Glossary

HIPAA Violation

What is HIPAA?

HIPAA stands for the Health Insurance Portability and Accountability Act of 1996. It is a federal law that provides privacy standards to protect medical information about individuals, as well as security measures to safeguard the integrity of electronic protected health information (ePHI). HIPAA requires healthcare providers, insurers, and other entities that handle personal health data to maintain appropriate safeguards for its protection. The act also outlines procedures for reporting breaches in patient data and establishes civil penalties for non-compliance with HIPAA regulations.

What is a HIPAA violation? 

A HIPAA violation is any action that violates the Health Insurance Portability and Accountability Act of 1996. Examples include improper disposal of patient records, sharing confidential information with unauthorized individuals or entities, accessing patient data without authorization, using unsecured networks to store or transmit patient data, and failing to provide adequate physical safeguards for protected health information (PHI).

The fines for HIPAA violations can range from $100 to $50,000 per violation (or per record), with a maximum penalty of $1.5 million per year for violations of an identical provision. In addition to monetary penalties, criminal prosecution may be pursued in cases involving the intentional misuse or disclosure of protected health information (PHI).

The penalties for violating the Health Insurance Portability and Accountability Act (HIPAA) of 1996 are divided into two categories: civil and criminal. 

Civil Penalties

The U.S. Department of Health & Human Services (HHS) Office for Civil Rights (OCR) is responsible for enforcing HIPAA Privacy Rules and can impose civil monetary penalties on covered entities or business associates that violate the rules. These fines range from $100 to $50,000 per violation with a maximum penalty of $1.5 million per year for repeat violations of an identical provision in cases involving willful neglect. 

Criminal Penalties

Criminal penalties for HIPAA violations range from fines of up to $50,000 and/or up to one year in prison for a person found guilty of knowingly obtaining or disclosing individually identifiable health information in violation of the Privacy Rule; to fines of up to $250,000 and/or up to five years in prison for an individual convicted of fraudulently obtaining personal health information.

HIPAA violation examples

1. Failing to properly dispose of patient information, such as leaving paper records in an open dumpster or sending electronic files without encryption. 

2. Accessing a patient’s medical record without authorization or appropriate justification. 

3. Sharing confidential health information with unauthorized third parties, such as employers or family members, without the patient’s permission. 

4. Discussing a patient’s care in public areas where others can overhear the conversation and potentially gain access to sensitive data. 

5. Using insecure methods of transmitting ePHI (electronic Protected Health Information), such as unencrypted email or text messages sent over non-secure networks like public Wi-Fi hotspots

HIPAA violation reporting 

HIPAA violation reporting is the process of submitting a complaint to the Office for Civil Rights (OCR) when an individual believes that their protected health information has been mishandled or misused. Complaints can be filed online, by mail, or by telephone and must include specific details about the alleged HIPAA violation.

HIPAA violation penalties 

The penalties for HIPAA violations by employees can be severe. Depending on the severity of the violation, an employee may face civil and/or criminal charges. Civil penalties can range from $100 to $50,000 per violation with a maximum annual penalty of up to $1.5 million. Criminal penalties for willful neglect or intentional misuse of protected health information (PHI) can result in fines and imprisonment for up to 10 years. Additionally, organizations may also terminate employment contracts due to HIPAA violations if necessary.

A HIPAA breach is the unauthorized use, disclosure, or access of protected health information (PHI). This can include a wide range of activities such as an employee accessing PHI without authorization or a hacker breaking into a system and stealing patient data. A HIPAA breach can have serious consequences for both individuals and organizations. In some cases, it may result in hefty fines and other penalties from government agencies like the Department of Health and Human Services (HHS). Additionally, those affected by a breach may suffer significant financial losses due to identity theft or medical fraud. It is important for healthcare organizations to take steps to protect their systems and data against potential breaches.

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