Omar Bennett
The Health Insurance Portability and Accountability Act (HIPAA) was established in 1996 to protect the privacy of individuals' health information. A HIPAA violation in the workplace is any failure to comply with the standards and implementation specifications of the HIPAA Administrative Simplification Rules. This includes any action taken by an employer or employee that results in the improper disclosure of a person's protected health information (PHI). If you suspect a HIPAA violation, you should report it to your supervisor or HR representative, who will then launch an investigation to determine the severity of the violation and take appropriate action. Depending on the nature of the violation, steps may include notifying the affected individuals, implementing new policies and safeguards, or potentially facing civil or criminal penalties. It is important to note that not all internal violations of HIPAA Rules need to be reported, but failure to notify the patient and OCR of a reportable breach of unsecured PHI could result in a financial penalty.
| Characteristics | Values |
|---|---|
| Failure to comply with HIPAA Administrative Simplification Rules | Privacy, Security, and Breach Notification Rules |
| Entities subject to HIPAA | Health plans, healthcare clearinghouses, healthcare providers, third-party businesses that provide a service for or on behalf of a covered entity, subcontractors of business associates, vendors of some personal health devices |
| Action taken by an employer or employee | Improper disclosure of a person's protected health information (PHI) |
| PHI disclosure without authorization | Accessing, using, disclosing, or selling PHI |
| Lack of security measures | Failing to implement adequate security measures, such as encryption and password protection |
| PHI available to someone it shouldn't be | Lost device, sending unencrypted data, or giving unauthorized access |
| Retaliatory action by employer | Intimidation, threats, coercion, discrimination, or other retaliatory action against an individual for the exercise of any right established or for participation in any process provided for by the Privacy Rule or Breach Notification Rule |
| Failure to notify | Failure to notify the patient and OCR of a reportable breach of unsecured PHI |
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What You'll Learn
Improper disclosure of PHI
A HIPAA violation in the workplace is any failure to comply with the HIPAA Privacy, Security, and Breach Notification Rules. This includes any action taken by an employer or employee that results in the improper disclosure of an individual's protected health information (PHI).
Another form of improper disclosure is the sharing of medical records with someone who does not have permission to view them. This can include disclosing PHI to a patient's employer or other officials without obtaining an attestation that the information will not be used for a criminal, civil, or administrative investigation. It also includes providing more information than is necessary to achieve the purpose of an allowable disclosure. For instance, the Children's Medical Center of Dallas faced a $3.2 million civil monetary penalty for failing to address known risks, including not using encryption on portable devices, which led to impermissible disclosures.
PHI violations can also occur when there is a lack of security measures to protect PHI. This could be a result of failing to implement encryption or alternative equivalent security measures, such as password protection. Additionally, not conducting regular risk assessments and having insufficient workforce training on HIPAA rules can lead to improper disclosures. For example, the Catholic Health Care Services of the Archdiocese of Philadelphia paid a $650,000 settlement for failing to use encryption and conduct an enterprise-wide risk analysis.
Furthermore, improper disposal of PHI can result in HIPAA violations. When physical PHI and electronic PHI (ePHI) are no longer required, HIPAA Rules mandate their secure and permanent destruction. Failure to do so can lead to significant financial penalties, as seen in the case of New England Dermatology and Laser Center, which was fined $300,640 for improperly disposing of medical records containing PHI.
In summary, improper disclosure of PHI in the workplace can take various forms, including unauthorized access, sharing information without permission, insufficient security measures, lack of risk assessments and training, and improper disposal of PHI. It is crucial for organizations and individuals handling PHI to comply with HIPAA regulations to avoid penalties and protect patient privacy.
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Inadequate security measures
The HIPAA Security Rule establishes a national set of security standards to protect electronic protected health information (ePHI). Regulated entities must train their employees on security policies and procedures, and sanctions must be applied to employees who violate privacy policies.
Entities subject to HIPAA include health plans, healthcare clearinghouses, healthcare providers, third-party businesses that provide services for or on behalf of a covered entity, subcontractors, and vendors of some personal health devices. All these entities must implement adequate security measures to protect ePHI.
The HIPAA Privacy Rule governs the use and disclosure of protected health information (PHI) by covered entities. These include healthcare clearinghouses, health insurers, employer-sponsored healthcare plans, and medical providers. Covered entities are required to disclose PHI to an individual upon request within 30 days and as mandated by law enforcement.
Business associates, such as third-party businesses that provide services for covered entities, are also subject to the HIPAA Security Rule and are civilly and criminally liable for penalties for violations. Business associates should develop clear procedures for handling, storing, and transmitting PHI, train employees on privacy and security guidelines, and establish access control and encryption guidelines.
In summary, inadequate security measures as a HIPAA violation can include a lack of basic security protocols, failure to train employees on security policies, and non-compliance by business associates. It is important for entities subject to HIPAA to implement comprehensive security measures to protect ePHI and PHI and avoid violations.
