Healthcare Data Privacy

December 2018 Healthcare Data Breach Report

Posted by HIPAA Journal

November was a particularly bad month for healthcare data breaches, so it is no surprise that there was an improvement in December. November was the worst month of the year in terms of the number of healthcare records exposed (3,230,063) and the second worst for breaches (34). December was the second-best month for healthcare data breaches with 23 incidents reported, only one more than January.

2018 Healthcare Data Breaches

In total, 516,370 records were exposed, impermissibly disclosed, or stolen in breaches reported in December: A considerable improvement on November. Were it not for the late reporting of the Adams County breach, December would have been the best month of the year to date in terms of the records exposed. The Adams County breach was experienced in March 2018, confirmed on June 29, yet reporting to OCR was delayed until December 11.

2018 Healthcare Data Breaches - Records Exposed

Largest Healthcare Data Breaches in December 2018

Rank Name of Covered Entity Covered Entity Type Individuals Affected Type of Breach
1 Adams County Healthcare Provider 258,120 Unauthorized Access/Disclosure
2 JAND Inc. d/b/a Warby Parker Healthcare Provider 177,890 Hacking/IT Incident
3 University of Vermont Health Network – Elizabethtown Community Hospital Healthcare Provider 32,470 Hacking/IT Incident
4 The Podiatric Offices of Bobby Yee Healthcare Provider 24,000 Hacking/IT Incident
5 Choice Rehabilitation Business Associate 4,309 Hacking/IT Incident
6 Virtual Radiologic Professionals, LLC Healthcare Provider 2,568 Hacking/IT Incident
7 Kent County Community Mental Health Authority Healthcare Provider 2,284 Hacking/IT Incident
8 Butler County Board of County Commissioners Health Plan 1,912 Unauthorized Access/Disclosure
9 Barnes-Jewish Hospital Healthcare Provider 1,643 Hacking/IT Incident
10 Tift Regional Medical Center Healthcare Provider 1,045 Hacking/IT Incident

Causes of December 2018 Healthcare Data Breaches

The healthcare industry experiences more insider breaches than other industry sectors, although in December, hacking/IT Incidents outnumbered unauthorized/access disclosure incidents by almost two to one. Eight of the top ten data breaches for the month were hacks, ransomware attacks, and other IT incidents.

While unauthorized access/disclosure incidents usually impact fewer individuals that hacking breaches, that was not the case in December. The largest breach of the month was the unauthorized accessing of a network server by a former employee of Adams County, WI.

In total, 264,049 healthcare records were exposed in the 7 unauthorized access/disclosure incidents reported in December. The mean breach size was 37,721 records and the median breach size was 911 records.

250,404 healthcare records were exposed in the 13 hacking/IT incidents. The mean breach size was 19,261 records and the median breach size was 1,643 records.

There were two theft incidents reported in December and one case of improper disposal of paper records. No lost devices were reported.

Causes of December 2018 Healthcare Data Breaches

Location of Breached Protected Health Information

Phishing attacks continue to plague healthcare organizations and December was no exception. The largest phishing incident reported in December affected 32,470 patients of Elizabethtown Community Hospital. The PHI was contained in a single email account.

Three email accounts were compromised at Kent County Community Mental Health Authority, although they only contained the PHI of 2,200 individuals.

The most common location of breached PHI in December was email, although network server breaches were more severe. The two largest December 2018 healthcare data breaches were network server incidents which impacted 436,010 individuals – 84.43% of the total number of breached records in December.

Location of Breached Protected Health Information

Data Breaches by Covered-Entity Type

Health plans made it through November without reporting any data breaches, although they didn’t fare so well in December. 6 health plan data breaches were announced in December; however, all were relatively small, with only the breach at Butler County Board of County Commissioners impacting more than 1,000 plan members (1,912).

One data breach was reported by a business associate of a HIPAA-covered entity, although a further three breaches had some business associate involvement. The remaining 16 breaches were reported by healthcare providers.

