The Health Insurance Portability and Accountability Act, “(HIPAA”) is a federal law enacted in 1996 to provide privacy and security protections for patients’ medical information. The primary purpose of HIPAA is to ensure the confidentiality and integrity of personal health information (PHI) while allowing for the flow of health information needed to provide quality healthcare and for other important purposes, such as healthcare operations and research.

Covered Entities:
HIPAA sets standards for the protection of PHI and applies to covered entities, which include healthcare providers, health plans, and healthcare clearinghouses. It also applies to business associates, which are individuals or organizations that perform certain functions or activities involving PHI on behalf of covered entities. Examples of business associates include billing companies, IT support firms, and transcription services. These entities must  provide individuals with certain rights regarding their health information, such as the right to access their records and request corrections.

  • Healthcare Providers: This includes doctors, nurses, clinics, hospitals, dentists, psychologists, chiropractors, nursing homes, pharmacies, and other healthcare professionals and facilities that electronically transmit health information.
  • Health Plans: This category includes health insurance companies, HMOs (Health Maintenance Organizations), Medicare, Medicaid, employer-sponsored health plans, and government programs that pay for healthcare.
  • Healthcare Clearinghouses: These are entities that process nonstandard health information they receive from other entities into a standard format, such as converting paper claims to electronic format. Clearinghouses also include billing services and repricing companies.

While HIPAA itself does not directly regulate employers in most cases, employers still need to be mindful of other applicable laws governing employee health information and ensure compliance with privacy and confidentiality requirements in the employment context.

HIPAA violations can result in significant penalties, including civil and criminal penalties, depending on the severity of the violation. The U.S. Department of Health and Human Services’ Office for Civil Rights is responsible for enforcing HIPAA’s privacy and security rules.

HIPAA violations occur when covered entities or business associates fail to comply with the privacy and security requirements set forth by the Act.

  • Unauthorized Disclosure: Sharing or disclosing protected health information (PHI) without proper authorization or consent is a violation of HIPAA. This can include discussing a patient’s medical condition or treatment in a public setting where others can overhear.
  • Insufficient Data Security: Failing to implement appropriate safeguards to protect PHI from unauthorized access or breaches is a violation. This could involve weak passwords, lack of encryption, inadequate physical security measures, or improper disposal of sensitive information.
  • Lack of Privacy Policies: Not having policies and procedures in place to protect patient privacy, such as failing to provide patients with a notice of privacy practices or neglecting to train employees on privacy rules, is a violation.
  • Improper Use of PHI: Using or accessing PHI for purposes unrelated to treatment, payment, or healthcare operations without valid authorization is a violation. This can occur when employees access patient records out of curiosity or for personal reasons.
  • Failure to Provide Access to PHI: Failing to provide individuals with timely access to their own medical records or denying their requests for amendments or corrections violates HIPAA. Patients have the right to access and make changes to their PHI under certain circumstances.
  • Inadequate Business Associate Agreements: Covered entities must have written agreements in place with their business associates that outline the responsibilities of each party regarding the protection of PHI. Failing to have these agreements or not including the required provisions is a violation.

  • Breach Notification Failure: If a covered entity experiences a breach of unsecured PHI, they are required to notify affected individuals, the Department of Health and Human Services, and in some cases, the media. Failing to provide timely breach notifications is a violation.

Not all healthcare-related entities are considered covered entities under HIPAA. For example, life insurers, employers, most schools and universities, and certain government agencies are generally not classified as covered entities under HIPAA. However, these entities may still be subject to other laws or regulations that govern the privacy and security of health information.

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Disclaimer: Every situation is different and particular facts may vary thereby changing or altering a possible course of action or conclusion. The information contained herein is intended to be general in nature as laws vary between federal, state, counties, and municipalities and therefore may not apply to any given matter. This information is not intended to be legal advice or relied upon as a legal opinion, course of action, accounting, tax, or other professional services. You should consult the proper legal or professional advisor knowledgeable in the area that pertains to your particular situation.

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