Organizations in the healthcare sector are often plagued by inaccurate security measures and frequent protocol errors that result in malicious entities hacking into sensitive patient data. This is why the Health Insurance Portability and Accountability Act (HIPAA) was created to protect the confidentiality and security of patient medical records. Healthcare providers, health plans, and their business partners are all subject to HIPAA laws, which establish stringent guidelines for managing and securing private patient information. If there is a HIPAA violation, the individual or organization involved may suffer serious repercussions, such as high penalties and legal action.
Many HIPAA violations contribute to lost, compromised, or stolen patient data and sensitive medical records. These include lax security policies, neglected risk assessment audits, internal human errors, and a lack of employee HIPAA training. However, you can easily avoid the risks of such HIPAA infractions by implementing the appropriate security controls, conducting regular audits, and providing quality employee training. This blog will provide a comprehensive overview of what a HIPAA violation is, how much it can cost you, and the nine most common examples of it.
What is a HIPAA Violation?
A HIPAA violation results from a business associate, covered entity, or workforce employee intentionally and wrongfully accessing, transmitting, or gaining protected health information (PHI) for a purpose prohibited under 1320d-6 of the Social Security Act.
In the age of digital records, HIPAA statutes strive to modernize healthcare information. By regulating security measures around access to medical information, they outline patient data privacy requirements. There are three main rules under the HIPAA legislation: the Privacy, Security, and Breach Notification Rules. Individuals and businesses in the healthcare sector must always abide by these laws. HIPAA is managed by the Office for Civil Rights (OCR) of the Department of Health and Human Services (HHS).
Knowing what “covered entities” under HIPAA is also important. These include hospitals, insurance companies, clinic clearing houses, cash-only vendors who don’t work with insurance companies, healthcare technology businesses, healthcare recruitment service providers, etc. They also affect companies that offer services to healthcare professionals who might interact with PHI.
How Much Do HIPAA Violations Cost?
There are two types of penalties under HIPAA—Civil and Criminal.
- Civil HIPAA Violations
Civil sanctions are handed down if those who violate the law do so without malice. In other words, they were either careless or oblivious to the consequences of their conduct. The following are the penalties in such a situation:
- If the offender were unaware that they were breaking HIPAA laws, they would be penalized a minimum of $100 for each infraction;
- A minimum fine of $1,000 is imposed if the offender did not act with purposeful negligence and had reasons for their behavior;
- If the offender remedied the problem after engaging in intentional negligence, they will still be subject to a minimum fine of $10,000, and,
- A minimum fine of $50,000 is imposed for each infraction if the offender acted with intentional disregard and did not remedy the situation.
- Criminal HIPAA Violations
Criminal penalties (much more severe) may be imposed if the violators had malicious intent when they committed the offense. Penalties in these situations include:
- A person who knowingly acquires and discloses PHI may be subject to a fine of up to $50,000 and a prison sentence of up to one year;
- A person who violates the HIPAA laws while acting under pretenses faces a fine of up to $100,000 and a maximum 5-year sentence in prison; and,
- If someone violates the law for their benefit (by selling PHI or using it to hurt a patient), they might be fined up to $250,000 and imprisoned for up to 10 years.
In the following section, we will highlight the nine most common HIPAA violations that you must be aware of.
9 Most Common Examples of HIPAA Violations
HIPAA violations can occur accidentally or be carried out by malicious entities with bad intentions. Here are nine examples of HIPAA violations that you should know about if you handle sensitive patient information regularly or are somehow related to the healthcare sector in any way:
- Unencrypted Data
It is easy to understand the risks of not encrypting PHI data. If a device containing PHI is lost or stolen, encrypting the data is an additional security measure. If a password-protected device is accessed in any other way (such as by hacking), it provides an extra layer of security. It is strongly advised, even though it is not a strict HIPAA requirement. The HIPAA requirements in your State should also be familiar to you, as many States have legislation requiring the encryption of ePHI and PII. You must ensure the data is secured so your PHI can get into the right hands.
- No Safeguards Against Getting Hacked or Phished
You might never expect it to happen to you; however, medical ePHI is at increased risk from hacking. Medical practices should take all reasonable precautions to protect themselves from hacking because some people want to utilize this information for illicit purposes.
There are two types of potential ePHI hacks—the hackers are trying to sell the information to a third-party business that stands to gain anything from it, or they want money from you and use ransomware to seize control of the data and threaten to erase it all if they are not paid.
The best place to start is by ensuring that any devices containing ePHI have antivirus software installed and running. In addition to this, you should use firewalls for increased security. Last, you should create distinct and challenging passwords to remember and change frequently.
- Medical Record Mishandling
Stepping away from open computer screens or leaving paper documents on your desk increases the chance that unauthorized third parties will view PHI. Physical charts are frequently left in hospital rooms after a patient has transferred. By mandating closed screens and utilizing digital records, you can improve security. Organizations should also try to create a way to hide patient records from the public.
