An Ultimate Guide To HIPAA Violation

If you’re in the healthcare industry, it’s important that you pay attention to the Health Insurance Portability and Accountability Act (HIPAA) because breaking its rules could land you in some serious trouble. You’re looking at hefty fines, at the very least. The more serious cases can lead to prison sentences. 

The Department of Health and Human Services (HHS) and the Office for Civil Rights (OCR) are the primary enforcers of HIPAA regulations. 

So, it’s important to ensure you understand and abide by these rules. In this article, we break down what HIPAA violation are and go into the 3 types of HIPAA violations.

What is a HIPAA violation?

HIPAA violations arise when an entity fails to comply with the standards outlined by HIPAA, a U.S. Federal legislation established in 1996. Most HIPAA violations are attributed to improper access or disclosure of protected health information (PHI) belonging to patients.

Also, these violations may also include improper personnel training or insufficient security of access logs.

Any incident that qualifies to breach the requirements of the five principles of HIPAA is considered a HIPAA violation. HIPAA has five rules that organizations processing PHI are expected to follow. Any organization that fails to comply with these rules will violate HIPAA.

There are a few exceptions of course, but we’ll cover that later.

Sometimes a HIPAA law violation could also be when organizations that deal with patient data overshare information than the minimum amount required to complete the transaction.

It is also a violation when organizations leave their databases (cloud or on-prem) in a format that does not require decryption to obtain access.

How will you know if there is a HIPAA violation?

HIPAA violations can take many forms, but some common signs may indicate a potential violation. 

Here are a few things to look out for:

• If you notice that someone is accessing patient information that they’re not supposed to, or if you receive a complaint from a patient that their information has been accessed without their consent, that could be a red flag for a HIPAA violation.
• HIPAA violations can occur when patient information needs to be handled properly. For example, if you see someone leaving patient files out in the open where anyone can see them, or if you come across patient information in a dumpster or recycling bin, that could be a sign of a HIPAA violation.
• If your organization experiences a breach of patient information, you should receive a breach notification. This notification will provide details about the breach, including what information was affected and how many patients were on the list.
• Patients can file complaints if they feel that their HIPAA rights have been violated. If you receive a complaint from a patient or their representative, it’s important to take it seriously and investigate it thoroughly.

Most Common HIPAA violations

HIPAA violation is a serious issue. To help you avoid this in the future, we have some common HIPAA violations you need to look out for:

1. Poor access control

According to the Department of Health and Human Services and state attorney generals, one of the top common HIPAA violations in healthcare services is the lack of proper access control policies.

With the rise of electronically protected health information (ePHI), some inherent risks and vulnerabilities need to be addressed to protect patient privacy.

For example, digitally-accessible medical records require proper security measures to ensure that medical staff or physicians do not accidentally access protected health information (PHI) they are not authorized to view. This could lead to the exposure of sensitive patient data.

2. Device theft

Medical data is a prized target for cybercriminals and a significant threat to patient privacy. Healthcare institutions frequently encounter device theft, which is among the most common ways that PHI is lost.

When devices such as mobile phones, laptops, or USBs are lost or stolen, it can expose sensitive data, making it vulnerable to cyber crimes such as medical fraud and identity theft.

Device theft often occurs due to poor physical security and a lack of device policies within the institution.

For example, physicians or doctors usually take their work devices home and leave them unattended in cars, hotel rooms, or other public areas, resulting in stolen devices. In most cases of device theft, the devices were also left unencrypted, which makes matters worse.

Healthcare institutions must implement robust policies to safeguard devices to prevent PHI from being compromised. This includes:

• Ensure that the devices have strong encryption with strong passwords
• Limiting the amount of patient data that is stored on mobile devices or laptops
• Establishing clear protocols for the use and transport of devices that contain PHI
• Encouraging staff to report any lost or stolen devices immediately
• Regularly conduct security assessments and audits to identify and address any vulnerabilities promptly.

3. Improper disposal of PHI and medical data

Overlooking the proper disposal of medical records is a major HIPAA violation that needs to be addressed. Though it may not happen often, it can still result in severe penalties.

For example, in 2022, The New England Dermatology and Laser Center was fined a staggering $300,640 for negligently disposing of PHI.

Regrettably, interns and new staff members in healthcare institutions are known to dispose of complete physical copies of medical records without destroying sensitive information.

This also applies to digital data within old laptops, hard drives, or USBs that contain PHI and are incorrectly wiped out after their retention period expires.

