An Overview of the HIPAA Privacy Rule

Meeba Gracy

Meeba Gracy

Mar 09, 2024

HIPAA privacy rule

Medical information: who has access to it and how is that access governed? There is a lot of ambiguity around this topic. This confusion was the driving factor behind Congress giving a green light to the Health Insurance Portability and Accountability Act (HIPAA), which includes a set of regulations known as the HIPAA Privacy Rule. 

In this blog post, we’ll overview HIPAA’s Privacy Rule, exploring why Congress deemed these rules necessary and what they mean for safeguarding health data.

Let’s dive in…

  • The HIPAA Privacy Rule was created as a part of the broader Health Insurance Portability and Accountability Act of 1996
  • The Privacy rule intends to protect individual’s personal health information and give patients more control over their medical records
  • The rule applies to covered entities and business associates that deal directly or indirectly with Protected Health Information (PHI)
  • Violation of the Privacy Rule can attract civil and criminal penalties

History of HIPAA Privacy Rule

HIPAA was introduced in 1996 with the underlying goal of increasing access to healthcare across the country. It was crafted as a three-pronged solution through ensuring portability, tax provisions, and, most notably, administrative simplification. 

The HIPAA Privacy Rule was foremost in and entered through works of the Department of Health and Human Services (HHS). This rule was highly sought after as it can create an effective system where the digital transmission of health records is done more safely and prevent major privacy complications. 

HIPAA privacy rule goal

Remember that before 1999, the government or authorities rarely complied with the federal regulations protecting health information privacy. However, the need for a powerful role grew rampant over the increase in violations, and finally, HHS stepped in with a solution. The solution: the introduction of the HIPAA Privacy Rule.

After considering public feedback for a model regulation for HIPAA privacy, they amended the Common Rule to include robust regulations for the disclosure and use of PHI by CE’s (covered entities). 

This version of the HIPAA Privacy Standards required most healthcare providers to comply by April 14, 2003. Behind these regulations is Congress’ acknowledgment of how much data from personal health records contributes to conducting countless medical research.

What is the HIPAA Privacy Rule?

The HIPAA privacy rule establishes national standards for covered entities to safeguard individuals’ protected health information by providing patient’s certain rights over their medical records and personal information.

The HIPAA Privacy Rule addresses the main disclosure and use of PHI of an individual by entities. It gives an individual more control over their personally identifiable information.

Advocating for Stronger Privacy Rules

Today, various privacy advocates pointed out that the U.S. is overdue for stronger safeguards than HIPAA regulation. These demands mainly relate to health care instead of medical research.  

Hence, a Harris Poll was conducted as part of this study to gain fresh insight into this issue.

After analyzing the data from the study, the committee found that citizens were highly skeptical of their PHI’s privacy and security. However, they noted that while HIPAA’s Privacy standard has somewhat lessened these worries, it didn’t eradicate them. 

Another thing to note is that while most survey participants expressed discomfort with having their PHI being used for research purposes without notice and express consent, most respondents were willing to provide their data if certain precautions were in place. The scope of the research is available. 

Although it’s been more than 27 years since its introduction, the HIPAA privacy rule summary still stands tall today as one of its most achievements amongst other regulations set out by HHS.

To whom do the HIPAA Privacy Rules apply?

The HIPAA Privacy rules apply to any entity that deals directly or indirectly with ePHI. The covered entities, such as health plans, healthcare providers etc. directly collect, receive or process PHI and must abide by HIPAA rules. Business associates perform certain functions on PHI on behalf of covered entities and must protect this information.

The Privacy Rule applies to:

HIPAA privacy rule applies to

1. Health plans

Health plans in the context of privacy rules include employers, church, and government health plans. It also includes multi-employer health plans.

Recommended: HIPAA compliance form for employers

2. Health Care Providers

Now, this is where it gets interesting: health care providers are covered under privacy rules regardless of their size. It applies to anyone who electronically transfers PHI, including referrals, authorization, insurance claims, transactions, or benefits eligibility.

