HIPAA Violations Reporting [Steps + Examples]

One of the complexities of navigating HIPAA compliance that organizations find daunting is disclosing violations. However, surprisingly, the covered entities face far fewer consequences for HIPAA violations reporting than the ones failing to report an incident. It saves them from fines, penalties, OCR investigation and raising suspicion among clients and partners. According to a recent report, the OCR resolved 87% of violation complaints without formal investigations. This indicates how proactive reporting comes with less disruptive resolutions.

However, many organizations are unintentionally conceal violations because they don’t know what constitutes a violation or are unaware of the reporting process

This blog serves as your go-to resource for HIPAA violations and reporting. Let’s dive in.

What is HIPAA violation reporting?

HIPAA violation reporting is the process of notifying the concerned authorities about failure to comply with HIPAA standards because of unauthorized access, disclosure or mishandling of unsecured PHI or ePHI.

A reporting process includes filing a report with the Department of Health and Human Services Office for Civil Rights (OCR), submitting additional paperwork such as proof of notification to affected persons, undertaking a remedial action plan review, etc.

How to report a HIPAA Violation?

When it comes to reporting HIPAA violations, individuals and organizations have numerous options.

 Here are the three ways to report a HIPAA violation:

Here are the three ways to report a HIPAA violation:

Reporting HIPAA violations internally

Suppose healthcare employees suspect a breach of HIPAA regulations. It is recommended to promptly report the incident to their immediate supervisor, the designated Privacy Officer, the first point of contact regarding HIPAA compliance.

Employees should feel safe telling their superior or manager about the incident, who determines if the incident constitutes a breach. If so, the organization’s HIPAA compliance personnel must be contacted and instructed to resolve the situation. And ensure that it is handled per HIPAA rules. This procedure guarantees that any HIPAA violation is promptly remedied while maintaining the privacy and security of protected health information.

Furthermore, to ensure HIPAA compliance internally, organizations should form a task force to follow up on violations and monitor existing systems and procedures. Training employees on these regulations is also necessary to help them identify violations and report them.

Reporting HIPAA violations to HHS’ Office for Civil Rights

Organizations can report potential violations through an online form on OCR’s Breach Reporting Portal, via email, or by fax. Once a report has been submitted, an OCR representative will contact the organization to verify and confirm receipt of the complaint.

When reporting HIPAA violations to the Department of Health and Human Services Office for Civil Rights (OCR), organizations should ensure that they follow their policies and any applicable state laws.

 The OCR takes all reports of suspected HIPAA violations and thoroughly investigates them. This includes appropriately documenting the incident, gathering evidence to back up the claims, and submitting a comprehensive and accurate report. 

Organizations should report full details of the incident within 180 days of the incident. Failure to report within the mentioned time period could cost you significant charges, and organizations or healthcare entities will be held accountable for violations due to willful neglect of HIPAA rules. If it is proven that the breach was caused intentionally, organizations may face legal issues and monetary penalties.

Reporting HIPAA violations anonymously

There are ways for persons who want to report a violation anonymously. By downloading the complaint form and withholding any contact information, one can report a violation via mail.

An individual can also utilize the OCR site to offer specific details about the occurrence while concealing contact information.

Reporting HIPAA violations anonymously is not recommended as it can lead to a lack of accountability and malicious claims. Anonymous reports can sometimes result in insufficient evidence and can lead to the investigation being inconclusive. 

Furthermore, due to the confidential nature of medical information protected by HIPAA guidelines, organizations may be unable to investigate anonymous allegations properly before taking corrective action. Without follow-up inquiries or conducting interviews with witnesses, organizations may be unable to verify the accuracy of anonymous reporting and to take rightful action.

Also check out: HIPAA breach notification rule

HIPAA violation reporting examples

HIPAA violation can cause serious consequences for organizations that fail to comply with the law. Some of the common HIPAA violations reported by organizations are listed below:

Unauthorized access 

One of the most common HIPAA violations reported by organizations is unauthorized access or use of PHI. This breach occurs when an individual or organization gets, modifies, discloses, or uses protected health information without the patient’s or authorized representative’s permission. Among these activities are:

• Obtaining medical records without a valid purpose.
• Sharing sensitive information with unauthorized people.
• Using PHI for reasons other than delivering patient care. 

Lack of employee training

Lack of compliance training is another potentially costly violation of HIPAA regulations. Companies must ensure their employees understand the importance of PHI security. And also follows protocols in order to access and handle confidential patient data securely. 

When organizations fail to provide clear guidance and comprehensive HIPAA training materials, they risk exposing patient data to unauthorized access or misuse. This violation can lead to hefty fines and sanctions and cause significant reputational damage to the organization.

Use of unsecured networks for transmitting PHI

Using unsecured networks to transmit PHI is a severe violation of HIPAA regulations. Unsecured networks can be accessed by unauthorized individuals and malicious actors, leading to the theft or misuse of confidential patient data. 

