What Constitutes a HIPAA Violation?

A HIPAA violation occurs when an entity or individual fails to comply with any aspect of the standards and provisions outlined in 45 CFR Parts 160, 162, and 164, including unauthorized access and disclosure of protected health information (PHI), inadequate data security measures, insufficient employee training, and negligent handling of patient records, with consequences ranging from fines imposed by state attorneys general and the Department of Health and Human Services Office for Civil Rights (OCR) to potential criminal penalties, including imprisonment, highlighting importance of strict adherence to HIPAA regulations to ensure the privacy and security of healthcare data.

Common HIPAA Violations:

  1. Unauthorized Access and Disclosure: Instances where individuals access patient records without proper authorization or share sensitive information without consent.
  2. Inadequate Data Security Measures: Failure to implement sufficient safeguards for electronic PHI, including lax security measures like weak passwords, lack of encryption, and inadequate access controls.
  3. Insufficient Employee Training: Violations occur when employees are not adequately trained on HIPAA regulations, leading to inadvertent breaches. Adequate training is necessary for ensuring staff members understand the importance of safeguarding patient information.
  4. Negligent Handling of PHI: Mishandling or improper disposal of physical records containing PHI constitutes a violation. Entities must adhere to secure practices when handling and disposing of patient information to prevent unauthorized access.
  5. Unencrypted Electronic Communication: Sending unencrypted emails or messages containing PHI without adequate safeguards exposes sensitive information to potential unauthorized access.
  6. Insufficient Access Controls: Failing to implement robust access controls, such as user authentication and authorization mechanisms, can result in unauthorized individuals gaining access to PHI within electronic systems.
  7. Delayed Breach Notification: Entities must promptly notify affected individuals and regulatory bodies in the event of a breach; failure to provide timely notification constitutes a violation of the HIPAA Breach Notification Rule.
  8. Incomplete Risk Assessments: Failing to conduct thorough and periodic risk assessments to identify and mitigate potential vulnerabilities in the handling of PHI is a violation of HIPAA regulations.
  9. Lack of Business Associate Agreements: Entities must establish and maintain agreements with business associates who handle PHI on their behalf; failure to have these agreements in place is a violation of HIPAA rules.
  10. Inadequate Physical Security Measures: Neglecting to implement proper physical security measures, such as access controls and surveillance, for areas where physical PHI is stored can result in unauthorized access.
  11. Use of Unsecured Mobile Devices: Transmitting or storing PHI on unsecured mobile devices without encryption or proper safeguards exposes patient information to potential breaches.
  12. Failure to Provide Patients Access to Their PHI: Entities must facilitate patients’ right to access their health information. Failure to do so is a violation of patient rights under the HIPAA Privacy Rule.
  13. Improper Disposal of Electronic Devices: Discarding electronic devices containing PHI without proper data erasure measures poses a risk of unauthorized access and is considered a violation.
  14. Non-Compliance with Individual Rights Requests: Failure to honor patients’ requests regarding the access, amendment, or restriction of their PHI is a violation of the HIPAA Privacy Rule.

How HIPAA Violations Are Discovered:

Most HIPAA violations are identified through internal audits conducted by HIPAA-covered entities. Employees may self-report violations or bring attention to breaches by their colleagues. OCR bears the responsibility in policing HIPAA rules, responding to complaints from healthcare employees, patients, and health plan members. OCR also investigates breaches involving more than 500 records and conducts periodic audits of covered entities and business associates.

Penalties for Breaches of HIPAA Rules:

Penalty TypeDescription
State FinesState attorneys general can impose fines up to $25,000 per violation category, per calendar year.
OCR Financial PenaltiesThe Office for Civil Rights (OCR) has the authority to levy financial penalties up to $1.5 million per violation category, per year.
Criminal PenaltiesCriminal penalties may include imprisonment for up to 10 years for certain HIPAA violations.
Entities Subject to PenaltiesHealthcare providers, health plans, business associates, and individuals are all subject to these penalties.
Emphasis on ComplianceStrict compliance with HIPAA regulations is important to avoid severe penalties and uphold patient data security.

Comprehensive adherence to HIPAA regulations is necessary for entities handling healthcare information, and maintaining compliance with robust security measures is key to safeguard patient privacy and avoid the severe penalties associated with violations. A proactive approach is necessary as healthcare technology and data management continues to evolve. Regular training programs ensure employees are well-versed in HIPAA’s details, while internal audits help identify and rectify vulnerabilities. This cohesive strategy, incorporating ongoing education, risk assessments, and timely security measures, not only meets HIPAA standards but also promotes a culture of continuous improvement and dedication to patient data protection.

Daniel Lopez

Daniel Lopez is the HIPAA expert behind HIPAA Coach. Daniel has over 10 years experience as a HIPAA trainer and has developed deep experience in teaching HIPAA to healthcare professionals. Daniel has contributed to numerous publications including expert articles on The HIPAA Guide. Daniel is currently a staff writer on HIPAA at the Healthcare IT Journal. Daniel was a subject matter expert for ComplianceJunction's online HIPAA training. Daniel's academic background in Health Information Management is the foundation of his HIPAA expertise. Daniel's primary professional interest is protecting patient privacy, which he believes is the core of the HIPAA regulations and the best route to HIPAA compliance. You can reach Daniel on the contact page of HIPAA Coach and follow him on Twitter https://twitter.com/DanielLHIPAA