The HHS’ Office for Civil Rights (OCR) is continuing its crackdown on healthcare providers that are not fully complying with the HIPAA right of access. Last week, OCR announced its ninth enforcement action against a HIPAA-covered entity for the failure to provide patients with timely access to their medical records at a reasonable cost.

HIPAA gives patients the right to view or receive a copy of their medical records. When a request is made for access to medical records, HIPAA-covered entities must provide access or supply a copy of the requested medical records as soon as possible, but no later than 30 days after the request is received.

By obtaining a copy of their medical records, patients can share those records with other providers, research organizations, or individuals of their choosing. Patients can check their medical records for errors and submit requests to correct any mistakes. In the event of a ransomware attack that renders medical records inaccessible, patients who have a copy of their records ensure that their health histories are never lost.

Under the OCR HIPAA Right of Access Initiative, complaints from individuals who have been denied access to their medical records or have faced delays in receiving a copy of their records are investigated. When violations of the HIPAA right of access are uncovered, financial penalties are issued. The aim of penalties is to encourage compliance by making noncompliance very costly.

The latest financial penalty was imposed on NY Spine, a private medical practice with offices in New York and Miami that specializes in neurology and pain management. OCR received a complaint from a patient in July 2019 who claimed to have sent multiple requests to NY Spine in June 2019 requesting a copy of her protected health information.

NY Spine responded to the requests and provided some of her records but failed to provide the diagnostic films that she had specifically requested. It took intervention from OCR for NY Spine to provide those records. The patient was finally provided with a complete copy of all the requested records in October 2020, 16 months after the first request was submitted.

NY Spine and OCR agreed to settle the case for $100,000. NY Spine is also required to adopt a corrective action plan and will be monitored by OCR for compliance for 2 years.

“No one should have to wait over a year to get copies of their medical records.  HIPAA entitles patients to timely access to their records and we will continue our stepped up enforcement of the right of access until covered entities get the message,” said Roger Severino, OCR Director.

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The Department of Health and Human Services’ Office for Civil Rights has announced its 12^th HIPAA penalty of 2020 and its 8^th under the HIPAA Right of Access enforcement initiative that was launched in 2019. The $160,000 settlement is the largest HIPAA penalty to date for a failure to provide an individual with timely access to their requested medical records.

On January 24, 2018, Dignity Health, doing business as St. Joseph’s Hospital and Medical Center (SJHMC), received a request from the mother of a patient who wanted a copy of her son’s medical records. The mother was acting as the personal representative of her son. After not receiving all of the requested records by April 25, 2018, the mother lodged a complaint with the Office for Civil Rights.

OCR investigated the potential HIPAA violation and determined the complainant had requested four specific sets of medical records from SJHMC. The first request was sent on January 24, 2018, and the same records were requested on March 22, April 3, and May 2, 2018.

SJHMC did respond to the requests and provided some, but not all, of the requested records. The mother made contact with SJHMC again on May 2, May 10 and May 15, 2018 to request the records that had not been provided. SJHMC responded and sent additional records, but not the specific records that had been requested. It took until December 19, 2019 for SJHMC to provide all the records she had requested – 22 months after the initial request had been sent.

SJHMC agreed to pay the $160,000 financial penalty to settle the case with no admission of liability. SJHMC will also adopt a corrective action plan to address all areas of noncompliance and will be monitored for compliance by OCR for two years.

“It shouldn’t take a federal investigation to secure access to patient medical records, but too often that’s what it takes when health care providers don’t take their HIPAA obligations seriously.  OCR has many right of access investigations open across the country, and will continue to vigorously enforce this right to better empower patients,” said Roger Severino, OCR Director.

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The Department of Health and Human Services’ Office for Civil Rights (OCR) has imposed a $6.85 million HIPAA penalty on Premera Blue Cross to resolve HIPAA violations discovered during the investigation of a 2014 data breach involving the electronic protected health information of 10.4 million individuals.

Mountainlake Terrace, WA-based Premera Blue Cross is the largest health plan in the Pacific Northwest and serves more than 2 million individuals in Washington and Alaska. In May 2014, an advanced persistent threat group gained access to Premera’s computer system where they remained undetected for almost 9 months. The hackers targeted the health plan with a spear phishing email that installed malware. The malware gave the APT group access to ePHI such as names, addresses, dates of birth, email addresses, Social Security numbers, bank account information, and health plan clinical information.

The breach was discovered by Premera Blue Cross in January 2015 and OCR was notified about the breach in March 2015. OCR launched an investigation into the breach and discovered “systemic noncompliance” with the HIPAA Rules.

OCR determined that Premera Blue Cross had failed to:

• Conduct a comprehensive and accurate risk analysis to identify all risks to the confidentiality, integrity, and availability of ePHI.
• Reduce risks and vulnerabilities to ePHI to a reasonable and appropriate level.
• Implement sufficient hardware, software, and procedural mechanisms to record and analyze activity related to information systems containing ePHI, prior to March 8, 2015.
• Prevent unauthorized access to the ePHI of 10,466,692 individuals.

