A Step-By-Step Guide On Reporting HIPAA Violations

The Health Insurance Portability and Accountability Act (HIPAA) sets the standard for protecting sensitive patient information, ensuring that healthcare providers and other covered entities maintain the privacy and security of patient data. But what happens when there’s a HIPAA violation? This guide will walk you through the process of understanding HIPAA, the types of violations, how to report a HIPAA violation, and provide tips for maintaining compliance.

Understanding HIPAA & Its Importance

HIPAA was enacted in 1996 to protect the privacy and security of patient’s health information, known as protected health information (PHI). It sets standards for electronic transactions, privacy, and security, ensuring that patients can trust their information is safe with healthcare providers and other covered entities.

A HIPAA violation occurs when an individual or organization fails to comply with the provisions of the HIPAA Privacy, Security, or Breach Notification Rules. These rules govern the use, disclosure, and safeguarding of protected health information (PHI).

• The Privacy Rule – The Privacy Rule regulates the use and disclosure of PHI. It requires covered entities to obtain written authorization from patients before using or disclosing their information for purposes.
• The Security Rule – The Security Rule establishes standards for safeguarding electronic PHI (ePHI). It requires covered entities to implement administrative, physical, and technical safeguards to protect ePHI from unauthorized access, use, or disclosure.

Top 4 HIPAA Violations

HIPAA violations can be categorized into four main types. Each type is characterized by specific actions or inactions, as well as the level of intent behind the violation. Understanding these categories can help organizations identify potential risks and implement appropriate preventative measures.

Unintentional Violations

Unintentional violations occur when individuals or organizations unknowingly breach HIPAA rules. These violations are usually the result of human error or lack of awareness. Common examples include:

• Improper Disposal of PHI: Discarding PHI in regular trash or recycling bins instead of using secure shredding or disposal methods.
• Accidental Disclosure: Sharing PHI with unauthorized individuals, either verbally or in writing, without realizing the breach.
• Mishandling PHI: Leaving PHI unattended or unsecured in public spaces, such as on desks, computer screens, or printed documents.

Willful Neglect

Willful neglect involves a conscious disregard for HIPAA rules. In these cases, individuals or organizations are aware of the requirements but choose not to comply. Examples of willful neglect include:

• Lack of Security Measures: Failing to implement required safeguards, such as encryption or access controls, to protect PHI from unauthorized access.
• Inadequate Employee Training: Neglecting to provide employees with the necessary information and training on HIPAA policies and procedures.
• Failure to Conduct Risk Assessments: Ignoring the need to regularly assess and address vulnerabilities in the organization’s privacy and security practices.

Reasonable Cause

Reasonable cause violations occur when individuals or organizations could not have prevented the violation despite reasonable efforts. These violations often result from circumstances beyond the control of the responsible party, such as:

• Third-Party Breaches: A violation occurs when a business associate or subcontractor mishandles PHI, despite the healthcare organization’s efforts to ensure compliance.
• Natural Disasters: Events like fires, floods, or earthquakes damage the organization’s infrastructure, leading to the accidental exposure of PHI.
• Unforeseeable Technical Issues: Software or hardware failures compromise the security of PHI, despite regular maintenance and updates.

Criminal Violations

Criminal violations involve the intentional theft, disclosure, or misuse of PHI for personal gain or malicious intent. These violations are considered the most severe and may lead to criminal prosecution. Examples of criminal violations include:

• Identity Theft: Stealing PHI to assume another person’s identity for financial gain or to access medical services.
• Insider Breaches: Employees with authorized access to PHI deliberately share or sell the information for personal benefit or to cause harm.
• Cyberattacks: Hackers or other malicious actors target healthcare organizations to steal PHI for financial gain or to disrupt operations.

How To Report a HIPAA Violation

If you suspect a HIPAA violation has occurred, follow these steps to report the incident:

• Document the Violation: Record the details of the suspected violation, including the date, time, location, individuals involved, and any evidence supporting your claim.
• Contact the Privacy Officer: Report the suspected violation to your organization’s designated Privacy Officer, who will investigate the issue and determine the appropriate course of action.
• Developing a Compliance Program: Covered entities and business associates should have a HIPAA compliance program in place to prevent, detect, and address violations. A comprehensive program includes policies and procedures, employee training, risk assessments, and incident response plans.
• Training Employees: Employee training is essential for HIPAA compliance. Staff members must understand the importance of protecting PHI and the consequences of non-compliance. Provide regular training on HIPAA regulations, best practices for safeguarding PHI, and how to report potential violations.
• File a Complaint with HHS OCR: If the violation cannot be resolved internally, you may file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights (OCR). Visit their website for instructions on how to submit your complaint.
• Notify State Authorities: If the violation involves state-specific privacy laws, report the incident to the relevant state regulatory agency.

HIPAA Violation Reporting Timeline

According to HIPAA regulations, complaints must be filed within 180 days of when the complainant knew or should have known about the alleged violation. However, the OCR may grant a waiver for this deadline if there’s a good reason for the delay.

Tips For Preventing HIPAA Violations

Below are some tips to minimize the risk of HIPAA violations, healthcare organizations should:

• Regular Risk Assessments – Perform regular risk assessments to identify potential vulnerabilities in your organization’s handling of PHI. Address any identified weaknesses and implement necessary safeguards.
• Implementing Strong Security Measures – Ensure that your organization has strong security measures in place, such as firewalls, antivirus software, and intrusion detection systems. Regularly update and patch your systems to protect against threats.
• Develop Comprehensive Policies and Procedures: Establish clear guidelines and protocols for handling PHI in compliance with HIPAA regulations.
• Encrypting PHI – Encryption is a crucial step in protecting ePHI from unauthorized access. Encrypt all ePHI, both in transit and at rest, using industry-standard encryption protocols.
• Maintain Audit Trails: Keep detailed records of PHI access and disclosures to facilitate compliance monitoring and investigations.

By understanding the different types of HIPAA violations, healthcare organizations can better identify potential risks, take necessary precautions, and respond effectively in the event of a breach.

Possible Consequences Of HIPAA Violations

HIPAA violations can lead to severe consequences for both individuals and organizations. The penalties are determined based on the level of culpability and may include:

Financial Penalties

Violations of HIPAA can result in substantial financial penalties, ranging from $100 to $50,000 per violation, with an annual maximum of $1.5 million for identical violations. The exact amount depends on the severity of the violation and the entity’s level of culpability.

Criminal Charges

In some cases, individuals responsible for HIPAA violations may face criminal charges. Criminal penalties range from fines up to $250,000 and imprisonment for up to 10 years, depending on the nature and intent of the violation.

Conclusion

HIPAA compliance is crucial to safeguarding patient privacy and ensuring the trustworthiness of healthcare organizations. By understanding the different types of HIPAA violations, knowing how to report a HIPAA violation, and prevention strategies, you can contribute to the protection of sensitive patient information and the overall integrity of the healthcare system. Additionally, implementing robust compliance programs and security measures can reduce the risk of future violations.

If you are looking to implement any of the Infosec compliance frameworks such as SOC 2 compliance, HIPAA, ISO 27001, and GDPR compliance, Impanix can help. Book a Free consultation call with our experts or email us at  [email protected] for inquiries.