Data Breaches by Covered-Entity Type

Healthcare Data Breaches by State

In December 2018, healthcare organizations in 13 states reported PHI breaches. Minnesota was the worst affected state with a total of four breaches followed by Arizona with three. There were two breaches reported by healthcare organizations based in each of California, Missouri, New York, Ohio, and Wisconsin, and a single breach was experienced in each of Georgia, Illinois, Kentucky, Massachusetts, Michigan, and Pennsylvania.

HIPAA Fines and Settlements in December 2018

The Department of Health and Human Services’ Office for Civil Rights (OCR) agreed two settlements with HIPAA-covered entities in December to resolve violations of HIPAA Rules. OCR finished the year on ten fines and settlements, the same number as 2017. (You can view all 2018 HIPAA fines and settlements here).

Advanced Care Hospitalists, a Florida Contractor Physicians’ Group, was investigated by OCR following the submission of a breach report in April 2014. The report stated the PHI of 400 patients had been subject to unauthorized access, although the number of individuals affected was subsequently increased to 8,855 patients.

OCR confirmed there had been a preventable impermissible disclosure of PHI, and found that a business associate had been engaged without first entering into a business associate agreement. Additionally, insufficient security measures had been implemented and there had been no effort to comply with HIPAA Rules prior to April 1, 2014. Advanced Care Hospitalists and OCR settled the HIPAA violation case for $500,000.

On June 7, 2013, OCR received a complaint about Pagosa Springs Medical Center, a critical access hospital in Colorado, which had failed to terminate access to a web-based scheduling calendar after an employee’s contract had been terminated. The OCR investigation confirmed the former employee accessed the calendar on two occasions after leaving employment.

For the failure to terminate employee access and the lack of a business associate agreement with Google covering Google Calendar resulted in a financial penalty of $111,400 for Pagosa Springs Medical Center.

There were two financial penalties issued by state Attorneys General in December to resolve violations of HIPAA Rules.

The Massachusetts Attorney General fined McLean Hospital $75,000 over a breach of 1,500 patients PHI. The information was stored on backup tapes that had been taken offsite by an employee. When the employee was terminated, McLean Hospital was unable to recover two of the backup tapes.

The New Jersey Attorney General issued a financial penalty of $100,000 to EmblemHealth over an impermissible disclosure of PHI. In 2016, an EmblemHealth mailing had Social Security numbers printed on the outside of envelopes. This was the second fine for EmblemHealth in relation to the breach. The New York Attorney General had previously settled its case with EmblemHealth for $575,000 earlier in the year.

 

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Revised Common Rule Now Effective

Posted by HIPAA Journal

The updated Federal Policy for the Protection of Human Subjects (45 CFR part 46), otherwise known as the Common Rule, is now in effect. The compliance date of the revised Common Rule was January 21, 2019.

The Common Rule governs federally funded research on human subjects and was introduced in 1991. The Common Rule was amended in 2015 and underwent a major revision in 2017 to improve protections for research subjects while easing the administrative burden on researchers, especially for low-risk research.

The compliance date of the revised Common Rule was initially January 19, 2018; however, two days before the compliance date, an interim final rule was published which delayed the compliance date initially for six months, and subsequently for another six months.

Regulated entities were required to comply with the pre-2018 version of the Common Rule until January 20, 2019, with the exception of three provisions of the revised Common Rule which aimed to reduce the administrative burden on researchers.

Those three provisions, which could be adopted between July 2019 and January 20, 2019, were:

  • A change to the definition of research, which exempted certain research activities such as public surveillance activities to monitor the spread of disease, journalistic activities, and criminal investigations.
  • Eliminating the requirement for continuing reviews of certain categories of research that are considered low-risk
  • Eliminating the requirement that institutional review boards (IRB) review grant applications or other funding proposals related to the research

Now that the compliance date has arrived, regulated entities that receive federal funding for research now need to work quickly to implement all of the changes to the Common Rule, including the above three principles if they have not already been adopted.

