HIPAA Violation: What You Need to Know

Do you know a single HIPAA violation can cost a lot that your hospital can’t afford? However, HIPAA violation is common in the healthcare sector; hence healthcare professionals and individuals must know everything about HIPAA violation!

HIPAA stands for the Health Insurance Portability and Accountability Act. It’s a law that sets standards for the protection of sensitive patient health information (PHI). This law applies to healthcare providers, health plans, healthcare clearinghouses, and their business associates who have access to such information. HIPAA violations can result in serious consequences for both individuals and organizations, and it's important to understand what constitutes a HIPAA violation and the different categories of such violations.

What is a HIPAA Violation?

On a daily basis, we are getting frequent news and evidence of HIPAA violations. According to a recent report, HHS has found over 300,000 complaints against hospitals, health plans, and healthcare providers for not compliance HIPAA or violating HIPAA rules. If you’re assuming what happens after HIPAA violation and what exactly it is? In simple terms, when a covered entity or healthcare business associates fail to comply with HIPAA rules and regulations, it leads to HIPAA violations.

HIPAA violations can occur in a variety of ways, such as a healthcare provider disclosing a patient's medical information to an unauthorized person or a health plan failing to implement proper security measures to protect electronic health records (EHRs).

HIPAA Violation Categories

HIPAA (Health Insurance Portability and Accountability Act) violations are classified into four categories with minimum and maximum limits of penalties. It is listed by the HHS (US Department of Health and Human Services) and the OCR (Office of Civil Rights) in their memorandum. The first two categories of HIPAA violations are for covered entities and business associates, on the other hand, the next two categories are for those cases that are categorized as ‘wilful neglect.’

Category 1: People who are unaware or won’t know HIPAA violation by exercising reasonable due diligence lies in this category.

Category 2: If there’s reasonable evidence that a covered entity or business associate violates HIPAA compliance after due diligence, then it will lie in the second category.

Category 3: Neglectation by the will of the HIPAA rules, but corrective measures were deployed within 30 days.

Category 4: Willful neglection of HIPAA is made without implementing any corrective measures even after 30 days from the date of discovery.

The penalty value for each of these violation categories is capped, and the value of the fine is determined based on the decision of the OCR and judiciary.

HIPAA Violation Penalties

HIPAA violation penalties are classified as civil penalties and criminal penalties. Civil penalties are usually issued to organizations or healthcare entities under categories 1 or 2 of the HIPAA violation categories.

If the entity was unaware that HIPAA rules were being violated, the cost of HIPAA violations/ penalties range from a minimum fine of $127 could go up to $63,000 per year. If there is a reasonable cause, and wilful neglect is not demonstrated, a minimum fine of $1000 could go up to $100,000 per year.

If there is wilful neglect but has worked to implement corrective measures immediately after discovery, a minimum fine of $10,000 could go up to $250,000 per year. If there is wilful neglect, but no corrective measures were implemented after discovery, a minimum fine of $50,000 could go up to $1.5 million per year.

Criminal penalties in HIPAA are levied when individuals or entities knowingly gain access to PHI (Protected Health Information) using unauthorized means or when they use PHI without authorization. However, criminal penalties are further divided into three tiers.

• Tier 1 involves deliberately obtaining and disclosing PHI without authorization, which carries a monetary fine of $50,000 and up to one year in jail.
• Tier 2 involves obtaining PHI under false pretenses, which carries a monetary fine of $100,000 and up to five years in jail.
• Tier 3 involves obtaining PHI for personal gain or with malicious intent, which carries a monetary fine of $250,000 and up to 10 years in jail.

In conclusion, understanding the categories and penalties of HIPAA violations is crucial for healthcare providers and organizations. Compliance with HIPAA regulations is essential for the protection of patient privacy and data security. Any violation can result in severe penalties, and organizations should take appropriate measures to ensure HIPAA compliance.