HIPAA Violations: Understanding the Risks and Penalties

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?

A HIPAA violation occurs when a covered entity, business associate, or an individual wrongfully gets access to PHI (Protected Health Information) belonging to patients. It causes non-compliance with the HIPAA standards, a federal legislation pertaining to healthcare companies in the US.

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, here are 3 common HIPAA violations you need to look out for:

1. Insufficient access control

According to the Department of HHS (Health and Human Services), a lack of proper access control policies tops the list of HIPAA violations. 

Organizations need to focus more on risks related to access control as health information is currently present in the form of ePHIs. This is essential for protecting patient’s 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. As a result, PHI gets into the wrong hands. 

When devices such as mobile phones, laptops, or USBs fall victim of theft, it can expose sensitive data, making it vulnerable to cyber crimes such as fraud and identity theft.

Stolen devices result from improper physical and network security in healthcare facilities and the absence of proper policies. 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. Not disposing of PHI properly

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, Cornell Prescription Pharmacy was fined a staggering $125,000 for not taking proper measures in PHI disposal.

Regrettably, interns and new staff members in healthcare institutions are known to dispose of records without destroying sensitive data.

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:

Here is a detailed list of examples of HIPAA violations with case studies.

How to avoid HIPAA violations?

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)

What if you fail to comply with HIPAA?

HIPAA violations can cause monetary fines with a ballpark of $127 to $250,000, depending on the type of violation you’ve committed. Apart from financial fines, it can also lead to civil litigation and even criminal charges.

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.