These days, people who are not familiar with the term HIPAA could get them in trouble. For people working in the medical field, it is crucial.
HIPAA violation happens whenever someone accesses, uses, or discloses Protected Health Information. So, anyone with access to protected health information will be held responsible in case of a HIPAA violation. The punishment and penalties are very severe, starting from the $50,000 to the maximum criminal penalty of $250,000.
To understand who’s responsible and the punishments for this violation, we need to get familiar with HIPAA first. If we look at the stats of HIPAA breaches from 2009 to 2021 in the United States, the number went from 18 to 712. This fact alone showcases the importance of learning about HIPAA and its rules.
What is HIPAA?
When people say HIPAA, they mean the series of national standards. Organizations in the healthcare business should have these standards in place to safeguard the security and privacy of Protected Healthcare Information (PHI). Any information which is demographic and individually identifiable goes under PHI.
For instance, full face images, names, date of birth, phone number, social security number, and serial number. So, if you work in a healthcare company, your cybersecurity provider should comply with HIPAA standards. Healthcare suppliers, Health Insurance Plans, and Healthcare clearinghouses come under the same umbrella.
- One of the main benefits of HIPAA is to assist its users in continuing their health insurance even when they are in between or switching jobs.
- HIPAA protects people from health care fraud and abuse.
- Mandate regulations and standards on electronic billing from healthcare information.
- Impose very secure, careful, and confidential handling of the Protected Health Information.
The security rule and privacy rule under HIPAA complement one another. They mandate the observance of protocols assuring the confidentiality and security of PHI. Whenever it is transferred, received, or shared by HIPAA-compliant health care suppliers. They also include covered businesses and associates who handle their data.
All PHI formats, including written, spoken, and electronic, are subject to HIPAA regulations. It instructs covered companies to provide the only PHI data sets which are required for conducting business.
HIPAA: Rules and Regulations
To fully understand the HIPAA violations and the penalties for them, we need to understand the rules and regulations of HIPAA. Well, there are six rules out of which four are essential. Let’s go through every one of them.
HIPAA: Privacy Rule
All the information stored by the health plans and other healthcare services that can identify a person must be protected. That’s where the HIPAA privacy rule comes into action. They provide national standards for all healthcare transactions electronically.
HIPAA: Security Rule
The most important rule when it comes to HIPAA rules and regulations. All the electronic protected health information needs to be protected. The security measures are there to protect the confidentiality and integrity of the information.
The security rule requires covered entities to impose all the technical safeguards. Also includes encryption and transmission security. For instance, access control requirements only allow people and software programs to have access to PHI.
HIPAA: The Omnibus Rule
To strengthen the security and privacy of health information created under HIPAA, the Omnibus Rule comes into action. It applies numerous requirements of the Health Information Technology. They are for the Economic and Clinical Health (HITECH) Act. Additionally, it establishes accountability for businesses. Also for the person in charge of managing PHI through the HIPAA's penalty provisions.
Breach Notification Rule
According to this rule, PHI data breaches must be reported to HIPAA-covered businesses. Also to their business partners. According to the rule, affected parties, the HHS Secretary, and, under certain conditions, the media, must be notified. Business partners are also required to inform covered entities.
Security Rule in Depth
The security rule of HIPAA is the most important one. That’s why it is imperative that all cyber security services include safety measures for the security of PHI. Below, you will see the most crucial areas that the security rule of HIPAA comprises. Take a look.
Administrative: Policies, Actions, and Procedures
Administrative measures, rules, and guidelines are covered here for safeguarding e-PHI. It stands for electronically protected health information.
- Information Access Management. According to this, covered entities are required to limit PHI access to those who need it. This should be in accordance with their particular tasks and responsibilities.
- Security Incident Procedures. Policies and procedures are needed for these. So that staff members are aware of how to protect e-PHI in the event of a security incident.
- Security Management Process. The business policies, practices, employee security, and HIPAA compliance training are covered. Additionally, it outlines requirements for risk registers, risk assessments, and risk management plans.
- Evaluation. According to this, covered entities need to have current security monitoring and evaluation plans.
- Workforce Security. Employee access to e-PHI must be provided by rules and processes in order to comply with workforce security requirements. It further specifies that access to PHI must be stopped if an employee's position changes or if they leave the company.
- Assigned Security Responsibility. It calls for covered entities to name a person who will be in charge of creating and carrying out organizational policies and procedures.
- Contingency Plans. Plans for contingency deal with interruptions that aren’t breaches. It also includes those brought on by a power outage or a natural calamity. In the event of a crisis, it needs policies and processes to guarantee confidentiality and integrity.
- Contract and Other Managements. Contracts with service suppliers and other third parties who create, receive, maintain, or transfer PHI. All of them must follow specific HIPAA regulations. This is valid for business associate contracts and other agreements.
- Training and Security Awareness. Covered businesses are required to train personnel in security policies, procedures, and practices. It should be in accordance with security awareness and training requirements.
This section takes into account the specific steps that covered entities take to protect PHI. Such as facility and equipment security physically. Sections include
- Security and Workstation Use. All e-PHI accessible workstations must have physical security with restricted access for it.
- Facility Access Control. Policies and procedures for limiting physical access to buildings that house PHI and the systems that store it. They include data centers, IT staff offices, workstations, and ancillary equipment.
- Media and Device Control. The regulations for "receiving and removing hardware and electronic media that include e-PHI into and out of a facility. The mobility of these items within a facility" is outlined in the device and media control guidelines. It's also essential to think about how to get rid of old hardware, software, and records including patient data.
Technical Safety (Cyber)
Access, audit, integrity, authentication, and transmission security controls are used to secure e-PHI.