If you are wondering what constitutes a healthcare provider, here are some examples:

  • Institutional providers
  • Physicians
  • Dentists and other practitioners
  • Medical or health services
  • Person or organization that provides bills

3. Business Associates

Business Associates are those contractors or non-workforce members who might need access to PHI. For example, suppose you’re a healthcare organization that needs to outsource I.T. services. In that case, you’ll need to make sure that you have a “Business Associate Agreement” with your vendor or contractor before allowing them access to this sensitive data. 

4. Hybrid Entities

An entity that performs both HIPAA-regulated and non-regulated activities is known as a “hybrid entity.” For example, UNC is a hybrid institution. Take the Student Health Center and Counseling Center, for instance; these are part of UNC’s healthcare system.

Information that HIPAA Privacy Rule Protects

The HIPAA privacy rule safeguards all information about an individual’s health that a covered entity or its business associate might hold, whether verbal, electronic, or paper. In regulatory slang, this protected data falls under one acronym – PHI. It can include

  • Information related to the past, present, or future condition of the patient
  • Information on the treatment of the physical or medical condition of the patient
  • Information related to payment of the diagnosis or treatment of the patient

Here’s the list of PHI that the Privacy rules cover:

  • Name
  • Address
  • Social Security Number
  • Bear Number
  • Marital status
  • Birth date,
  • Hospital admit date
  • Hospital appointment date and discharge date
  • Telephone and Fax numbers
  • Email addresses
  • Insurance l.D. number
  • Insurance account number
  • Driver’s license
  • Demographics related to insurance information
  • Family information
  • Signature in sheets at any healthcare center
  • A person’s physical and mental well-being, either in the past, present or future
  • Any data that can be linked to a particular person or reasonably believed to enable the identification of an individual as a patient, student, or employee constitutes personal information
  • Whether it be the past, present or future, compensation for medical services is a PHI

Unlock the power of automation for your HIPAA program

How does the HIPAA privacy rule protect information?

The HIPAA privacy rule is designed to protect the privacy and security of patient’s health information by enforcing minimum necessary standards, requiring organizations to implement safeguards, and holding the violators accountable.

1. Limits on permissible use and disclosure

The HIPAA privacy standard imposes restrictions on usage and disclosure of PHI to protect it from unauthorized access. Covered entities must use, disclose or request minimum necessary information for purposes such as treatment, payment or any required healthcare operations. The PHI must be disclosed only with the patient’s consent.

2. Patient rights

The HIPAA privacy rule grants certain rights to patients to ensure greater control over their information and protect their privacy. The rights include right to access, right to amendment, right to request restrictions, right to file a complaint etc.

3. Safeguards

The rule also requires covered entities to implement technical, physical, and administrative safeguards to safeguard the confidentiality, integrity, and availability of PHI and ensure only authorized users have access to it.

Sprinto effortlessly helps you uphold these safeguards by helping you implement a comprehensive HIPAA program with privacy and security assessments, HIPAA-aligned policies, HIPAA training, business associate agreements and more. Ensure continuous monitoring and continuous compliance with Sprinto. Schedule a demo.

HIPAA privacy rule testimonial

4. Accountability

The HIPAA Privacy Rule holds organizations accountable whenever there is a breach of information security and imposes civil and criminal penalties depending on the severity of the violation.

5. What do service providers need consent?

First of all, all healthcare providers are responsible for protecting your privacy! Hence, they must acquire your consent before using or disclosing any PHI to provide treatment, manage payment, and handle operations.

6. Disclosing PHI with public health authorities

While protecting patients’ privacy is a top priority, it’s also important to enable public health authorities to access necessary information for them to do their job. 

The Privacy Rule recognizes this necessity by allowing PHI to be shared with these authorities so they can effectively work towards the collective well-being of our communities. This is important to understand what the HIPAA privacy rule stands for!