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Retaliation against complainants
HIPAA's General Administrative Requirements also prohibit covered entities from intimidation, discrimination, and retaliation if a member of the workforce files a complaint or supports a compliance investigation. Patients and plan members can report HIPAA violations to their state Attorney General or the HHS Office for Civil Rights without first reporting to the Privacy Officer.
If an employee experiences retaliation for reporting a HIPAA violation, they can seek a remedy through the HHS, which is empowered to investigate allegations of retaliation. The organization found to have violated the anti-retaliation rules may be subject to civil monetary penalties and corrective action plans. Additionally, the employee may file a whistleblower lawsuit in state court to seek monetary damages.
It is important to note that not all internal violations of HIPAA Rules need to be reported. However, failing to notify the patient and OCR of a reportable breach of unsecured PHI could result in financial penalties. When in doubt, employees can seek guidance from their supervisor or the organization's Privacy Officer to determine the appropriate course of action.
To prevent retaliation and encourage a culture of compliance, organizations should implement clear procedures for handling, storing, and transmitting PHI, provide training on privacy and security guidelines, and establish access control and encryption measures. Regular monitoring for unauthorized access or breaches of PHI data is also crucial.
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Non-compliance by business associates
Business associates must comply with the HIPAA Privacy Rule, which governs the use and disclosure of protected health information (PHI). They must obtain satisfactory assurances that they will use PHI only for the purposes for which it was provided, safeguard it from misuse, and comply with the covered entity's duties under the Privacy Rule.
To ensure compliance, business associates should develop and implement HIPAA policies and procedures that align with the HIPAA Rules. This includes establishing clear procedures for handling, storing, and transmitting PHI, as well as training employees on privacy and security guidelines. Access control and encryption guidelines are also crucial to prevent unauthorized access to PHI.
Violations of HIPAA by business associates can result in severe consequences, including civil and criminal penalties ranging from $100 to $1.5 million. Additionally, covered entities can sue business associates for breaching the terms of their Business Associate Agreements (BAAs), which often contain additional indemnification or penalty provisions.
If a covered entity becomes aware of a material breach or violation by a business associate, they are required to take reasonable steps to rectify the issue. If unsuccessful, they must terminate the contract or arrangement. If termination is not feasible, the covered entity must report the problem to the Department of Health and Human Services (HHS) Office for Civil Rights (OCR).
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Failure to report a violation
Failure to report a HIPAA violation in the workplace can have serious consequences. If an employee suspects or accidentally violates HIPAA rules or believes that a colleague or employer is failing to comply with the rules, they should report it. The failure to do so could result in financial penalties for the covered entity or business associate.
HIPAA violations include any failure to comply with the standards and implementation specifications of the HIPAA Administrative Simplification Rules, including the HIPAA Privacy, Security, and Breach Notification Rules. Common violations include unauthorized access to patient information, disclosure of PHI without authorization, and lack of security measures. If an employee suspects any of these violations, they should report them to their supervisor or the organization's HIPAA Privacy Officer, who will conduct an investigation and risk assessment. This will determine whether the violation is reportable to the patient and OCR as a breach of unsecured PHI.
Employees who fail to report violations may face consequences if the violation is later discovered. While not all internal violations need to be reported, employees should be aware that their organization may face financial penalties if a breach of unsecured PHI is not reported to the patient and OCR. Additionally, employees who fail to report violations may be viewed unfavorably and may be subject to disciplinary action.
It is important to note that employees have the right to report HIPAA violations without fear of retaliation. HIPAA laws protect employees from intimidation, threats, coercion, discrimination, or other retaliatory actions by their employers. If an employee believes their rights have been violated through retaliation, they can seek remedies through HHS investigations, civil monetary penalties, and corrective action plans, or by filing a whistleblower lawsuit.
To ensure compliance and avoid consequences, employees should be trained on privacy and security guidelines, understand how to respond to patient access and accounting requests, and know the correct channels for reporting HIPAA violations. These channels include the organization's Privacy Officer, State Attorney General, and HHS' Office for Civil Rights. By taking these steps, employees can help protect their organization and patient's data from the severe consequences of HIPAA violations, including civil and criminal penalties.
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Frequently asked questions
A HIPAA violation in the workplace is any failure to comply with the standards and implementation specifications of the HIPAA Administrative Simplification Rules. This includes any action taken by an employer or employee that results in the improper disclosure of a person's protected health information (PHI).
Common examples of HIPAA violations in the workplace include unauthorized access to patient records, sharing a person's medical records without their permission, and failing to implement adequate security measures such as encryption and password protection.
If you discover a potential HIPAA violation in the workplace, you should report it to your supervisor or the organization's HIPAA Privacy Officer. They will then launch an investigation to determine the severity of the violation and take appropriate action.
The consequences of a HIPAA violation can vary depending on its severity. The Office for Civil Rights (OCR) investigates complaints about potential HIPAA violations and may impose financial penalties, ranging from $100 to $1.5 million per violation. However, the OCR prefers to offer guidance and education instead of fines whenever possible.
Yes, there are certain situations where employers are permitted to request medically related information without violating HIPAA. For example, employers can ask a doctor to confirm the medical need for an employee's work absence or review worker's compensation records.
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