The penalties for HIPAA violations include civil monetary penalties ranging from $137 to $68,928 per violation, depending on the level of culpability. Criminal penalties can also be imposed for intentional violations, leading to fines and potential imprisonment.

In addition to financial penalties, corrective action plans may be required to address compliance deficiencies. State attorneys general can also bring civil actions, resulting in monetary damages.  Plus, covered entities may be required to adopt a corrective action plan to bring policies and procedures up to the standards demanded by HIPAA.

In this article, we provide a detailed explanation of penalties for HIPAA violations.

You can also use the article in conjunction with our free HIPAA Violations Checklist to understand what is required to ensure full compliance. Please use the form on this page to arrange for your copy.

HIPAA, PHI & HITECH

The Health Insurance Portability and Accountability Act of 1996 placed a number of requirements on HIPAA-covered entities to safeguard the Protected Health Information (PHI) of patients, and to strictly control when PHI can be divulged, and to whom.

Since the Enforcement Final Rule of 2006, OCR has had the power to issue financial penalties (and/or corrective action plans) to HIPAA-covered entities that fail to comply with HIPAA Rules.

Financial penalties for HIPAA violations were updated by the HIPAA Omnibus Rule, which introduced charges in line with the Health Information Technology for Economic and Clinical Health Act (HITECH). The Omnibus Rule took effect on March 26, 2013.

Since the introduction of the Omnibus Rule, the new penalties for HIPAA violations apply to healthcare providers, health plans, healthcare clearinghouses, and all other covered entities, as well as to business associates (BAs) of covered entities that are found to have violated HIPAA Rules.

Financial penalties are intended to act as a deterrent to prevent the violation of HIPAA laws, while also ensuring covered entities are held accountable for their actions – or lack of them – when it comes to protecting the privacy of patients and the confidentiality of health data and providing patients with access to their health records on request.

The penalty structure for a violation of HIPAA laws is tiered, based on the knowledge a covered entity had of the violation. The OCR sets the penalty based on a number of “general factors” and the seriousness of the HIPAA violation.

Ignorance of HIPAA Rules is no excuse for failing to comply with HIPAA Rules. It is the responsibility of each covered entity to ensure that HIPAA Rules are understood and followed. In cases when a covered entity is discovered to committed a willful violation of HIPAA laws, the maximum fines may apply.

What Constitutes a HIPAA Violation?

There is much talk of HIPAA violations in the media, but what constitutes a HIPAA violation? A HIPAA violation is when a HIPAA-covered entity – or a business associate – fails to comply with one or more of the provisions of the HIPAA Privacy, Security, or Breach Notification Rules.

A violation may be deliberate or unintentional. An example of an unintentional HIPAA violation is when too much PHI is disclosed and the minimum necessary information standard is violated. When PHI is disclosed, it must be limited to the minimum necessary information to achieve the purpose for which it is disclosed. Financial penalties for HIPAA violations can be issued for unintentional HIPAA violations, although the penalties will be at a lower rate for willful violations of HIPAA Rules.

An example of a deliberate violation is unnecessarily delaying the issuing of breach notification letters to patients and exceeding the maximum timeframe of 60 days following the discovery of a breach to issue notifications – A violation of the HIPAA Breach Notification Rule.

Many HIPAA violations are the result of negligence, such as the failure to perform an organization-wide risk assessment. Financial penalties for HIPAA violations have frequently been issued for risk assessment failures.

Penalties for HIPAA violations can potentially be issued for all HIPAA violations, although OCR typically resolves most cases through voluntary HIPAA compliance, issuing technical guidance, or accepting a covered entity or business associate’s plan to address the violations and change policies and procedures to prevent future violations from occurring. Financial penalties for HIPAA violations are reserved for the most serious violations of HIPAA Rules and for when OCR wants to “send a message” about specific violation types.

What Happens if You Violate HIPAA? – HIPAA Violation Classifications

What happens if you violate HIPAA? That depends on the severity of the violation. OCR prefers to resolve HIPAA violations using non-punitive measures, such as voluntary compliance or issuing technical guidance to help covered entities address areas of non-compliance. However, if the violations are serious, have been allowed to persist for a long time, or if there are multiple areas of noncompliance, financial penalties may be appropriate.

The four categories used for the penalty structure are as follows:

• Tier 1: A violation that the covered entity was unaware of and could not have realistically avoided, had a reasonable amount of care been taken to abide by HIPAA Rules
• Tier 2: A violation that the covered entity should have been aware of but could not have avoided even with a reasonable amount of care. (but falling short of willful neglect of HIPAA Rules)
• Tier 3: A violation suffered as a direct result of “willful neglect” of HIPAA Rules, in cases where an attempt has been made to correct the violation
• Tier 4: A violation of HIPAA Rules constituting willful neglect, where no attempt has been made to correct the violation within 30 days

In the case of unknown violations, where the covered entity could not have been expected to avoid a data breach, it may seem unreasonable for a covered entity to be issued with a fine. OCR appreciates this and has the discretion to waive a financial penalty. The penalty cannot be waived if the violation involved willful neglect of the Privacy, Security, and Breach Notification Rules.

HIPAA Violation Penalty Structure

Each category of violation carries a separate HIPAA penalty. It is up to OCR to determine a financial penalty within the appropriate range. OCR considers a number of factors when determining penalties, such as the length of time a violation was allowed to persist, the number of people affected, and the nature of the data exposed. An organization’s willingness to assist with an OCR investigation is also taken into account. The general factors that can affect the amount of the financial penalty also include prior history, the organization’s financial condition, and the level of harm caused by the violation.

• Tier 1: Minimum fine of $100 per violation up to $50,000
• Tier 2: Minimum fine of $1,000 per violation up to $50,000
• Tier 3: Minimum fine of $10,000 per violation up to $50,000
• Tier 4: Minimum fine of $50,000 per violation

The above fines for HIPAA violations are those stipulated by the HITECH Act, and these figures are adjusted annually to factor in cost-of-living increases to ensure that the civil monetary penalties continue to serve as an effective deterrent. Under the Federal Civil Penalties Inflation Adjustment Act of 1990, later amended by the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, cost-of-living increases are stipulated by the Office of Management and Budget (OMB). On January 15 each year,  the multiplier set by OMB should be applied by all federal agencies to their CMPs. This year, the HHS published its annual increases in the Federal Register on October 6, which is also the effective date for the updated civil monetary penalties.