- Device Theft
Cybercrimes like medical fraud or identity theft typically exploit sensitive information on lost or stolen equipment from healthcare organizations. Mobile devices, computers, and USBs are the most often stolen items. Device theft frequently occurs due to lax institutional device rules and inadequate physical security. Medical professionals frequently take their work equipment home with them and leave it unattended in parked automobiles, hotel rooms, or other public places, which leads to device theft. The fact that most stolen gadgets were not encrypted only worsens the situation.
Healthcare facilities need to establish rules about the following to prevent equipment theft:
- educating staff about appropriate device handling and storage;
- physical device security (sign-out procedures and physical security;
- encrypting your device in the event of theft; and,
- Program for tracking devices and reporting a stolen device.
- No Proper Authorization to Share ePHI
PHI primarily consists of sensitive information which should only be accessible to those who need to know. Sharing and discussing cases with co-workers could seem harmless, but it could lead to data leaks or legal action. The use of social engineering is among the most popular hacking techniques. In other words, the hackers attempt to deceive the appropriate personnel into disclosing information rather than outright hacking into computers. This information may be used to access computer systems or to obtain PHI. You must ensure that all crucial information is provided exclusively to authorized employees and behind closed doors to prevent this from happening. Even inadvertently disclosing patient data to family members may violate HIPAA.
- Lack of Employee Training
Every HIPAA-covered business entity is expected to give their employees HIPAA-certified training.
To demonstrate proper training, all relevant employees (including business associates, nurses, office administrators, receptionists, hospital volunteers, interns, and doctors) who handle significant PHI must receive a HIPAA certification. Under HIPAA regulations, basic cybersecurity training is insufficient since the Privacy and Security Rules have unique requirements that may be different from those of other businesses or industries.
You can use the following opportunities for training and education:
- during the procedures for onboarding new employees;
- when job duties and roles shift yearly;
- when fresh HIPAA security upgrades are published; and,
- Hospital security procedures have changed drastically.
- Improper Disposal of Old PHI Records
The correct disposal of PHI documents is one of the most crucial policies to enforce while educating your team about HIPAA rules. For example, every piece of PHI-containing data, including social security numbers, details of medical procedures, diagnoses, etc., should be shredded, burned, or completely erased from hard drives. Staff employees should also be aware of this. It could fall into the wrong hands and constitute a major HIPAA violation if any of this information is left sitting about in a trash can, computer’s recent files folder, etc. You can stop this from happening with the right employee training and enforcement by a compliance officer or other personnel. HIPAA requires all hospitals and clinics to follow the correct processes for getting rid of physical and digital medical data. It is vital to put detailed rules in place for handling expired PHI data, as well as teaching staff members the best ways to get rid of old PHI records and other medical information.
- Accessing PHI from an Unsecured Location
Many clinicians, especially doctors and nurses, work after hours and access PHI on their computers. While it might appear innocent initially, this can have terrible repercussions. There are numerous potential pitfalls with this, such as —
- The clinician accidentally lets a family member see a confidential patient document that is open on their computer or,
- Malware is unintentionally downloaded into the computer by a family member, and the PHI data is then discovered and stolen by hackers.
That is just the beginning; there are many more ways for hackers to gain access to the computer if they are especially targeting the hospital. The recommended practice is to have a dedicated laptop for anything involving patient information and access it to avoid this. All electronic devices should be turned off and password-protected when not in use.
- Failure to Enter Into a HIPAA-Compliant Business Associate Agreement (BAA) with Third-Party Contractors
In their daily operations, almost all healthcare organizations collaborate with other firms, many of which are frequently given access to PHI. Any organization that handles PHI is required to adhere to HIPAA regulations. Thus, before granting access to PHI to third-party contractors who conduct business with healthcare providers, a business associate agreement (BAA) needs to be signed.
A BAA is necessary since most third parties don’t normally handle sensitive patient data as their primary duty. Many vendors and providers may not be HIPAA-compliant because following its particular data security measures isn’t mandated in their specific business. However, they must adhere to HIPAA after they sign a business agreement with the healthcare organization.
Potential incidents that mandate HIPAA compliance may include, for example:
- handling of medical contracts without authorization by regional or off-site departments;
- the likelihood of other suppliers or businesses acquiring, disposing of, or merging with the third-party business; and,
- rapid onboarding of outside business partners to satisfy the urgent needs of the healthcare provider.
Organizations should designate a dedicated person to manage all third-party contracts to prevent HIPAA non-compliance and guarantee the entire BAA process is thorough and HIPAA-compliant. Organizations that fail to enter a BAA frequently do so because of inadequate oversight or because the institutions are ignorant of the HIPAA laws and regulations.
Some additional examples of HIPAA violations include impermissible PHI disclosure and employee misconduct, denying patient access to health records, social sharing of sensitive patient information, reporting breaches past the 60-day deadline, and more.
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