To avoid this:

• Provide employees with proper training and guidelines for the proper disposal of medical records, including digital data
• Implement regular audits to ensure that proper disposal policies are being followed
• Assign responsibility to a designated person or team to oversee the secure disposal of PHI

Check out more such common violations in this video:

How to avoid HIPAA violation in 2023?

Employers and employees often cause HIPAA violations due to negligence. This negligence is often a byproduct of a lack of training on HIPAA regulations and best practices for the entire employee workforce in an organization.

This can be solved by including periodic training programs that make the employees of the org aware of the current threat landscape and the best practices to follow to ensure continued HIPAA compliance and a more robust security posture. 

We solve this by offering modular training programs in our package, thus eliminating the need for you to look for training programs from other vendors/service providers who charge between $10,000 to $25,000, depending on the size of your organization.

• Conducting training programs for all the employees in your organization about the importance of cyber security and making them aware of the current threat landscape. This enables them to become the organization’s first layer of defense and report any suspicious activity immediately.
• Conduct periodic HIPAA risk assessments to understand whether the technical safeguards are enough or additional security measures are required.
• Deploy encryption in every stage of the lifecycle of protected health information. In other words, information that enters and exits your organization should be encrypted.
• Implement safeguards that allow only authorized access to PHI/e-PHI. 
• When an employee leaves your organization, ensure a thorough offboarding is conducted.
• Use unique IDs to ensure any suspicious activity is logged and tracked.
• Protect PHI from unauthorized use (internal and external) 
• Inform the affected users about the breach and the impact of the breach within 60 days after discovery.
• Text messaging should not be used when sharing PHI ( use HIPAA-approved applications for secure messaging instead)

Penalties for HIPAA violations

HIPAA violations can lead to various penalties, from financial fines to civil litigation and even criminal charges. The severity of the monetary penalties varies depending on the nature of the violation, with a range of $127 to $250,000.

It is important to note that HIPAA regulations hold organizations accountable for maintaining PHI’s confidentiality, integrity, and availability. Any breach of HIPAA compliance can result in penalties when identified during audits, investigations, or complaints.

What are the 4 levels of HIPAA violation?

There are 4 levels of HIPAA violation. These levels are based on the level of negligence or intentionality involved in the violation and the resulting harm caused by the violation. 

• Tier 1: Minimum fine of $100 per violation up to $50,000.
• Tier 2: Minimum fine of $1,000 per violation up to $50,000.
• Tier 3: Minimum fine of $10,000 per violation up to $50,000.
• Tier 4: Minimum fine of $50,000 per violation.

Sprinto helps you avoid HIPAA non-compliance fines

As an entity dealing with sensitive patient and medical data, it’s important you understand and abide by HIPAA requirements. The consequences of non-compliance are severe, including monetary penalties of up to $250,000, potential jail time, and both civil and criminal lawsuits. And this is why you need a solution that helps you stay ahead of the curve. 

A compliance automation platform like Sprinto affords you complete visibility of your business’s security controls, allowing you to stay compliant at any point in time. You can now create new data security policies, schedule training sessions for employees on handling ePHI and medical data, and automate evidence collection with ease. Let’s make your HIPAA compliance journey a breeze. Speak to our experts.

And the damage to your organization’s reputation can be irreparable. So why take the risk? Trust Sprinto to keep you compliant and protected. Talk to our experts!

FAQs

1. How can you tell if your organization is violating HIPAA?

As an organization, you should conduct periodic risk assessments and internal audits to ensure that you follow HIPAA guidelines. These activities often highlight instances of non-compliance. In addition, hiring a third-party HIPAA-compliant auditor to review your organization’s compliance posture is also a great way to gain insights.

2. What qualifies as a HIPAA violation?

Many HIPAA breaches are usually related to the unauthorized access or disclosure of patients’ PHI. Nonetheless, non-compliance instances may also include inadequate training of personnel or inadequate monitoring of access logs.

3. What is not protected by HIPAA?

Although various industries are subject to strict regulations, HIPAA does not apply to hotels, retail stores, airlines, or veterinary clinics. These establishments do not meet the “covered entity” definition under HIPAA.

4. What are the types of HIPAA violations?

HIPAA violations are usually categorized into three buckets. They are administrative violations, civil violations, and criminal violations. The Centre deals with administrative violations for CMS and OCR. In any civil case, if the OCR finds a reasonable criminal intent, those cases become criminal cases and are referred to the Department of Justice for further investigation.

5. Is gossiping a HIPAA violation?

Suppose workplace gossip pertains to an individual whose identifiable health information is safeguarded by the Privacy Rule and takes place within a Covered Entity’s or Business Associate’s workplace. In that case, it is an instance of HIPAA violation.