protected health information

The Reality of HIPAA Violations and Enforcement

Who is ultimately responsible for enforcement of HIPAA and what types of penalties are levied when a covered entity or business associate is found to be non-compliant with the regulations? Many healthcare offices and their staff don’t know the answer to this question; they have only a vague notion about the enforcement and the consequences of not adhering to the law.

The real HIPAA enforcement agency is the U.S. Department of Health and Human Services (HHS), Office for Civil Rights (OCR). Complaints are filed with the OCR, and they are responsible for administering, investigating and enforcing the HIPAA privacy standards. The Centers for Medicare & Medicaid (CMS) enforce the code set and security standards.

The American Recovery and Reinvestment Act of 2009 created a tiered penalty configuration for HIPAA violations. But it is the OCR that determines the amount of each penalty, and it is dependent upon the nature and extent of harm that results from the breach. For example:

  • The fine for a first time infringement by someone who did not know they violated HIPAA could be as low as $100 or as high as $50,000.
  • The fine for a violation due to willful neglect, but corrected within the required time period, is a minimum of $10,000 per violation with a maximum of $50,000.
  • The fine when the willful neglect violation is not corrected increases from $10,000 to $50,000.

However, whenever there is a violation that is not considered willful neglect and it is corrected within 30 days of notice, the OCR cannot impose the civil penalty.

A Privacy Rule infraction can be considered criminal and may lead to prosecution by the Department of Justice if someone deliberately acquires or discloses a person’s health information; the fine is $50,000 and up to one year in jail. Whenever an offense is committed through deception, the fine is $100,000 and the jail time is 5 years. And, if person’s health information was sold, transferred or used for profit-making, or any type of personal gain or intent to harm, the fines can go as high as $250,000 with imprisonment for up to 10 years.

Knowing that enforcement of HIPAA is real and that the penalties can be financially and professionally devastating, healthcare offices need to prioritize their training efforts for all of their staff. There truly is no excuse for any healthcare office not to be thoroughly trained in HIPAA law, because if they are found to be out of compliance HHS will not accept ignorance of the law as a defense.

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