All civil monetary penalties assessed by OCR on or after October 6, 2023, will use the new rates for violations that occurred on or after November 2, 2015.

2023 HIPAA Penalty Structure

Penalty Tier	Culpability	Minimum Penalty per Violation – Inflation Adjusted	Max Penalty per Violation – Inflation Adjusted	Maximum Penalty Per Year (cap) – Inflation Adjusted
Tier 1	Lack of Knowledge	$137	$68,928	$2,067,813
Tier 2	Reasonable Cause	$1,379	$68,928	$2,067,813
Tier 3	Willful Neglect	$13,785	$68,928	$2,067,813
Tier 4	Willful Neglect (not corrected within 30 days)	$68,928	$2,067,813	$2,067,813

OCR 2019 Notice of Enforcement Discretion Applies New Maximum Annual Penalties for HIPAA Violations

The above table of penalties is still officially in force; however, in 2019, the HHS reviewed the language of the HITECH Act with respect to the required increases for HIPAA violations and determined that the language of the HITECH Act had been misinterpreted and that it did not call for the same maximum annual penalty cap to be applied equally across all four penalty tiers. Instead, the HHS determined that the maximum annual penalty of $1.5 million ($2,067,813 in 2023) should only apply to the most serious Tier 4 violation category.

Rather than issue further rulemaking which would see the new penalty structure changed in the Federal Register, the HHS announced that OCR would be exercising enforcement discretion and would be applying a different penalty structure where each tier had a separate annual penalty cap. A Notice of Enforcement Discretion (NED) was issued in April 2019 which states that OCR will apply penalties according to the table below. These have been adjusted by The HIPAA Journal based on the multipliers set by OMB.

The penalty structure OCR is using is not legally binding, and further rulemaking is required before its new interpretation is set in stone. The NED is still in effect and will remain so indefinitely. Since the NED only applied caps to the annual penalties, this creates an anomaly, as the maximum penalty per violation in Tier 1 is still technically $63,973, which is higher than the annual penalty cap. Therefore the annual penalty cap is shown as the maximum penalty per violation in the table below for tier 1.

Penalty Tier	Culpability	Minimum Penalty per Violation	Maximum Penalty per Violation	Annual Penalty Cap
Tier 1	Lack of Knowledge	$137	$34,464	$34,464
Tier 2	Reasonable Cause	$1,379	$68,928	$137,886
Tier 3	Willful Neglect	$13,785	$68,928	$344,638
Tier 4	Willful neglect (not corrected within 30 days	$68,928	$68,928	$2,067,813

*This table was last updated on October 6, 2023, and includes the inflationary updates for 2023. 

Attorneys General Can Also Issue HIPAA Violation Fines

Since the introduction of the HITECH Act (Section 13410(e) (1)) in February 2009, state attorneys general have the authority to hold HIPAA-covered entities accountable for the unauthorized use or disclosure of PHI of state residents and can file civil actions with the federal district courts. HIPAA violation fines can be issued up to a maximum level of $25,000 per violation category, per calendar year. The minimum fine applicable is $100 per violation.

A covered entity suffering a data breach affecting residents in multiple states may be ordered to pay HIPAA violation fines to attorneys general in multiple states. Relatively few states have taken action against HIPAA-regulated entities for violations of the HIPAA Rules – California, Connecticut, Indiana, Massachusetts, Minnesota, New Jersey, New York, Vermont, and the District of Columbia. In recent years attorneys general have joined forces and have pursued penalties for HIPAA violations in response to large-scale data breaches that have affected individuals across the United States, and have pooled their resources and taken a cut of any settlements or civil monetary penalties. While only a small number of states have exercised their authority to issue fines for HIPAA violations, that does not mean HIPAA violations are going unpunished. Many states have pursued financial penalties for equivalent violations of state laws.

Can HIPAA Violations be Criminal?

When a HIPAA-covered entity or business associate violates HIPAA Rules, civil penalties can be imposed. When healthcare professionals violate HIPAA, it is usually their employer that receives the penalty, but not always. If healthcare professionals knowingly obtain or use protected health information for reasons that are not permitted by the HIPAA Privacy Rule, they may be found to be criminally liable for the HIPAA violation under the criminal enforcement provision of the Social Security Act.

Criminal HIPAA violations are prosecuted by the Department of Justice, which is increasingly taking action against individuals who have knowingly violated HIPAA Rules. There have been several cases that have resulted in substantial fines and prison sentences.

Criminal HIPAA violations include theft of patient information for financial gain and wrongful disclosures with intent to cause harm. A lack of understanding of HIPAA requirements may not be a valid defense. When an individual “knowingly” violates HIPAA, knowingly means that they have some knowledge of the facts that constitute the offense, not that they definitely know that they are violating HIPAA Rules.

Criminal Penalties for HIPAA Violations

Criminal penalties for HIPAA violations are divided into three separate tiers, with the term – and an accompanying fine – decided by a judge based on the facts of each individual case. As with OCR, a number of general factors are considered which will affect the penalty issued. If an individual has profited from the theft, access, or disclosure of PHI, it may be necessary for all money received to be refunded, in addition to the payment of a fine.

The tiers of criminal penalties for HIPAA violations are:

Tier 1:   Reasonable cause or no knowledge of violation – Up to 1 year in jail

Tier 2:   Obtaining PHI under false pretenses – Up to 5 years in jail

Tier 3:   Obtaining PHI for personal gain or with malicious intent – Up to 10 years in jail

In recent years, the number of employees discovered to be accessing or stealing PHI – for various reasons – has increased. The value of PHI on the black market is considerable, and this can be a big temptation for some individuals. It is therefore essential that controls are put in place to limit the opportunity for individuals to steal patient data, and for systems and policies to be put in place to ensure improper access and theft of PHI is identified promptly.

All staff likely to come into contact with PHI as part of their work duties should be informed of the HIPAA criminal penalties and that violations will not only result in loss of employment but potentially also a lengthy jail term and a heavy fine.