Notable changes in the revised Common Rule are detailed below:

Consent Forms

Consent forms can be long and complex, but the changes to the Common Rule will make it easier for voluntary research subjects to find the information they need.

Consent forms need to include a concise explanation at the start of the document in which all of the key information about the study is clearly explained, including the purpose of the study, the risks and benefits, and appropriate alternative treatments that may be beneficial to the research subject.

Future uses of research data must also be specified and a statement must also be included on the consent form which explains if and when the results of the study will be made available to the research subject.

A statement will need to be included, if applicable, explaining that biospecimens may be used for commercial profit and whether the research subject will receive a share of that profit.

IRBs do not need to obtain informed consent in cases of obtaining information or biospecimens for screening, recruiting, or determining eligibility of prospective subjects, under certain circumstances.

Consent forms for clinical trials that are conducted by or supported by a Federal department or agency require an approved consent form which must be posted online or made available on a federal website that serves as a depository for consent forms.

Broad Consent

The final rule allows for the optional use of broad consent for the storage and secondary use of identifiable private information and biospecimens in lieu of obtaining study-specific informed consent.

Study Reviews by Single IRB

One notable change for federally funded studies that require IRB approval is the requirement to have a single IRB oversee research studies that are conducted at multiple sites. Compliance with this aspect of the revised Common Rule is not mandatory until January 21, 2020.

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State AG Proposes Tougher Data Breach Notification Laws in North Carolina

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Following an increase in data breaches affecting North Carolina residents in 2017, state Attorney General Josh Stein and state representative Jason Saine introduced a bill to update data breach notification laws in North Carolina and increase protections for state residents

The bill, Act to Strengthen Identity Theft Protections, was introduced in January 2018 and proposed changes to state laws that would have made North Carolina breach notification laws some of the toughest in the country. The January 2018 version of the bill proposed an expansion of the definition of a breach, changes to the definition of personal information, and a maximum of 15 days from the discovery of a breach to issue notifications to breach victims.

Attorney General Stein and Rep. Saine unveiled a revised version of the bill on January 17, 2019. While some of the proposed updates have been scaled back, new requirements have also been introduced to increase protections for state residents.

The updated bill coincides with the release of the state’s annual security breach report for 2018. The report shows there were 1,057 data breaches affecting state residents in 2018. Those breaches impacted 1.9 million state residents. While there was a 63% decrease in individuals affected by data breaches from 2017, the number of breaches increased 3.4% year over year.

The proposed update to the definition of a data breach remains unchanged from the 2018 version of the bill and defines a breach as “Any incident of unauthorized access to or acquisition of someone’s personal information that may harm the person.” As such, the new definition broadens the definition to include ransomware attacks.

Ransomware is typically used only to extort money from victims. However, in recent months there has been a growing trend of combining ransomware with other malware variants such as information stealers, making data theft more likely. Regardless of the nature of the ransomware attack, the bill requires notifications to be issued to allow state residents to make an informed decision about the actions that need to be taken to reduce the risk of harm.

The bill also requires businesses that own or license personal information to implement and maintain reasonable security procedures and practices, which must be appropriate to the nature of information collected and maintained. Of note to HIPAA-covered entities, the definition of personal information has been expanded to include medical information, genetic information, and insurance account numbers.

The 2018 version of the bill called for breach notifications to be issued within 15 days of the discovery of a breach. The latest incarnation has seen the timescale for issuing notifications changed to within 30 days of discovery of a breach.

Any business that experiences a data breach that is found to have failed to implement appropriate security measures or fails to issue notifications within the 30-day deadline will be in violation of the Unfair and Deceptive Trade Practices Act, and could be issued with a civil monetary penalty.

If the legislation is passed, state residents will be allowed to place a credit freeze on their credit reports free of charge. Credit agencies will be required to put in place “A simple, one-stop shop for freezing and unfreezing credit reports across all major consumer reporting agencies, without the person having to take any additional action.”

