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Consequences for HIPAA Violations

A recent HHS Office for Civil Rights email blast outlined a story that many of us have heard before, another business closed with significant monies paid out in fines. Filefax, Inc. has agreed to pay $100,000 in order to settle potential violations of the HIPAA Privacy Rule. Once a medical records storage company for covered entities, Filefax shut their doors during the OCR investigation yet could not escape additional fines and penalties that followed after their doors were closed. The bottom line, HIPAA violations do not stop just because a business closes.

The consequences of HIPAA violations are significant and far reaching. Beyond the financial ramifications, organizations stand to lose their good standing reputation, client/patient trust and their ability to operate a business. It can take organizations months, even years to recover from penalties if they ever do, so why have so many of us read the headlines but not heeded the warnings?

What Qualifies as a HIPAA Violation?

A HIPAA violation occurs when either a covered entity (CE) or business associate (BA) fails to comply with one of more provisions of the HIPAA Security, Privacy or Breach Notification Rules. Violations may result for a number of reasons and may be deliberate or unintentional.

  • Example of a Deliberate Violation – Inadequate Privacy training for clinical staff which results in a patient complaint regarding disclosing their full identity through a verbal announcement in a waiting area or hospital emergency room.
  • Example of a Unintentional Violation – Commonly this is a symptom of negligence such as: failure to complete a Security Risk Analysis, failure to employ encryption for laptops/electronic media resulting in loss/theft or failure to maintain policies and procedures instructing staff members on how to appropriately handle protected health information (PHI.)
Penalties and Fines

The penalties and/or fines administered by OCR are based on the severity of each HIPAA violation. Some HIPAA violations can be expensive and vary greatly in cost based on the level of negligence displayed. Contrary to what the headlines may lead you to believe, OCR will first strive to resolve violations using non-punitive measures such as issuing guidance to help the provider fix the areas without issuing a fine however that is not always possible.

If a penalty is issued, it can range in cost from $100 to $50,000 per violation (or record) with a maximum penalty of $1.5 million per year of violations of an identical provision. OCR takes many different factors into account when determining what is the appropriate financial penalty and uses a four tiered approach as shown in the image below. A few of these factors include: number of patients affected, what specific data was exposed and for how long, etc. Along with the financial ramifications, HIPAA violations can also carry criminal charges that may result in jail time if warranted.

Avoidance is Key

Being that the stakes are high and much is on the line, how does a practice or organization protect themselves against HIPAA violations? Show due-diligence.  The best task to start with is complete a comprehensive, organization wide HIPAA risk analysis to determine any gaps in compliance. Without a baseline knowledge about their security, privacy and breach-notification posture, both CE’s and BA’s operate day to day unaware of their security vulnerabilities which can directly lead to HIPAA violations and data breaches.

Unsure where your organization stands? Take our short 5-minute HIPAA compliance quiz designed to quickly outline your organization’s basic level of compliance.

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