State attorneys general are cracking down on data theft and are keen to make examples out of individuals found to have violated HIPAA Privacy Rules. A jail term for the theft of HIPAA data is therefore highly likely.

Convictions and Jail Time for HIPAA Violations

Florida Medical Clinic Worker Sentenced to 48 Months in Jail over Theft of PHI

3-Year Jail Term for VA Employee Who Stole Patient Data

Former New York Dental Practice Receptionist Sentenced to 2-6 years for HIPAA Violation

UPMC Patient Care Coordinator Gets 1 Year Jail Term for HIPAA Violation

Employee Sanctions for HIPAA Violations

Not all HIPAA violations are a result of insider theft, and many Covered Entities and Business Associates apply a scale of employee sanctions for HIPAA violations depending on factors such as whether the violation was intentional or accidental, whether it was reported by the employee as soon as the violation was realized,  and the magnitude of the breach. Some Covered Entities also apply employee sanctions for HIPAA violations on employees who were aware a violation (by another employee) had occurred but failed to report it.

Employee sanctions for HIPAA violations vary in gravity from further training to dismissal. The decision should be taken in consultation with HIPAA Privacy and Security Officers, who may have to conduct interviews with the employee, investigate audit trails, and review telephone logs – including the telephone logs of the employee´s mobile phone. Because of the expense and disruption attributable to applying employee sanctions for HIPAA violations, it is worthwhile dedicating more resources to initial employee training in order to prevent HIPAA violations – whether intentional or accidental – from occurring.

Receiving a Civil Penalty for Unknowingly Violating HIPAA

Although it was mentioned above that OCR has the discretion to waive a civil penalty for unknowingly violating HIPAA, ignorance of HIPAA regulations is not regarded as a justifiable excuse for failing to implement the appropriate safeguards. In April 2017, the remote cardiac monitoring service CardioNet was fined $2.5 million for failing to fully understand the HIPAA requirements and subsequently failing to conduct a complete risk assessment.

As a result of the incomplete risk assessment, the PHI of 1,391 individuals was potentially disclosed without authorization when a laptop containing the data was stolen from a car parked outside an employee´s home. Speaking after details of the fine had been announced, OCR Director Roger Severino described the civil penalty for unknowingly violating HIPAA as a penalty for disregarding security.

It may also be possible for a CE or BA to receive a civil penalty for unknowingly violating HIPAA if the state in which the violation occurs allows individuals to bring legal action against the person(s) responsible for the violation. Although HIPAA lacks a private right of action, individuals can still use state regulations to establish a standard of care under common law. Several cases of this nature are currently in progress.

Penalties for Non-Compliance with HIPAA

When deciding on an appropriate settlement, OCR considers the severity of the violation, the extent of non-compliance with HIPAA Rules, the number of individuals impacted, and the impact a breach has had on those individuals. OCR also considers the financial position of the covered entity. Punitive measures may be necessary, but penalties for HIPAA violations should not result in a covered entity being forced out of business.

The purpose of these penalties for HIPAA violations is in part to punish covered entities for serious violations of HIPAA Rules, but also to send a message to other healthcare organizations that noncompliance with HIPAA Rules is not acceptable.

HIPAA Penalties 2023

OCR is expected to continue to aggressively enforce HIPAA compliance in 2023 after a record-breaking year of HIPAA fines and settlements. OCR is continuing to crack down on violations of the HIPAA Right of Access, which has been one of OCR’s main enforcement priority priorities since the agency launched its HIPAA Right of Access initiative in late 2019. The majority of enforcement actions for HIPAA violations in the past two years have been for HIPAA Right of Access violations. OCR has confirmed its intent to continue to enforce this aspect of HIPAA compliance with an early HIPAA penalty in 2023.

In 2018, OCR announced an enforcement action against the University of Texas MD Anderson Cancer Center for a data breach and lack of encryption, but the penalty was overturned on appeal. On January 14, 2021, a three-member panel for the Fifth Circuit Court of Appeals unanimously vacated the $4,348,000 penalty, and since that date, only a handful of HIPAA penalties have been issued for violations of the HIPAA Rules other than HIPAA Right of Access failures. The decision by the Court of Appeals was widely thought to have affected OCR’s willingness to pursue financial penalties for certain HIPAA violations, but in 2022, multiple financial penalties were imposed for other HIPAA violations. OCR now has a new Director, Melanie Fontes Rainer, who was appointed on September 14, 2022, as the successor to Lisa J. Pino. Fontes Rainer will oversee the department’s enforcement activities and is expected to stamp her mark on enforcement, and we may well see a change in the HIPAA violation cases in 2023 that result in financial penalties.

From a compliance perspective, there are several points that are worth making for 2023. HIPAA-covered entities that provide telehealth services need to ensure that when the COVID-19 Public Health Emergency is declared over, the platforms they use for telehealth are HIPAA-compliant, as OCR’s Notice of Enforcement Discretion regarding the good faith provision of telehealth services will also come to an end. OCR issued guidance in 2022 confirming that breach notifications need to be issued within 60 days of the discovery of a data breach, which could indicate this aspect of compliance will be more aggressively enforced, and it is also likely that OCR will be scrutinizing the use of website tracking technologies now that guidance has been issued for healthcare providers confirming patient authorizations and business associate agreements are required.

This post will be updated as and when the 2023 HIPAA penalties are announced and 2023 HIPAA enforcement trends become clear.

2023 HIPAA Fines and Settlements

HIPAA-Regulated Entity	Reason	Individuals Impacted	Amount
St. Joseph’s Medical Center	Disclosure of PHI to a reporter	3	$80,000
Doctors’ Management Services	Multiple HIPAA Security Rule failures	206,695	$100,000
LA Care Health Plan	Multiple HIPAA Security Rule failures	1,498	$1,300,000
UnitedHealthcare	HIPAA Right of Access failure	1	$80,000
iHealth Solutions (dba Advantum Health)	Unsecured server – Impermissible disclosure of ePHI; risk analysis failure.	267	$75,000
Yakima Valley Memorial Hospital	Snooping by security guards – Lack of policies and procedures identified.	419	$240,000
Manasa Health Center, LLC	Impermissible disclosure of PHI on an Internet platform, Privacy Rule and Breach Notification Rule policies and procedures	4	$30,000
MedEvolve Inc.	Impermissible disclosure, business associate agreement failure, risk analysis incomplete	230,572	$350,000
David Mente, MA, LPC	HIPAA Right of Access failure	1	$15,000
Banner Health	HIPAA Security Rule Violations	2.81 million	$1,250,000
Life Hope Labs, LLC	HIPAA Right of Access failure	1	$16,500

2022 HIPAA Fines and Settlements

22 HIPAA enforcement actions in 2022 resulted in financial penalties being imposed. OCR has continued with its 2019 HIPAA enforcement initiative targeting noncompliance with the HIPAA Right of Access, with the 2022 total bringing the number of enforcement actions under this initiative up to 42. Financial penalties were also imposed for impermissible disclosures of patient information on social media websites, inadequate security safeguards to ensure the confidentiality, integrity, and availability of ePHI, inadequate notices of privacy practices, and risk analysis failures.