Companies doing business in the state of North Carolina will be required to provide breach victims with 2 years of free credit monitoring services in the event of a breach of Social Security numbers, and four years of free credit monitoring services for breaches at credit agencies.

Any business that wants to access or use a person’s credit report or credit score will be required to obtain consent from the person in advance and must explain why access to the information is required. State residents will also be given the right to submit a request to a consumer reporting agency for a list of all information the agency maintains, including credit and non-credit related information, and a list of all entities to which that information has been disclosed.

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Physician Receives Probation for Criminal HIPAA Violation

Posted by HIPAA Journal

A physician who pleaded guilty to a criminal violation of HIPAA Rules has received 6 months’ probation rather than a jail term and fine for the wrongful disclosure of patients’ PHI to a pharmaceutical firm.

The case was prosecuted by the Department of Justice in Massachusetts in conjunction with a case against Massachusetts-based pharma firm Aegerion.

In September 2017, the Novelion Therapeutics subsidiary Aegerion agreed to plead guilty to mis-branding the prescription drug Juxtapid. The case also included deferred prosecution related to criminal liability under HIPAA for causing false claims to be submitted to federal healthcare programs for the drug.

Aegerion admitted to conspiring to obtain the individually identifiable health information of patients without authorization for financial gain, in violation of 42 U.S.C. §§ 1320d-6(a) and 1320-6(b)(3) and HIPAA Rules. Aegerion agreed to pay more than $35 million in fines to resolve criminal and civil liability.

The DOJ also charged a Georgia-based pediatric cardiologist with criminal violations of HIPAA Rules for allowing a sales representative of Aegerion to access the confidential health information of patients without first obtaining patient consent. The sales rep was allowed to view the information of patients who had not been diagnosed with a medical condition that could be treated with Juxtapid (lomitapide) in order to identify new potential candidates for the drug.

This is the second such criminal HIPAA violation case in Massachusetts in the past four months to result in probation rather than a jail term or fine. In September, Massachusetts gynecologist Rita Luthra was given 1 year of probation over payments received by a pharmaceutical firm (Warner Chilcott) for providing sales reps with access to the individually identifiable health information of patients for financial gain. While prosecutors were pushing for a fine and a jail term to act as a deterrent, Judge Mastroianni explained in his ruling, “Her loss of license and ability to practice is a substantial deterrent.”

While probation was received in both of these cases, a substantial fine, jail term, and loss of license are real possibilities for physicians found to have criminally violated HIPAA Rules. Both physicians could have received a fine of up to $50,000 for the violations and up to one year in jail.

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CMS Completes Rollout of New Medicare Cards 3 Months Ahead of Schedule

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Individuals with Medicare have been provided with new Medicare cards without Social Security numbers as part of the Centers for Medicare & Medicaid Services (CMS) efforts to combat fraud and abuse and protect against identity theft.

Instead of Social Security numbers, the new Medicare cards use unique, randomly generated Medicare Beneficiary Identifiers that include a combination of numbers and letters. CMS has issued more than 61 million new cards over the course of the past 9 months and has now completed the rollout three months ahead of the April 2019 deadline set by Congress in the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015.

“Safeguarding our beneficiaries’ personal information continues to be one of our top priorities,” explained CMS Administrator Seema Verma in a January 16 press release. “The Trump Administration is committed to modernizing Medicare and has expedited this process to ensure the protection of Medicare beneficiaries and taxpayer dollars from the potential for fraud and abuse due to personal information that existed on the old cards.”

More than half of all healthcare claims processed by the CMS now use the new Medicare Beneficiary Identifiers. As of January 11, 2019, 58% of all Medicare fee-for-service claims submitted by healthcare providers have used the new identifiers.

People with Medicare should destroy their old cards when they receive their new card, although other plan cards such as Medicare Advantage Plan and Medicare Drug Plan cards should be retained.

