The Healthcare Insurance Portability and Accountability Act (HIPAA) helps in controlling both electronic Protected Health Information (ePHI) and Protected Health Information (PHI). For noncompliance, HIPAA, which is federally regulated, comes with severe business impacts and penalties.
What does HIPAA stipulate?
Congress passed the Healthcare Insurance Portability and Accountability Act (HIPAA) in 1996 to safeguard information as individuals shifted from one job to the next. Later in 2003, the US Department of Health and Human Services established the HIPAA Privacy Rule.
Back in 2005, the HIPAA Security Rule redirected its attention to electronically stored Protected Health Information (ePHI) in a bid to come up with three types of safeguards for compliance. Physical safeguards include access control to data storage locations. Administrative safeguards entail procedures and policies that indicate compliance whereas technical safeguards include communications conveying Protected Health Information (PHI) electronically via open networks.
What are business associates and covered entities?
According to HIPAA, covered entities are healthcare providers, health plans, and health care clearinghouses that convey ePHI or PHI electronically. The compliance program also defines business associates as those entities with access to either PHI or ePHI mainly because they carry out activities or functions on a covered entity’s behalf.
Healthcare providers consist of pharmacies, nursing homes, dentists, chiropractors, doctors, psychologists and clinics. Health plans comprise of company health plans, HMOs, health insurance companies, and government programs like Medicaid, Medicare, and the veterans and military health care programs.
On the other hand, a healthcare clearinghouse functions as a “
The Healthcare Insurance Portability and Accountability Act (HIPAA) stipulates that all covered entities dealing with business associates ought to have a written agreement or contract that outlines the responsibilities of business associates regarding protected health information (PHI).
Who controls HIPAA?
The Office for Civil Rights or OCR, a section of the Department of Health and Human Services, helps in enforcing the Privacy and Security Rules. In fact, the unit’s website enables individuals to file their complaints against business associates and covered entities. What’s more, people can also submit their claims through the site’s portal, fax, email, and mail.
What are the ramifications for HIPAA violations?
The consequences for violating HIPAA stem out of the HIPAA Enforcement Rule, which helps in imposing civil money fines. Although HHS amended the Enforcement Rule in between 1996 and 2009, HITECH reinforced HIPAA and combined the rules, specifically under the Omnibus Act.
What civil penalties come with HIPAA violations?
The Office for Civil Rights enforces civil penalties mainly on a tiered basis. Just like civil law, the violation looks at whether an entity willfully, knowingly or neglectfully infringed the law.
A HIPAA violation that is committed unknowingly can result in a minimum of $100 for each violation as well as a yearly maximum fine of $25,000, primarily for repeat violations. Nonetheless, the maximum penalty can be as much as $50,000 for a single violation and an annual maximum of a whopping $1.5 million.
For the second tier, which is also referred to as the reasonable cause, features a minimum penalty for HIPAA violations amounting to $1,000 for each infringement, with a yearly maximum penalty of $100,000 intended for repeat violations. In this tier, the maximum fine costs a staggering $50,000 for a single violation coupled with a yearly maximum fine of $1.5 million.
The third group of civil fines looks at whether the violation resulted from willful neglect, even though it is rectified within the stipulated duration. The tier includes a minimum fine of $10,000 per infringement, with a yearly maximum fine of $250,000 targeting repeat violations. The maximum fine here is $50,000 for a single violation, with a maximum annual fine of $1.5 million.
Finally, entities found to have neglected HIPAA’s conditions without rectifying them within the stipulated duration will be charged with a minimum fine of $50,000 for each violation, with a yearly maximum penalty of $1.5 million. In this tier, the maximum fine is equivalent to the minimum penalty.
Can a HIPAA violation result in a jail term?
The Department of Just is tasked with the responsibility of overseeing the criminal fines linked with HIPAA. The criminal violations are divided into tiers. If a covered organization knowingly obtains and discloses personal health information, a penalty of $50,000 and 1-year jail term could be imposed.
False pretenses can result in fines amounting to $100,000 and a maximum jail term of 10 years.
For violations where ePHI or PHI was infringed with the intention of transferring, selling or using it for personal gain, malicious harm or commercial gain, the penalty grows to $250,000- and 10-years imprisonment.
Is violating HIPAA a felony?
Indictments for HIPAA violations are rare. Even though some have taken place in the past, most still fall under misdemeanor. More often, the OCR addresses the fundamental causes of the issue and assists the entities in becoming compliant.
How can automation ease HIPAA compliance?
The Department of Health and Human Services (HHS)
An audit for HIPAA compliance is similar, which means that audit management software that offers one source of truth can assist you in saving time.