In January 2021, the HITECH Act was amended to incentivize HIPAA-regulated entities to adopt ‘recognized security practices’ to better protect patient data. While it is not mandatory for recognized security practices to be implemented and maintained, HIPAA-regulated entities that demonstrate that they have implemented recognized security practices that have been in place continuously for the 12 months preceding a data breach will benefit from lower financial penalties, and shorter audits and investigations.

2022 HIPAA Settlements

HIPAA-Regulated Entity	Reason	Individuals Impacted	Amount
Health Specialists of Central Florida Inc	HIPAA Right of Access failure	1	$20,000
New Vision Dental	Impermissible disclosure of ePHI on Yelp, and notice of privacy practices failure	<20	$23,000
Great Expressions Dental Center of Georgia, P.C.	HIPAA Right of Access failure (delay + fee)	1	$80,000
Family Dental Care, P.C.	HIPAA Right of Access failure	1	$30,000
B. Steven L. Hardy, D.D.S., LTD, dba Paradise Family Dental	HIPAA Right of Access failure	1	$25,000
New England Dermatology and Laser Center	Improper disposal of PHI, failure to maintain appropriate safeguards	58,106	$300,640
Memorial Hermann Health System	HIPAA Right of Access failure	1	$240,000
Southwest Surgical Associates	HIPAA Right of Access failure	1	$65,000
Hillcrest Nursing and Rehabilitation	HIPAA Right of Access failure	1	$55,000
MelroseWakefield Healthcare	HIPAA Right of Access failure	1	$55,000
Erie County Medical Center Corporation	HIPAA Right of Access failure	1	$50,000
Fallbrook Family Health Center	HIPAA Right of Access failure	1	$30,000
Associated Retina Specialists	HIPAA Right of Access failure	1	$22,500
Coastal Ear, Nose, and Throat	HIPAA Right of Access failure	1	$20,000
Lawrence Bell, Jr. D.D.S	HIPAA Right of Access failure	1	$5,000
Danbury Psychiatric Consultants	HIPAA Right of Access failure	1	$3,500
Oklahoma State University – Center for Health Sciences	Risk analysis, security incident response and reporting, evaluation, audit controls, breach notifications & an unauthorized disclosure	279,865	$875,000
Dr. Brockley	HIPAA Right of Access	1	$30,000
Jacob & Associates	HIPAA Right of Access, notice of privacy practices, HIPAA Privacy Officer	1	$28,000
Northcutt Dental-Fairhope	Impermissible disclosure for marketing, notice of privacy practices, HIPAA Privacy Officer	5,385	$62,500

2022 Civil Monetary Penalties for HIPAA Violations

HIPAA-Regulated Entity	Reason	Individuals Impacted	Amount
ACPM Podiatry	HIPAA Right of Access failure	1	$100,000
Dr. U. Phillip Igbinadolor, D.M.D. & Associates, P.A	Impermissible disclosure on social media	1	$50,000

OCR HIPAA Fines 2021

There was a reduction in the number of financial penalties for HIPAA violations in 2021 from the record number of penalties in 2020, with OCR’s decision to finalize penalties potentially being affected by the COVID-19 pandemic. That said, penalties have continued to be imposed at relatively high levels, with most of the recent HIPAA violation cases in 2021 imposed for violations of the HIPAA Right of Access. Out of the 14 HIPAA violation cases in 2021 that have resulted in financial penalties, 12 have been for HIPAA Right of Access violations.

In January 2021, one of the largest ever HIPAA fines was imposed on Excellus Health Plan. The settlement resolved a HIPAA case that stemmed from an investigation of a breach of the PHI of 9,358,891 individuals that was reported to OCR in 2015. Aside from that penalty, most of the settlements and civil monetary penalties have been for relatively small amounts and have resulted from investigations of complaints from patients than reports of data breaches. As well as the 2021 HIPAA fines being lower, there was a much higher percentage of financial penalties imposed on small healthcare providers than in previous years. That trend is likely to continue in 2023.

2021 HIPAA Settlements

HIPAA Regulated Entity	Reason	Individuals Impacted	Amount
Advanced Spine & Pain Management	HIPAA Right of Access failure	1	$32,150
Denver Retina Center	HIPAA Right of Access failure	1	$30,000
Rainrock Treatment Center LLC (dba monte Nido Rainrock)	HIPAA Right of Access failure	1	$160,000
Wake Health Medical Group	HIPAA Right of Access failure	1	$10,000
Children’s Hospital & Medical Center	HIPAA Right of Access failure	1	$80,000
The Diabetes, Endocrinology & Lipidology Center, Inc.	HIPAA Right of Access failure	1	$5,000
AEON Clinical Laboratories (Peachstate)	HIPAA Security Rule failures (risk assessment, risk management, audit controls, and documentation of HIPAA Security Rule policies and procedures	Unknown	$25,000
Village Plastic Surgery	HIPAA Right of Access failure	1	$30,000
Arbour Hospital	HIPAA Right of Access failure	1	$65,000
Sharpe Healthcare	HIPAA Right of Access failure	1	$70,000
Renown Health	HIPAA Right of Access failure	1	$75,000
Excellus Health Plan	Multiple HIPAA Violations: Risk analysis, risk management, information system activity reviews, technical policies to prevent unauthorized ePHI access, breach of 9,358,891 records.	9,358,891	$5,100,000
Banner Health	HIPAA Right of Access failure	2	$200,000

2021 Civil Monetary Penalties for HIPAA Violations

HIPAA-Regulated Entity	Reason	Individuals Impacted	Amount
Dr. Robert Glaser	HIPAA Right of Access failure	1	$100,000

OCR HIPAA Fines 2020

2020 saw more financial penalties imposed on HIPAA-covered entities and business associates than in any other year since OCR started enforcing HIPAA compliance. 19 settlements were reached to resolve potential violations of the HIPAA Rules. OCR continued with its HIPAA Right of Access enforcement initiative that commenced in late 2019 and by year-end had settled 11 cases where patients had not been provided with timely access to their medical records for a reasonable cost-based fee.