While the new Medicare cards provide protection against identity theft, people with Medicare have been advised to still be vigilant for scams. The CMS suggests treating the new Medicare cards just like credit cards, and to only give cards/identifiers to trusted entities such as pharmacies, healthcare providers, and insurers.

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New Massachusetts Data Breach Notification Law Enacted

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A new Massachusetts data breach notification law has been enacted. The new legislation was signed into law by Massachusetts governor Charlie Baker on January 10, 2019 and will come into effect on April 11, 2019.

The new legislation updates existing Massachusetts data breach notification law and introduces new requirements for notifications.

Under Massachusetts law, a breach is defined as the unauthorized acquisition or use of sensitive personal information that carries a substantial risk of identity theft or fraud. Notifications must be issued if one or more of the following data elements are obtained by an unauthorized individual along with an individual’s first name and last name or first initial and last name.

  • Social Security number
  • Driver’s license number
  • State issued ID card number
  • Financial account number, or credit/ debit card number, with or without any required security code, access code, personal identification number or password, that would permit access to a resident’s financial account.

As with the previous law, there is no set timescale for issuing breach notifications. They must be issued “as soon as is practicable and without unreasonable delay,” after it has been established that a breach of personal information has occurred.

That said, one change to the timescale for issuing breach notifications is individuals and companies that have experienced a data breach can no longer wait until the total number of individuals impacted by the breach has been determined. The legislation states “In such case, and where otherwise necessary to update or correct the information required, a person or agency shall provide additional notice as soon as practicable and without unreasonable delay upon learning such additional information.”

One notable update to Massachusetts data breach notification law is the requirement to offer breach victims complimentary credit monitoring services, as is the case in Connecticut and Delaware. The minimum term for complimentary credit monitoring services is 18 months or, in the case of a consumer reporting agency, a minimum of 42 months.

Notifications are required to be issued to all individuals impacted by the breach, the Office of Consumer Affairs and Business Regulation, and the Massachusetts Attorney General’s Office.

The Office of Consumer Affairs and Business Regulation and the Attorney General’s Office must be provided with a detailed description of the nature and circumstances of the breach, the number of Massachusetts residents affected, the steps that have been taken relative to the security breach, steps that will be taken in the future in response to the breach, and whether law enforcement is investigating the breach. If the breach has been experienced by a parent company or affiliated organization, the name of that company must be detailed in the notification.

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OCR Seeks Permanent Deputy Director for Health Information Privacy

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The U.S. Department of Health and Human Services’ Office for Civil Rights has advertised for a permanent Deputy Director for Health Information Privacy. The position was posted on USAJOBS on January 14, 2019.

The last permanent Deputy Director was Deven McGraw, who left OCR in October 2017 for the private sector. Iliana Peters, OCR’s Senior Advisor for Compliance and Enforcement, took on the role of acting Deputy Director for Health Information Privacy but also left the post for the private sector in February 2018. Timothy Noonan, the former regional manager for the HHS Office for Civil Rights in Atlanta, replaced Peters in February 2018.

The role involves leading OCR’s day-to-day HIPAA privacy and security program operations, development of privacy and security policies, administrative rulemaking, interpretation of current regulations, providing technical assistance to the department’s regional offices, and coordinating HIPAA Privacy and Security Rule compliance activities to ensure consistent application of policies across all regional offices.

The Deputy Director for Health Information Privacy is a key player in the development of departmental policies, legislative, and regulatory proposals, and special OCR initiatives to ensure health information is protected and remains private.

The role involves advising OCR Director Roger Severino and senior OCR officials on HIPAA policies and application of those policies. The successful applicant will be required to work closely with the OCR Director and assist with the planning, organization, and formulation of policies and procedures for OCR and health privacy and security policies across the HHS.

According to the posting, the Deputy Director represents the Director and OCR on health information privacy and security matters and coordinates work where problems and issues involve more than one component of the HHS. The Deputy Director is also required to maintain relationships concerning health information privacy and security issues at a number of senior management levels.

