has a suite of security solutions that offer your organization complete visibility into on-premise or cloud resources. Extra security measures like 2FA mean you no longer have to worry about the loss of or unauthorized access to your health
care records. Add its strong data encryption serving as an additional layer of security, and the HIPAA Breach Notification rule becomes a thing of the past.
Thinking of nailing your compliance requirements and improving your compliance posture? Check out Perimeter81’s regulatory compliance solutions.
Want to get the latest updated information on staying HIPAA-compliant? Download our HIPAA compliance checklist.