2020 saw the second-largest settlement to resolve HIPAA violations. The health insurer Premera Blue Cross paid OCR $6,850,000 to resolve potential HIPAA violations discovered during the investigation of its 2015 breach of the ePHI of 10,466,692 individuals.

2020 OCR HIPAA Settlements

HIPAA-Regulated Entity	Reason	Individuals Impacted	Amount
Peter Wrobel, M.D., P.C., dba Elite Primary Care	HIPAA Right of Access failure	2	$36,000
University of Cincinnati Medical Center	HIPAA Right of Access failure	1	$65,000
Dr. Rajendra Bhayani	HIPAA Right of Access failure	1	$15,000
Riverside Psychiatric Medical Group	HIPAA Right of Access failure	1	$25,000
City of New Haven, CT	Failure to terminate access rights; risk analysis failure; failure to implement Privacy Rule policies; failure to issue unique IDs to allow system activity to be tracked; impermissible disclosure of the PHI of 498 individuals	498	$202,400
Aetna	Lack of technical and nontechnical evaluation in response to environmental or operational changes; identity check failure; minimum necessary information failure; impermissible disclosure of 18,849 records; lack of administrative, technical, and physical safeguards	18,849	$1,000,000
NY Spine	HIPAA Right of Access failure	1	$100,000
Dignity Health, dba St. Joseph’s Hospital and Medical Center	HIPAA Right of Access failure	1	$160,000
Premera Blue Cross	Risk assessment failure; risk management failure; insufficient hardware and software controls; unauthorized access to the PHI of 10,466,692 individuals	10,466,692	$6,850,000
CHSPSC LLC	Failure to conduct a risk analysis; failures to implement information system activity reviews, security incident procedures, and access controls, and a breach of the ePHI of more than 6 million individuals	6,121,158	$2,300,000
Athens Orthopedic Clinic PA	Failure to conduct a risk analysis; lack of risk management and audit controls; failure to maintain HIPAA policies and procedures; business associate agreement failure; and the failure to provide HIPAA Privacy Rule training to the workforce.	208,557	$1,500,000
Housing Works, Inc.	HIPAA Right of Access failure	1	$38,000
All Inclusive Medical Services, Inc.	HIPAA Right of Access failure	1	$15,000
Beth Israel Lahey Health Behavioral Services	HIPAA Right of Access failure	1	$70,000
King MD	HIPAA Right of Access failure	1	$3,500
Wise Psychiatry, PC	HIPAA Right of Access failure	1	$10,000
Lifespan Health System Affiliated Covered Entity	Lack of encryption; insufficient device and media controls; lack of business associate agreements; impermissible disclosure of 20,431 patients’ ePHI	20,431	$1,040,000
Metropolitan Community Health Services dba Agape Health Services	Longstanding, systemic noncompliance with the HIPAA Security Rule	1,263	$25,000

OCR HIPAA Fines 2019

HIPAA enforcement continued at a high level in 2019. Eight settlements were reached with HIPAA-covered entities and business associates to resolve HIPAA violations and two civil monetary penalties were issued. The financial penalties were imposed to resolve similar violations of HIPAA Rules as in previous years, but 2019 also saw the first financial penalties issued under OCR’s new HIPAA Right of Access initiative. Two covered entities settled cases over the failure to provide patients with a copy of their medical records, in the requested format, in a reasonable time frame.

2019 OCR HIPAA Settlements

HIPAA-Regulated Entity	Reason	Individuals Impacted	Amount
West Georgia Ambulance	Risk analysis failure; no security awareness training program; failure to implement HIPAA Security Rule policies and procedures.	500	$65,000
Korunda Medical, LLC	HIPAA Right of Access failure.	1 or more	$85,000
Sentara Hospitals	Breach notification failure; business associate agreement failure	577	$2,175,000
University of Rochester Medical Center	Loss of flash drive/laptop; no encryption; risk analysis failure; risk management failure; lack of device media controls.	43	$3,000,000
Elite Dental Associates	Social media disclosure; notice of privacy practices; impermissible PHI disclosure.	Unconfirmed	$10,000
Bayfront Health St Petersburg	HIPAA Right of Access failure	1	$85,000
Medical Informatics Engineering	Risk analysis failure; impermissible disclosure of 3.5 million records	3,500,000	$100,000
Touchstone Medical imaging	No BAAs; insufficient access rights; risk analysis failure; failure to respond to a security incident; breach notification failure; media notification failure; impermissible disclosure of 307,839 individuals’ PHI.	307,839	$3,000,000

2019 OCR Civil Monetary Penalties

HIPAA-Regulated Entity	Reason	Individuals Impacted	Amount
Texas Department of Aging and Disability Services	Risk analysis failure; access control failure; information system activity monitoring failure; impermissible disclosure of 6,617 patients ePHI	6,617	$1,600,000
Jackson Health System	Multiple Privacy Rule, Security Rule, and Breach Notification Rule violations	25,661	$2,154,000

OCR HIPAA Fines 2018

There was a year-over-year increase in HIPAA violation penalties in 2018. 11 financial penalties were agreed in 2018: 10 settlements and one civil monetary penalty. Two records were broken in 2018. 2018 saw the largest ever HIPAA settlement agreed – A $16 million financial penalty for Anthem Inc., to resolve HIPAA violations discovered during the investigation of its 78.8 million record breach in 2015. HIPAA-covered entities also paid more in fines than in any other year since OCR started enforcing compliance with HIPAA Rules: $28,683,400.