Applications are being accepted until February 5, 2019.

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Advertising Expenditures Increase 64% Following a Healthcare Data Breach

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A recent study has explored the relationship between advertising expenditures and healthcare data breaches. The study shows hospitals significantly increase advertising spending following a data breach.

Healthcare Data Breaches Are the Costliest to Mitigate

Healthcare data breaches are the most expensive to mitigate, far higher than breaches in other industry sectors. According to the Ponemon Institute/IBM Security’s 2018 cost of a data breach study, healthcare data breaches cost, on average, $408 per lost or stolen record. The costs are double, or in some cases almost triple, those in other industry sectors.

In addition to the high costs of mitigating the breaches, the same study confirmed that loss of patients to competitors is a very real threat. Data breaches cause damage to a brand and trust in an organization can be easily lost when confidential personal information is exposed or stolen.

The Ponemon Institute study revealed healthcare organizations have a high churn rate after a breach. At 6.7%, it is higher than the financial sector (6.1%), services (5.2%), energy (3.0%) and education (2.7%).

Hospitals’ Advertising Expenditure Increases 64% Following a Data Breach

In a recent study, Sung J. Choi, PhD and M. Eric Johnson, PhD., investigated how advertising expenditures at hospitals changed following a data breach.

The study, which was recently published in the American Journal of Managed Care, revealed hospitals increase advertising spending by an average of 64% in the year following a data breach. Advertising expenditures were found to be 79% higher over the two-year period following a data breach.

The researchers note that breached hospitals were most likely to be large or teaching hospitals located in urban settings. Hospitals that experienced data breaches had an average of 566 beds and were typically located in areas where there were other hospitals and, consequently, high competition for patients.

Hospitals in the control group that had not experienced a data breach spent an average of £238,000 on advertising each year, whereas hospitals that experienced data breaches spent an average of $817,205 on advertising in the year following a breach – Almost three times as much as the control group. An average of $1.75 million was spend on advertising in the two years following a breach.

The researchers suggest that the increase in spending is an attempt to minimize patient loss to competitors and to help repair hospitals’ reputations.

The researchers note that the data from the study came from 2011-2014 before ransomware attacks on hospitals became common. Given how much more these types of data breaches disrupt medical services provided by hospitals, advertising spending may be even higher following these types of breaches.

“Advertising and the efforts to fix the damages from a data breach increase healthcare costs and may divert resources and attention away from initiatives to improve care quality,” wrote the researchers. “Advertising costs subsequent to a breach are another cost to the healthcare system that could be avoided with better data security.”

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Summary of 2018 HIPAA Fines and Settlements

Posted by HIPAA Journal

This post summarizes the 2018 HIPAA fines and settlements that have resulted from the enforcement activities of the Department of Health and Human Services’ Office for Civil Rights (OCR) and state attorneys general.

Another Year of Heavy OCR HIPAA Enforcement

In 2016, there was a significant increase in HIPAA files and settlements compared to the previous year. In 2016, one civil monetary penalty was issued by OCR and 12 settlements were agreed with HIPAA covered entities and their business associates. In 2015, OCR only issued 6 financial penalties.

The high level of HIPAA enforcement continued in 2017 with 9 settlements agreed and one civil monetary penalty issued.

While there were two settlements agreed in February 2018 to resolve HIPAA violations, there were no further settlements or penalties until June. By the end of the summer it was looking like OCR had eased up on healthcare organizations that failed to comply with HIPAA Rules.

However, in September, a trio of settlements were agreed with hospitals that had allowed a film crew to record footage of patients without first gaining consent. Further settlements were agreed in October, November, and December and OCR finished the year on one civil monetary penalty and 9 settlements to resolve HIPAA violations.

Summary of 2018 HIPAA Fines and Settlements

While 2018 was not a record-breaking year in terms of the number of financial penalties for HIPAA violations, it was a record-breaker in terms of the total penalty amounts paid. OCR received $25,683,400 in financial penalties in 2018. The mean financial penalty was $2,568,340.

