The Most Common HIPAA Violations and Penalties and How to Avoid Them

HIPAA, short for the Health Insurance Portability and Accountability Act, is a set of rules to keep patient information safe. Sometimes, people who work in healthcare make mistakes and break these rules. This can lead to trouble, like fines or other penalties.

To stay out of trouble, it’s crucial to understand and follow the rules. It’s similar to learning the traffic rules before driving a car. Think of it like learning the rules of the road before driving a car. Knowing the rules helps you drive safely and avoid accidents.

So, we’re here to help you learn about the most common mistakes people make with HIPAA and how you can avoid them. This way, you can take care of your patients without worry. Ready to learn more? Let’s go!

What is HIPAA Violation?

A HIPAA violation occurs when someone doesn’t follow the rules set by HIPAA, whether by accident or on purpose. There are three main rules that explain what needs to be done to stay within the law.

HIPAA Privacy Rule

The HIPAA Privacy Rule is about keeping personal health information safe. It sets the standards for how medical records and health information should be handled and gives patients the right to see and fix their own medical records.

HIPAA Security Rule

The HIPAA Security Rule applies to healthcare providers, insurance plans, and data processing services, who must all make sure that electronic health information is secure. This rule is only for electronic records, not paper ones.

These entities must do the following to protect electronic health information:

• Keep it confidential, accurate, and available when needed.
• Protect it from threats to its security and integrity.
• Prevent it from being shared or used without permission.
• Make sure their employees follow HIPAA rules.

The rule outlines the administrative, physical, and technical protections needed to keep electronic health information safe. Not having these protections in place is a common reason why HIPAA rules are broken.

HIPAA Breach Notification Rule

The HIPAA Breach Notification Rule specifies the necessary actions for an organization to follow in the event of a data breach involving personal health information (PHI) or electronic PHI (ePHI).

If a breach occurs, the organization has to let the affected people know, and they also have to report it to the Secretary of Health and Human Services.

Sometimes, they might even need to tell the media. When a company has to announce a breach, it can damage their reputation and potentially lead to a decrease in customers.

How are HIPAA Penalties Determined?

HIPAA penalties are like different levels of punishment for breaking the rules, and they depend on a few things:

Tier 1: This is for when someone didn’t know they broke the rules and couldn’t have really stopped it from happening. It’s like getting a flat tire on a road with no warning signs.

Tier 2: This is when they should have known better but still couldn’t have stopped it, even if they were careful. It’s like when you trip over something that’s hard to see, even though you’re watching your step.

Tier 3: This is for when someone ignored the HIPAA rules on purpose but then tried to fix their mistake. It’s like realizing you left the water running, then rushing back to turn it off.

Tier 4: This is the most serious. It’s when someone completely ignored the rules and didn’t try to make things right within 30 days. It’s like knowing you left the water running and just letting it flood.

So, the penalties get more serious depending on whether the person knew they were doing something wrong and whether they tried to fix it.

The table below outlines the fines for HIPAA violations, which have been updated to account for inflation.

Tier	Minimum penalty per violation	Maximum penalty per violation	Maximum penalty per year
Tier 1	$127	$63,973	$1,919,173
Tier 2	$1,280	$63,973	$1,919,173
Tier 3	$12,794	$63,973	$1,919,173
Tier 4	$63,973	$1,919,173	$1,919,173

What Are the Most Common HIPAA Violations?

It is essential for businesses that handle personal health information (PHI) and electronic PHI (ePHI) to adhere to HIPAA compliance regulations. Let’s look at common slip-ups and how to avoid them:

Not Analyzing Risks Properly

It’s essential for organizations to regularly check for weak spots that could put ePHI at risk. Skipping this step can lead to breaches and hefty fines, like the $1.25 million penalty Banner Health faced in 2016. To stay on track with HIPAA, it’s important to do these risk checks and keep records of the findings to maintain HIPAA Compliance.

Misplacing Devices with ePHI

When laptops or phones with ePHI get lost, it’s a big deal. It can lead to a HIPAA violation and the need to tell everyone about the breach. With more people working on their own devices, this risk is even higher. To keep ePHI safe, companies should have strong rules about device use.

They should use access control systems to lock devices away when they’re not being used and keep track of who’s trying to use them. Another good move is to store and encrypt ePHI in a secure cloud service, so even if a device is lost, the information isn’t at risk.

Sneaking a Peek at Health Records

Looking at health records without the right permission is a big no-no. It can get someone fired or even lead to legal trouble. Usually, the organization doesn’t get fined, but it’s still a serious issue. To stop this from happening, there need to be tight controls on who can see ePHI.

For physical security, it’s important to have building security access control systems to stop unauthorized people from getting into places where PHI or ePHI is stored. Healthcare providers need to make sure they:

• Use managed access controls to secure physical entry to places with sensitive information.
• Keep logs of who comes and goes to spot any strange behavior.
• Protect software with ePHI using passwords and auto-logout features to avoid accidental leaks. The areas with these systems should also be locked down.
• Secure portable gadgets like phones, tablets, and USB drives with access controls. When it’s time to throw these devices away, they need to be cleaned of data properly, either by wiping them clean or destroying them completely.

Not Giving Patients Their Records Quickly

Hospitals have to let patients see their health records within 60 days. Two hospitals, including Cignet Health, didn’t do this between 2008 and 2009, and it cost them $4.3 million.

Not Making Proper Business Deals

When a healthcare place works with other companies, they have to sign special agreements that follow HIPAA. It’s their job to make sure these agreements are okay before they start working together.

Sharing Information They Shouldn’t

If a place lets out private health information by mistake or because they weren’t careful, they’ll probably have to pay money and tell everyone about the mistake.

Throwing Away Records the Wrong Way

When it’s time to get rid of old health records, they have to be destroyed safely, like shredding papers or wiping out electronic files.

Not Teaching Employees the Rules

It’s super important for all employees to know HIPAA rules well. If they don’t get taught properly, it can lead to more mistakes and fines. Good training helps keep everyone’s information safe.

Bottom Line

Following HIPAA’s rules for keeping health information safe is not just a legal must-do for U.S. healthcare businesses, it’s also smarter money-wise. Getting fined for breaking these rules can cost a lot, but the damage to a business’s good name can be even worse. So, it’s really important for healthcare providers and their patients to do everything they can to keep personal and electronic health information secure.