2018 OCR HIPAA Settlements

HIPAA-Regulated Entity	Reason	Individuals Impacted	Amount
Cottage Health	Risk analysis and risk management failures; No BAA	62,500	$3,000,000
Pagosa Springs Medical Center	Failure to terminate employee access; No BAA	557+	$111,400
Advanced Care Hospitalists	Impermissible PHI Disclosure; No BAA; Insufficient security measures; No HIPAA compliance efforts prior to April 1, 2014	9,255	$500,000
Allergy Associates of Hartford	PHI disclosure to a reporter; No sanctions against employees	1	$125,000
Anthem Inc	Risk analysis failure; Insufficient reviews of system activity; Failure to respond to a detected breach; Insufficient technical controls to prevent unauthorized ePHI access	78,800,000	$16,000,000
Boston Medical Center	Filming patients without consent	Unspecified	$100,000
Brigham and Women’s Hospital	Filming patients without consent	Unspecified	$384,000
Massachusetts General Hospital	Filming patients without consent	Unspecified	$515,000
Filefax, Inc.	Impermissible disclosure of physical PHI – Left unprotected in truck	2,150	$100,000
Fresenius Medical Care North America	5 breaches: Investigation revealed risk analysis failures; Impermissible disclosure of ePHI; Lack of policies covering electronic devices; Lack of encryption; Insufficient security policies; Insufficient physical safeguards	521	$3,500,000

2018 Civil Monetary Penalties for HIPAA Violations

HIPAA-Regulated Entity	Reason	Individuals Impacted	Amount
University of Texas MD Anderson Cancer Center	3 breaches resulting in an impermissible disclosure of ePHI; No Encryption	34,883	$4,348,000

OCR HIPAA Fines 2017

A summary of the 2017 OCR penalties for HIPAA violations.

2017 OCR HIPAA Settlements

HIPAA-Regulated Entity	Breach Summary	Individuals Impacted	Settlement Amount
Memorial Healthcare System	Impermissible access of PHI by employees; Impermissible disclosure of PHI to affiliated physicians’ offices	115,143	$5,500,000
Cardionet	Theft of an unencrypted laptop computer	1,391	$2,500,000
Memorial Hermann Health System	Disclosure of patient’s PHI to the media	1	$2,400,000
21st Century Oncology	Multiple HIPAA violations	2,213,597	$2,300,000
MAPFRE Life Insurance Company of Puerto Rico	Theft of an unencrypted USB storage device	2,209	$2,200,000
Presense Health	Delayed breach notifications	836	$475,000
Metro Community Provider Network	Lack of a security management process to safeguard ePHI	3,200	$400,000
Luke’s-Roosevelt Hospital Center Inc.	Impermissible disclosure of PHI to the patient’s employer	1	$387,000
The Center for Children’s Digestive Health	Lack of a business associate agreement	N/A	$31,000

2017 Civil Monetary Penalties for HIPAA Violations

HIPAA-Regulated Entity	Breach Summary	Individuals Impacted	Penalty Amount
Children’s Medical Center of Dallas	Theft of unencrypted devices	6,262	$3,200,000

OCR HIPAA Fines 2016

2016 was a record year for financial penalties to resolve violations of HIPAA Rules. 2016 saw 12 settlements agreed and one civil monetary penalty issued by OCR.

2016 OCR HIPAA Settlements

HIPAA-Regulated Entity	Breach Summary	Individuals Impacted	Settlement Amount
Feinstein Institute for Medical Research	Improper disclosure of research participants’ PHI	13,000	$3,900,000
Advocate Health Care Network	Theft of desktop computers; Loss of laptop; Improper accessing of data at a business associate	3,994,175	$5,550,000
University of Mississippi Medical Center	Unprotected network drive	10,000	$2,750,000
Oregon Health & Science University	Loss of unencrypted laptop; Storage on a cloud server without BAA	4,361	$2,700,000
New York Presbyterian Hospital	Filming of patients by a TV crew	Unconfirmed	$2,200,000
North Memorial Health Care of Minnesota	Theft of laptop computer; Improper disclosure to a business associate	299,401	$1,550,000
St. Joseph Health	PHI made available through search engines	31,800	$2,140,500
Raleigh Orthopaedic Clinic, P.A. of North Carolina	Improper disclosure to a business associate	17,300	$750,000
University of Massachusetts Amherst (UMass)	Malware infection	1,670	$650,000
Catholic Health Care Services of the Archdiocese of Philadelphia	Theft of mobile device	412	$650,000
Care New England Health System	Loss of two unencrypted backup tapes	14,000	$400,000
Complete P.T., Pool & Land Physical Therapy, Inc.	Improper disclosure of PHI (website testimonials)	Unconfirmed	$25,000

 2016 Civil Monetary Penalties for HIPAA Violations

HIPAA-Regulated Entity	Breach Summary	Individuals Impacted	Penalty Amount
Lincare, Inc.	Improper disclosure (unprotected documents)	278	$239,800

What are the Penalties for HIPAA Violations? FAQs

What is the maximum penalty for violating HIPAA?

The maximum penalty for violating HIPAA per violation is currently $68,928. However, it is rare that an event that results in the maximum penalty being issued is attributable to a single violation. For example, a data breach could be attributable to the failure to conduct a risk analysis, the failure to provide a security awareness training program, and a failure to prevent password sharing.

What are the consequences of a HIPAA violation?

The consequences of a HIPAA violation depend on the nature of the violation, the reason(s) behind it, the amount of harm it causes, and the organization´s previous history of compliance. In most cases, HIPAA violations are not attributable to willful neglect and HHS´ Office for Civil Rights will try to resolve first-time HIPAA violations via technical assistance or a corrective action plan.

What is the civil penalty for unknowingly violating HIPAA?

The civil penalty for unknowingly violating HIPAA is no different from knowingly violating HIPAA. As mentioned in the above article, there is no excuse for unknowingly violating HIPAA. The Privacy and Security Rules have been in existence for more than twenty years; and, to quote OCR Director Roger Severino “the civil penalty for unknowingly violating HIPAA is a penalty for disregarding security”.

What are the categories for punishing violations of federal health care laws?