2018 HIPAA fines and penalties total

The median HIPAA fine in 2018 was $442,000: Much lower than 2017 median of $2,250,000. It was also the lowest median fine amount of the last 5 years, although 2018 did see the largest ever HIPAA violation penalty.

In October 2018, Anthem Inc., settled its HIPAA violation case with OCR for $16,000,000. The massive fine was due to the extent of the HIPAA violations discovered by OCR and the scale of its 2015 data breach, which saw the protected health information of around 78,800,000 plan members stolen by hackers.

2018 HIPAA Fines and Settlements

Year Covered Entity Amount Settlement/CMP Reason
February 2018 Fresenius Medical Care North America $3,500,000 Settlement Risk analysis failures, impermissible disclosure of ePHI; Lack of policies covering electronic devices; Lack of encryption; Insufficient security policies; Insufficient physical safeguards
February 2018 Filefax, Inc. $100,000 Settlement Impermissible disclosure of PHI
June 2018 University of Texas MD Anderson Cancer Center $4,348,000 Civil Monetary Penalty Impermissible disclosure of ePHI; No Encryption
September 18 Massachusetts General Hospital $515,000 Settlement Filming patients without consent
September 18 Brigham and Women’s Hospital $384,000 Settlement Filming patients without consent
September 18 Boston Medical Center $100,000 Settlement Filming patients without consent
October 2018 Anthem Inc $16,000,000 Settlement Risk Analysis failures; Insufficient reviews of system activity; Failure related to response to a detected breach; Insufficient technical controls to prevent unauthorized ePHI access
November 2018 Allergy Associates of Hartford $125,000 Settlement PHI disclosure to reporter; No sanctions against employee
December 2018 Advanced Care Hospitalists $500,000 Settlement Impermissible PHI Disclosure; No BAA; Insufficient security measures; No HIPAA compliance efforts prior to April 1, 2014
December 2018 Pagosa Springs Medical Center $111,400 Settlement Failure to terminate employee access; No BAA

State Attorneys General HIPAA Enforcement Activities

It is difficult to obtain meaningful statistics on HIPAA fines and settlements by state attorneys general. While state attorneys general can issue fines for violations of HIPAA Rules, in many cases, financial penalties instead issued for violations of state laws. That said, 2018 did see a major increase in HIPAA enforcement activity by state attorneys general.

There were 12 HIPAA-related financial penalties issued in 2018 by state attorneys general. The New Jersey attorney general was the most active HIPAA enforcer behind OCR with 4 HIPAA fines, followed by New York with 3, Massachusetts with 2, and 1 financial penalty issued by each of Connecticut, District of Columbia, and Washington.

The largest attorney general HIPAA fine of 2018 – Aetna’s $1,150,000 penalty – was issued by New York. Aetna was also fined a total of $640,171 in a multi-state action by Connecticut, New Jersey, Washington, and the District of Columbia. Washington has yet to agree to a settlement amount with Aetna.

EmblemHealth was fined a total of $675,000 for a 2016 data breach: $575,000 by New York and $100,000 by New Jersey.

State Covered Entity Amount State Residents Affected
Massachusetts McLean Hospital $75,000 1,500
New Jersey EmblemHealth $100,000 6,443
New Jersey Best Transcription Medical $200,000 1,650
Washington Aetna TBA* 13,160 (multi-state total)
Connecticut Aetna $99,959 13,160 (multi-state total)
New Jersey Aetna $365,211.59 13,160 (multi-state total)
District of Columbia Aetna $175,000 13,160 (multi-state total)
Massachusetts UMass Memorial Medical Group / UMass Memorial Medical Center $230,000 15,000
New York Arc of Erie County $200,000 3,751
New Jersey Virtua Medical Group $417,816 1,654
New York EmblemHealth $575,000 81,122
New York Aetna $1,150,000 13,160 (multi-state total)

*Washington yet to determine settlement amount

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