Due to the nature of the HIPAA violations and scale of the breach, OCR determined a financial penalty was appropriate. Premera Blue Cross agreed to settle the HIPAA violation case with no admission of liability. In addition to the financial penalty, Premera Blue Cross has agreed to adopt a robust corrective action plan to address all areas of noncompliance discovered during the OCR investigation. Premera Blue Cross will also be closely monitored by OCR for two years to ensure compliance with the CAP.

“If large health insurance entities don’t invest the time and effort to identify their security vulnerabilities, be they technical or human, hackers surely will. This case vividly demonstrates the damage that results when hackers are allowed to roam undetected in a computer system for nearly nine months,” said Roger Severino, OCR Director.

“We are pleased to have reached an agreement with the federal Office for Civil Rights to resolve legal inquiries into the 2014 cyberattack on our data network,” said Premera Blue Cross in a statement. “The commitments we have agreed to are consistent with our ongoing focus on protecting personal customer information.”

Last year, Premera Blue Cross agreed to settle a $10 million HIPAA violation lawsuit over the breach. The health plan had been investigated by 30 state attorneys general who determined Premera Blue Cross had not met its obligations under HIPAA and Washington’s Consumer Protection Act. In 2019, Premera Blue Cross also agreed to settle a $74 million lawsuit filed on behalf of individuals whose ePHI was exposed in the breach.

The latest penalty is the second largest HIPAA penalty imposed on a covered entity or business associate by OCR to resolve HIPAA violations, behind the $16 million financial penalty imposed on Anthem Inc. over its 2015 data breach involving the ePHI of 79 million individuals.

The fine is the 11^th HIPAA violation penalty to be announced by OCR in 2020 and the 8^th to be announced this month. So far in 2020, OCR has been paid $10,786,500 to resolve HIPAA violations discovered during investigations of data breaches and HIPAA complaints.

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The HHS’ Office for Civil Rights has announced a settlement has been reached with Athens Orthopedic Clinic PA to resolve multiple violations of the Health Insurance Portability and Accountability Act (HIPAA) Rules.

OCR conducted an investigation into a data breach reported by the Athens, GA-based healthcare provider on July 29, 2016.  Athens Orthopedic Clinic had been notified by Dissent of Databreaches.net on June 26, 2026 that a database containing the electronic protected health information (ePHI) of Athens Orthopedic Clinic patients had been listed for sale online by a hacking group known as The Dark Overlord. The hackers are known for infiltrating systems, stealing data, and issuing ransom demands, payment of which are required to prevent the publication/sale of data.

Athens Orthopedic Clinic investigated the breach and determined that the hackers gained access to its systems on June 14, 2016 using vendor credentials and exfiltrated data from its EHR system. The records of 208,557 patients were stolen in the attack, including names, dates of birth, Social Security numbers, procedures performed, test results, clinical information, billing information, and health insurance details.

OCR accepts that it is not possible to prevent all cyberattacks, but when data breaches occur as a result of the failure to comply with the HIPAA Rules, financial penalties are appropriate.

“Hacking is the number one source of large health care data breaches. Health care providers that fail to follow the HIPAA Security Rule make their patients’ health data a tempting target for hackers,” said OCR Director Roger Severino.

The OCR investigation into the breach revealed systemic noncompliance with the HIPAA Rules. Athens Orthopedic Clinic had not conducted an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of ePHI, in violation of 45 C.F.R. § 164.308(a)(1)(ii)(B).

Security procedures had not been implemented to reduce the potential risks to ePHI to a reasonable and appropriate level, in violation of 45 C.F.R. § 164.308(a)(1)(ii)(A).

From September 30, 2015 to December 15, 2016, Athens Orthopedic Clinic failed to implement appropriate hardware, software, and procedures for recording and analyzing information system activity, in violation of 45 C.F.R. §§ 164.312(b).

It took until August 2016 for HIPAA policies and procedures to be maintained, in violation of 45 C.F.R. § 164.530(i) and (j), and prior to August 7, 2016, the clinic had not entered into business associate agreements with three of its vendors, in violation of 45 C.F.R. § 164.308(b)(3).

Prior to January 15, 2018, Athens Orthopedic Clinic had not provided HIPAA Privacy Rule training to the entire workforce, in violation of 45 C.F.R. § 164.530(b).

As a result of the compliance failures, Athens Orthopedic Clinic failed to prevent unauthorized access to the ePHI of 208,557 patients, in violation of 45 C.F.R. §164.502(a)).

In addition to the financial penalty, Athens Orthopedic Clinic has agreed to adopt a corrective action plan covering all aspects of noncompliance discovered during the OCR investigation. The clinic settled the case with no admission of liability.

This is the sixth HIPAA settlement to be announced by OCR in September and the 9^th HIPAA penalty of 2020. Earlier this month, OCR announced five settlements had been reached with HIPAA-covered entities under its HIPAA Right of Access initiative for failing to provide patients with a copy of their health information.

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