Who Should HIPAA Complaints be Directed to Within the Covered Entity?

HIPAA complaints within a covered entity should be directed to the individual responsible for HIPAA compliance, typically the Privacy Officer or Chief Information Security Officer (CISO), though alternative reporting to a line manager is also an option, emphasizing the importance of reporting all violations, even minor ones, for internal review, as well as highlighting the obligation for covered entities to conduct thorough assessments to determine the reportability of breaches under the HIPAA Breach Notification Rule to the Department of Health and Human Services’ Office for Civil Rights (OCR), with specific timeframes for reporting based on the scale of the breach. This highlights the importance of understanding when and how to report HIPAA breaches to OCR, noting that investigations are only conducted for named complainants, excluding anonymous complaints from review.

HIPAA training is a key component in upholding confidentiality and security within healthcare settings, providing individuals with the necessary knowledge to manage and adhere to the stringent guidelines of HIPAA. This training not only educates healthcare professionals on the importance of safeguarding patient information but also guides them in identifying and responding to potential breaches and violations. An important aspect of this training involves imparting a clear understanding of the proper channels for reporting such incidents within a covered entity. Knowing who to direct HIPAA complaints to is necessary for ensuring that any potential violations are addressed promptly and effectively. Equally important are the reporting processes, which individuals must be well-versed in to facilitate a seamless and comprehensive response to suspected breaches. HIPAA training contributes to developing a culture of compliance and accountability by instilling this knowledge, ultimately safeguarding the integrity and confidentiality of patient data within the healthcare environment.

When faced with a potential HIPAA violation, individuals are advised to bring it to the attention of the person responsible for HIPAA compliance within their group. Typically, this role is fulfilled by the Privacy Officer or CISO. However, individuals may also opt to report incidents to their line manager, providing an alternative avenue for disclosure. It is important to report all HIPAA violations, even seemingly minor breaches, as they might indicate greater issues. Accidental violations, too, should not be overlooked. Taking ownership of a minor violation during the internal reporting process is preferable to having it discovered by a colleague, during an audit, or worse, by regulatory authorities. Covered entities are obligated to conduct internal reviews of potential HIPAA violations to determine whether there has been a breach of HIPAA Rules. If a violation is identified, the entity must assess whether it is reportable under the HIPAA Breach Notification Rule to the OCR. Not all breaches are reportable, and a comprehensive risk assessment is necessary to make this determination.

The HIPAA Breach Notification Rule establishes specific timeframes for covered entities and their business associates to report breaches to OCR. Incidents impacting over 500 individuals must be reported as promptly as possible, with a deadline within 60 days of discovering the breach, while smaller breaches affecting less than 500 people can be reported annually but no later than 60 days after the end of the calendar year in which the breach was detected. Regardless of breach size, affected patients must receive notifications within 60 days, emphasizing the need for an understanding of the timing and process for reporting HIPAA breaches to OCR. It is important to highlight the option for individuals to file complaints directly with OCR in the event of a perceived HIPAA violation, with the clarification that OCR conducts investigations exclusively for named complainants, disregarding anonymous complaints from consideration.

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