- Integrity Controls. It deals with ways to stop and fix PHI mistakes as well as stopping illegal PHI additions, deletions, or modifications.
- Company or Person Authentication. The process for confirming the identities of individuals and organizations asking for access to PHI. It should be known as person or entity authentication.
- Audit Controls. Systems that hold e-PHI are required to be monitored and have their activities logged by audit controls. It also specifies the standards for audit methods. Also for audit frequency, evidence gathering, and analytical findings for HIPAA violations.
- Access Controls. Policies and practices for limiting authorized users' and software's electronic access to PHI.
- Transmission Security. E-PHI is protected while in transit thanks to this. It also includes encryption regulations.
What is HIPAA Violation?
Failure to adhere to a HIPAA rule or standard is a HIPAA violation. The regulations are 115 pages long, and there are numerous ways for an organization to break the laws. By far, failure to acquire a risk assessment or analysis is a violation. Others involve going against the patient's given Notice of Privacy Practices.
Other instances of HIPAA violations:x
- Failing to control threats or putting ineffective security measures for PHI.
- Lack of documentation of compliance efforts.
- Permitting illegal access to PHI (inadequate access controls).
- Publicly talking about protected health information (PHI).
- Failing to utilize encryption for electronic health information to prevent unwanted disclosure.
- Unauthorized PHI use, disclosures, and releases.
- Theft of PHI-storing equipment or patient records through office break-ins or other means.
- Failure to report hacks or breaches involving PHI within 60 days of discovery to the relevant people (or the Office for Civil Rights).
- Not offering security awareness and HIPAA training.
- Failure to execute business associate contracts with vendors in compliance with HIPAA.
- Inappropriate PHI disposal.
- Not giving copies of PHI to patients upon request Not installing PHI access controls.
- Not revoking PHI access credentials when they are no longer required.
- Breaching the "minimum necessary" requirement by disclosing more PHI than is necessary.
- Online or social media posting of PHI without authorization.
- Sending PHI inadvertently, such as by emailing or texting it without encryption.
- Failure to keep track of and retain PHI access logs.
What Are the Penalties of HIPAA Violation?
There are levels of fines for HIPAA compliance violations. Violations of HIPAA compliance may be expensive. Fine amounts for HIPAA violations range from $100 to $50,000 per violation. It depends on the degree of negligence and the number of patient records affected (or per record). violations of HIPAA may potentially lead to civil litigation or jail time.
First-tier. $100 per incident, up to $25,000 annually: The covered entity was unaware of the violation and could not have been expected to have known about it.
Second-tier. $1,000 per event, up to $100,000 annually. The covered entity did not behave negligently, but by exercising reasonable care, it should have been aware.
Third-tier. $10,000 per event, up to $250,000 annually. The covered entity engaged in "willful disregard" and promptly fixed the issue.
Fourth tier. $50,000 per event, up to $1.5 million annually. The covered entity behaved with intentional disregard and failed to make a timely adjustment.
The Office for Civil Rights (OCR) of the U.S. Department of Health and Human Services (HHS) manages HIPAA violation reports. It upholds adherence to the HIPAA Privacy and Security Rules by:
- Examining complaints
- Conducting audits for HIPAA compliance
- Spreading awareness of the HIPAA regulations
If the OCR finds a HIPAA breach, it will attempt to fix the problem within 30 days by adopting one of the following strategies:
- Voluntary compliance by the covered business
- OCR remedial measures
- A settlement pact between the agency and the covered entity
State Attorney General's Rights
State attorneys general have the right to pursue civil lawsuits in federal district courts. They can go against HIPAA-covered organizations for exposing the PHI of state citizens. Depending on the nature of the infringement, fines might be as high as $25,000.
The covered entity may have to pay penalties to more than one state if a data breach affects citizens of different states. HIPAA violations can result in litigation, criminal charges, and fines for the covered entity. Also the business partners, and specific personnel who are found to be accountable for rule violations.
HIPAA violations are often treated as civil offenses by the OCR. But a criminal enforcement clause is also included. As a result, medical personnel who handle PHI improperly risk legal action from the US Department of Justice.
Restitution of money obtained in return for PHI, as well as fines and jail time, are all possible penalties.
Tier 1: “Reasonable Cause” or "No knowledge" - Up to $50,000 and one year in jail.
Tier 2: Inappropriate PHI acquisition: Up to $100,000 in fines and five years in prison.
Tier 3: Obtaining PHI for personal gain or harmful purposes is punishable by up to $250,000 and ten years in prison.
HIPAA Violation Fines for Last Year
According to the stats, by October 31, 2021, OCR had paid out approximately $131 million in settlements or fines in 101 cases. Additionally, OCR has looked into allegations made against a variety of organizations. It includes big medical groups, hospital chains, group health plans, and small provider offices.
Last year, the following complaints were looked into the most frequently:
- The inability of patients to access their PHI.
- Using or releasing protected health information in excess of what is strictly necessary.
- Absence of administrative PHI protections.
- PHI usage and disclosure that is not authorized.
- Absence of PHI protections.
In terms of frequency, the following categories of covered entities have been obliged to take remedial action most in 2021:
- Public health facilities
- Outpatient settings
- Doctors' offices and private practices
The compliance of business partners and others who process and handle PHI for covered businesses. They have come under increased scrutiny from regulators.
These HIPAA rules and regulations are very essential to follow in today’s era. Especially if you work in a health organization. Patients trust the business to protect the privacy and security of their medical information. HIPAA compliance in addition to healthcare cybersecurity contribute to building their trust.
Utilizing dependable Healthcare Cybersecurity Solutions providers will simplify the HIPAA compliance process. It will free up more of your time so you can focus on your patients' care and health improvement.