The categories for punishing violations of federal health care laws vary considerably depending on which law is being violated or which section of which law is being violated. For example, with regard to the penalties for HIPAA violations, there are four civil categories for punishing violations and three criminal categories. However, in other federal healthcare laws (for example, the Social Security Act), there can be dozens of categories for punishing violations of federal healthcare laws.

What criminal consequences are possible with a Tier 3 violation?

The criminal consequences possible with a Tier 3 violation – wrongfully and knowingly obtaining PHI for personal gain, commercial advantage, or with malicious intent – are up to ten years in jail and/or a fine of up to $250,000. These penalties are pursued by the Department of Justice rather than HHS´ Office for Civil Rights.

What are the fines for HIPAA violations?

The fines for HIPAA violations (per violation – as of December 2023) are:

Tier 1 – from $137 to $34,464

Tier 2 – from $1,379 to $68,928

Tier 3 – from $13,785 to $68,928

Tier 4 – $68,928 per violation

It is important to be aware that, in addition to the fines for HIPAA violations issued by HHS´ Office for Civil Rights, State Attorneys General can issue additional fines for HIPAA violations. Furthermore, depending on the nature of the violation(s), it may be possible for affected individuals to bring a class action lawsuit against an organization guilty of a HIPAA violation.

What does a corrective action plan consist of?

A corrective action plan consists of measures to address the underlying issue(s) that led to a HIPAA violation(s) and therefore what the action plan consists of will be relevant to the nature of the violation(s). Typically, Covered Entities and Business Associates will be required to develop or revise policies to fill gaps in their compliance; and, when new or revised policies affect the functions of the workforce, provide training on the new or revised policies.

Are penalties for HIPAA violations always related to data breaches?

Penalties for HIPAA violations are not always related to data breaches. As you will see from the tables above, several Covered Entities have been fined or reached settlement resolutions for failing to provide patients with access to healthcare records within the permitted 30 days. One Covered Entity was fined for failing to have a Business Associate Agreement in place before disclosing ePHI to a Business Associate. None of these penalties for HIPAA violations involved a breach of unsecured PHI.

How does the Office for Civil Rights find out about HIPAA violations?

The Office for Civil Rights finds out about HIPAA violations in a number of ways. For example, Covered Entities are required to report breaches of unsecured PHI within 60 days (or annually if the breach involves fewer than 500 patients), patients can use the OCR complaints portal to report a delay or refusal to access health information, and members of Covered Entities´ workforces are granted whistleblower protection for reporting non-compliance.

What if a violation occurs due to a common non-compliant practice?

If a HIPAA violation occurs due to a common non-compliant practice, the penalty will depend on the nature of the violation, the consequences of the violation, and the perpetrator’s previous compliance history. Most often, a penalty will consist of refresher training and a compliance monitoring program – potentially by a third-party organization at the organization´s own cost.

Are HIPAA violations criminal?

HIPAA violations are criminal when an individual knowingly and wrongfully discloses individually identifiable health information. In such cases, a violation can be referred to the Department of Justice for criminal investigation. If the individual is found guilty of a criminal offense under § 1320d-6 of the Social Security Act, they can be fined up to $250,000 and sentenced to up to ten years in jail.

Has anybody ever received a custodial sentence for violating HIPAA?

A custodial sentence for violating HIPAA is rare, but it has happened – for example, when an employee has been found guilty of stealing PHI to commit identity theft or to sell for personal gain. Even when a violation does not result in a custodial sentence, the offending employee will likely be fined, lose their job, and have their license to practice withdrawn. Depending on how the employee accessed the data, Covered Entities, and Business Associates can also be fined for the same violation.

Who issues HIPAA violation fines?

HIPAA violation fines are most often issued by the Department of Health and Human Services’ Office for Civil Rights. However, fines for HIPAA violations can also be issued by State Attorneys General and the Federal Trade Commission; and – when the violation is criminal in nature – the Department of Justice can pursue criminal prosecutions against the perpetrators, which can also result in fines.

The Centers for Medicare and Medicaid Services (CMS) also have the authority to issue fines for violations of the HIPAA Administrative Requirements (45 CFR Part 162). To date, CMS has not exercised this option – preferring instead to resolve violations of Part 162 with technical assistance and corrective action plans.

Are HIPAA breach penalties always financial?

HIPAA breach penalties are not always financial. In fact, HHS’ Office for Civil Rights has only issued financial penalties in around 2% of cases it has investigated for HIPAA breaches – and penalties issued by State Attorneys General and the FTC are even rarer. The majority of HIPAA breaches are resolved via voluntary compliance, technical assistance, or a corrective action plan.

What HIPAA penalties are imposed by the State Attorneys General?

HIPAA penalties can be imposed by state Attorneys General when there is reason to believe residents of the state have been adversely affected by a violation of HIPAA. In such cases, state Attorneys General can bring a civil action on behalf of residents of the state, with penalties ranging from $100 per violation (per affected resident) to $25,000 per violation type (per affected resident).

Can CMS issue fines for HIPAA violations?

CMS can issue fines for HIPAA violations when the violation relates to the HIPAA Administrative Requirements (45 CFR Part 162). As yet, CMS has not exercised its authority to issue fines for HIPAA violations – instead resolving Part 162 complaints via voluntary compliance, technical assistance, and corrective action plans.

When can the FTC issue HIPAA violation penalties?

The FTC can issue HIPAA violation penalties when an individual or organization not covered by HIPAA experiences a data breach of unsecured PHI or fails to notify individuals following a data breach. Typically, organizations that create or maintain health data that is not covered by HIPAA include vendors of personal health appliances and wearables that transmit data to/from the vendor’s servers.

What is the penalty for a HIPAA violation by a hospital volunteer?

The penalty for a HIPAA violation by a hospital volunteer is the same as if the violation was committed by a paid member of the workforce. Similarly, if a patient complains to HHS’ Office for Civil Rights – and the complaint is investigated – the investigation will not consider the employed status of the violator because Covered Entities are required to train all members of the workforce on HIPAA policies and procedures regardless of whether they are volunteers, students, or employees.

How much is a HIPAA violation penalty?

How much a HIPAA violation penalty is depends on the nature of the violation, the consequences of the violation, the perpetrator’s prior compliance history, their willingness to assist any investigation into the violation, and the speed at which measures are put in place to prevent the violation from happening again. It can also be the case that HHS’ Office for Civil Rights uses a HIPAA violation penalty to “send a message” to other Covered Entities.