What happens if you violate the HIPAA privacy rule?

Violation of HIPAA Privacy Rule brings both financial and reputational repercussions in the form of fines, penalties, lawsuits, scrutiny, and tarnished public perception.

Here is what happens when you violate the rules:

1. Civil penalties

Civil penalties for HIPAA violations range from $137 per violation to $68928 per violation. They can go up to $2067183 if there is wilful neglect that is not corrected within 30 days of the violation.

2. Criminal penalties

Criminal penalties can include fines ranging from $50000-$250000 and imprisonment from 1-10 years, depending on the seriousness of the violation.

3. Regulatory scrutiny

Violating HIPAA rules can also attract regulatory scrutiny from the Department of Health and Human Services (HHS) and result in enforcement actions from the body like penalties and requirements for corrective action. 

5. Negative Public Perception

The HIPAA privacy rule violation can slow down your sales cycle because of negative publicity. The reputational damage can result in lack of trust from customers in safeguarding their personal information can hamper business operations.

Create and monitor your HIPAA compliance program

What rights do patients have under the HIPAA Privacy Rule?

The HIPAA Privacy Rule states that healthcare organizations (covered entities) must provide individuals access to PHI upon request. 

This includes inspecting or getting copies of PHI maintained by healthcare entities and having that PHI transmitted to a third party designated by you. 

The right applies to any information created, whether produced or stored electronically or physically on-site, remotely or in archives. Every data falls under this set of rights, regardless of when it was created or where it is stored (electronically, physically on-site, or remotely in archives).

Recommended: Five core components fo HIPAA

How Sprinto can help you adhere to HIPAA rules

Keeping up with HIPAA compliance can be a lot to deal with. Luckily, Sprinto has the answer. The compliance automation platform streamlines workflows for HIPAA Privacy rule and more.

We set you up for success by automating your HIPAA-related tasks, from assessing risk to evaluating your compliance posture.

  • Map and manage HIPAA requirements from one centralized place
    Run qualitative risk assessments and get actionable mitigation steps to work on
  • Roll-out pre-built HIPAA policies org-wide and ensure acknowledgements
  • Publish HIPAA training modules and keep track of completion rates
  • Leverage granular level automated checks and automated alerts to contain compliance drift
  • Get automatically collected evidence to breeze through the HIPAA audits

Our clients get HIPAA ready in weeks and maintain continuous compliance. Check out how Neurosynaptic got HIPAA ready in 5 sessions.

HIPAA privacy rule testimonial

Save yourself time and hassle so you can focus on what matters: growing your business. Reach out to our compliance experts and we’ll make quick work of HIPAA compliance.


Who enforces HIPAA rules?

The HIPAA rules including Security and Privacy rules are enforced by the U.S Department of Health and Human Services (HHS) Office for Civil Rights (OCR)

What is the major goal of the privacy rule?

The major goal of the HIPAA privacy rule is to safeguard individual’s protected health information and give patients more control over their medical records while ensuring access to the required information for high-quality healthcare.

What are the 3 rules of HIPAA?

The 3 rules of HIPAA are as follows:

  • Privacy rules
  • Security rules
  • Breach Notification rules

What are the four basic parts of the HIPAA privacy Rule?

The 4 basic parts of HIPAA privacy rule are as follows:

  • Administrative simplification
  • Privacy of health information
  • Security of electronic records
  • Insurance portability

Why does the HIPAA Privacy Rule exist?

The HIPAA Privacy Rule’s major reason is that it ensures top-tier protection of individuals’ health information. The Privacy Rule ensures this happens without compromising on necessary data flow.

Meeba Gracy

Meeba Gracy

Meeba, an ISC2-certified cybersecurity specialist, passionately decodes and delivers impactful content on compliance and complex digital security matters. Adept at transforming intricate concepts into accessible insights, she’s committed to enlightening readers. Off the clock, she can be found with her nose in the latest thriller novel or exploring new haunts in the city.

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