Organizations are required to secure networks with encryption, authentication protocols, and other security measures in order to avoid risk or exposure. 

Furthermore, companies are also required to monitor transmissions to ensure only authorized individuals are accessing PHI and monitor for any suspicious activity that could indicate an unauthorized breach. 

Release of wrong patient information

The release of wrong patient information is a serious HIPAA violation that can have significant consequences for organizations. This type of violation occurs when an individual or organization discloses protected health information (PHI) from one patient to another, often by mistake. 

For example, if a doctor accidentally sends a medical bill to the wrong address or if a hospital mistakenly sends out test results intended for one patient to another. This error can result in more than hefty fines due to non-compliance with federal regulations. 

Improper disposal of PHI

Improper disposal of PHI is one of the most common HIPAA violations. This type of violation occurs when an individual or organization fails to properly dispose of protected health information (PHI) in a way that ensures unauthorized individuals cannot access it. 

PHI must be disposed of securely through destruction, shredding, burning, or other methods approved by the U.S. Department of Health and Human Services to protect confidential patient data from unauthorized disclosure and misuse.

Failing to report a HIPAA violation can seriously affect organizations and individuals. The U.S. Department of Health and Human Services (HHS) has the authority to impose civil monetary penalties (CMPs) ranging from $100 to $1.5M (yearly) per violation, depending on the circumstances involved. 

Consequences for not reporting HIPAA violation

Organizations covered under HIPAA regulations must comply with reporting requirements as soon as possible after becoming aware of any potential security breaches or unauthorized releases of protected health information (PHI). 

Doing so can help protect organizations from costly penalties imposed by regulation authorities. These penalties can be civil or criminal penalties:

Civil penalties can range from $137 to $68928 per violation, depending on whether it was lack of knowledge, reasonable cause or willful neglect that was corrected or not. The annual cap for maximum penalty is $2067813.

Criminal penalties can range from $50000 and one-year imprisonment to a maximum of $250000 and up to 10 years of imprisonment.

Moreover, suppose an organization is guilty of failing to report a HIPAA violation, it may be required to pay additional CMPs and take other corrective action as part of its resolution agreement with OCR.

Not reporting HIPAA violations may also lead to reputational damage. Organizations that do not disclose breaches quickly and openly are often seen as uncooperative or untrustworthy when protecting private patient data.

Conclusion

HIPAA violations can seriously affect organizations and individuals, from hefty fines to reputational damage. It’s, therefore, important for any organization covered by HIPAA regulations to promptly report any potential breaches of private patient data. 

Taking the necessary steps to protect PHI is not only vital for avoiding costly penalties; it’s also essential for maintaining customer trust and building strong relationships with healthcare providers. Being open about security lapses helps organizations demonstrate their commitment to protecting confidential health information. This makes them more reliable partners when handling sensitive medical records.

Is there an easy way to stay compliant? Yes, that’s where we come in. Sprinto automates multiple facets of compliance and ensures that organizations comply with all applicable laws and regulations pertaining to the safety of patient data. This can help you reduce the risk of non-compliance while building trust with customers and business partners. Ready to take the fast route? Get started here.

FAQs about HIPAA violation reporting

Do all HIPAA violations have to be reported?

No, not every HIPAA violation needs to be self-reported. Only specific violations, or reportable breaches, must be reported per the HIPAA Privacy and Security Rules. Unauthorized access, theft, loss, or other unauthorized disclosure of protected health information are examples of breaches that need to be reported (PHI). 

Notifying a PHI breach is unnecessary if the covered entity or business associate concludes it is not a reportable breach. 

To ensure compliance with the HIPAA standards, all HIPAA violations—regardless of whether they constitute reportable breaches or not—should be addressed and remedied.

What Happens When an Employee Violates HIPAA?

An employee violating HIPAA can severely affect the organization and the individual involved. Depending on the severity of the violation, organizations may face hefty fines imposed by regulation authorities between $50,000 – $250,000. In severe cases, the employee can also be imprisoned for 1-10 years.

Can I Report HIPAA Violation Anonymously?

The provision for anonymous reporting of violations is not mentioned expressly in HIPAA regulations. Nevertheless, an individual can report something without revealing their identity. The investigation process may become more challenging because the information’s source cannot be verified in these situations. It’s crucial to remember that reporting a HIPAA violation is a responsible action, and anonymity could damage the report’s credibility. 

What practices would you put in place to ensure compliance with HIPAA?

To ensure HIPAA compliance, organizations should train the staff on HIPAA law and its specific requirements. Also, organizations should have policies for responding to potential security incidents or unauthorized releases of PHI. These policies should include identifying responsible parties for different situations. And should outline the steps necessary to report a HIPAA violation promptly.

What is the Time Period for Reporting HIPAA Violation?

Organizations covered under HIPAA, are legally required to report any potential security breaches or unauthorized releases of protected health information (PHI) within 60 days. Failing to do so may result in costly civil monetary penalties (CMPs).