What are the HIPAA violation consequences for a medical student?

The HIPAA violation consequences for a medical student will depend on the sanctions policy at the healthcare facility where they are working. Usually – unless the HIPAA violation has serious consequences – the medical student will receive a verbal warning. However, the verbal warning will be recorded in their HR file and may affect future employment opportunities.

Who sets HIPAA fines and penalties?

HIPAA fines and penalties actually existed before HIPAA and were originally related to fraudulent claims for treatment made by healthcare providers to federal agencies (i.e., Medicare). The fines and penalties were increased in the text of HIPAA and applied to violations of the Privacy and Security Rules in 2005 when the Department for Health and Human Services (HHS) published the Enforcement Rule.

The HIPAA fines and penalties were subsequently increased by Congress via the HITECH Act 2009, since 2015, the fines and penalties issued by HHS’ Office for Civil Rights have been adjusted annually to account for inflation. There have been no increases in the HIPAA fines and penalties that can be imposed by State Attorneys General since the passage of HITECH nor in the fines and penalties for criminal violations of HIPAA.

Are HIPAA breach fines always the same for each type of violation?

HIPAA breach fines can be the same for each type of violation but – under §160.408 of the Administrative Simplification provisions – the Secretary for Health and Human Services is required to take a number of factors into account when determining the amount of a HIPAA breach fine.

What is the cost of a HIPAA violation?

The cost of a HIPAA violation varies according to the nature of the violation, who is responsible for it, and what the consequences are. For example, a disclosure of more than the minimum necessary PHI by a member of a Covered Entity’s workforce who with no previous record of non-compliance will likely receive a verbal warning and may have to undergo further training.

Conversely, a healthcare organization that willfully and knowingly neglects to implement the Security Rule safeguards, and consequently experiences a data breach affecting thousands of patients, will likely receive a multi-million dollar fine. Between the two extremes, most violations incur some degree of cost – whether it is reported internally or notified to HHS’ Office for Civil Rights.

Can patients claim monetary damages for a HIPAA violation?

Patients cannot claim monetary damages for a HIPAA violation under HIPAA law, but many states have privacy, security, and/or breach notification laws that do allow for a private right of action depending on the nature of the violation and the degree of harm suffered. If individuals feel they have suffered harm due to the negligence of a HIPAA Covered Entity or Business Associate, they should seek independent legal advice from an attorney.

What are HIPAA penalties for non-compliance?

HIPAA penalties for non-compliance vary according to the nature of the violation, which section of HIPAA has been violated, and the consequences of the violation. The HIPAA penalties for non-compliance also vary according to who the non-compliant party is. For example, the penalties for non-compliance by a member of the workforce will likely be a verbal or written warning, while the penalties for non-compliance by a Covered Entity will range from technical assistance to a fine.

What is the fine described by HIPAA/HITECH for companies that accidentally release PHI but perform due diligence?

The fine described by HIPAA/HITECH for companies that accidentally release PHI but perform due diligence is a Tier 1 fine for the “Lack of Knowledge” level of culpability. At present (December 2023), the amount of the fine is between $137 per violation to $34,464 per violation – but these amounts will be adjusted for inflation during 2024.

What is the maximum fine per HIPAA violation according to the Final Omnibus Rule?

The maximum fine per HIPAA violation according to the Final Omnibus Rule is $1.5 million. However, it is important to be aware that the tiered HIPAA penalty structure with the $1.5 million penalty cap was introduced by the HITECH Act in 2009 and adopted by the Final Omnibus Rule in 2013. Additionally, since 2015, the maximum fine per HIPAA violation has been increased each year to account for inflation.

What are the criminal penalties for HIPAA violations?

The criminal penalties for HIPAA violations vary according to the motive for the offense. According to §1177 of the Social Security Act, a person who obtains, discloses, uses – or causes to be used – individually identifiable health information maintained by a Covered Entity can be fined up to $50,000 and/or imprisoned for up to a year.

However, if the offense is committed under false pretenses, the fine increases up to $100,000 and the prison term up to five years; and, if the offense is committed with the intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, the fine increases up to $250,000 and the jail term up to ten years.

What are the consequences of violating HIPAA for a nurse?

The consequences of violating HIPAA for a nurse most often depend on the nature of the violation, the impact of the violation, the nurse’s previous compliance record, and the content of the Covered Entity’s sanctions policy. Typically, a first offense with a minor impact will result in a verbal warning and/or refresher training. However, the consequences of violating HIPAA for a nurse could escalate for a serious or repeated offense to a written warning, a suspension, or termination of employment.

Are there HIPAA violation fines for individuals?

There are no HIPAA violation fines for individuals unless an individual qualifies as a HIPAA Covered Entity or Business Associate (i.e., a freelance counselor) and they violate HIPAA in their role as such. Individuals employed by Covered Entities or Business Associates cannot be fined for civil violations but could be fined if a violation is considered criminal and referred to the Department of Justice.

What is the minimum fine for intentional and uncorrected release of PHI?

The minimum fine for intentional and uncorrected release of PHI is currently $68,928 if the offender is a Covered Entity or Business Associate. If the offender is a member of a Covered Entity’s or Business Associate’s workforce, and they violate HIPAA intentionally with criminal intent, there is no set minimum fine. The Courts can decide on a fine of up to $250,000.

What are HIPAA civil monetary penalties?

HIPAA civil monetary penalties are fines sometimes imposed on HIPAA Covered Entities and Business Associates for violations of HIPAA. The term can sometimes be shortened to HIPAA penalties, or HIPAA settlements when the perpetrator negotiates a settlement with HHS’ Office for Civil Rights to avoid a lengthy – and potentially costly – dispute over how the civil monetary penalties should be.

Are HIPAA violations sanctioned differently in different states?

HIPAA violations are not sanctioned differently in different states; although, in some areas, State Attorneys General are more willing to pursue HIPAA violation sanctions against a Covered Entity than in other states. This may be because the state has more stringent privacy or data security regulations than HIPAA, or because a significant number of state residents are impacted by HIPAA violations.

The post What are the Penalties for HIPAA Violations? appeared first on HIPAA Journal.