The HIPAA Enforcement Rule is a pivotal component of U.S. Healthcare regulation and a rule that empowers the Health and Human Services (HHS) to enforce HIPAA compliance of the Health Insurance Portability and Accountability Act (HIPAA).

The HIPAA Enforcement rules were created to ensure that entities entrusted with sensitive health information adhere to stringent physical, administrative, and technical safeguards. The HIPAA Enforcement Rule delineates the scope, responsibilities, and repercussions for non-compliance with the demands of safeguarding the confidentiality and integrity of patients’ electronic health records and data.

Understanding the intricacies of the rules is crucial when understanding the landscape of healthcare information management and the consequential measures implemented to uphold patient rights. Atlantic.Net is an expert in HIPAA-compliant hosting; join us as this article explains everything you need to know about the HIPAA enforcement rule.

Who is subject to HIPAA rules?

The Enforcement Rule has authority over all Covered Entities, such as healthcare providers, health plans, and clearinghouses, along with any Business Associates responsible for handling or processing Protected Health Information (PHI).

How does the HIPAA Enforcement Rule work?

Compliance with the HIPAA Enforcement Rule is mandatory, and the potential consequences of non-compliance include civil money penalties and legal action for each HIPAA violation. The Office for Civil Rights (OCR) administers compliance reviews, audits, and investigations and is responsible for imposing civil penalties for HIPAA violations.

Recognizing the importance of these privacy and security rules in protecting sensitive health information is a legal obligation and a fundamental step in ensuring the security of individually identifiable health information within the healthcare industry. Efforts toward voluntary compliance and corrective actions are crucial in meeting HIPAA privacy and security rules, preventing breaches, and maintaining HIPAA Compliance.

How the Health and Human Services enforces HIPAA Privacy and HIPAA Security Rules.

Enforcing HIPAA Privacy and Security Rules is the responsibility of the HHS Office for Civil Rights (OCR). When potential violations surface, the OCR investigates alleged breaches to ascertain whether covered entities or business associates have broken the established HIPAA rules and regulations.

The enforcement framework encourages compliance while imposing heavy penalties for persistent non-compliance or violation. Should the OCR uncover violations, it may undertake various actions. For example, the OCR might impose civil monetary penalties in cases of willful neglect or repeated offenses. These HIPAA violation penalties range in severity based on the nature and extent of the violation. Typically, the OCR will mandate a corrective action plan to redress the identified compliance shortcomings.

The HHS Office for Civil Rights seeks to educate covered entities and business associates about HIPAA rules, privacy practices, the Privacy Rule, and security requirements, offering technical assistance and guidance to ensure a better understanding of regulatory affairs. The goal is to foster compliance practices within the healthcare industry to reduce the need for a resolution agreement.

In certain severe cases where violations occur due to deliberate or willful neglect, criminal penalties might be invoked against the covered entity or the business associate. The OCR may collaborate with HHS administrative law judges and law enforcement agencies to address any criminal violations, ensuring that those responsible face appropriate legal consequences.

What does the HIPAA Enforcement Rule include?

First and foremost, it defines the obligations of Covered Entities and Business associates to ensure compliance with HIPAA’s privacy, security, and breach notification rules. The OCR follows a sequence of steps: initiating inquiries based on complaints or disclosures, conducting preliminary reviews, and, if necessary, launching formal investigations involving interviews and record examinations.

Should the OCR find violations, it can impose civil money penalties (CMPs) on the Covered Entity and Business Associate for failing to adhere to HIPAA regulations. The penalties range from $10,000 to $50,000 per violation and are a consequence of severe and willful violations under the HIPAA Enforcement Rule.

As part of its enforcement action, the OCR considers various factors, such as the history of compliance by the Covered Entity and the nature of the violation, providing the Covered Entity the opportunity for corrective action before imposing penalties. In cases of disagreement, an administrative hearing is called for entities to challenge the OCR’s decisions.

How many financial penalties have been imposed for violations of HIPAA?

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) has resolved 140 cases related to HIPAA violations by either reaching settlements or applying civil monetary penalties (CMPs). The total amount involved in these cases stands at $137,018,772.00.

These resolved cases cover a broad spectrum of violations and corrective actions, such as:

  • Unauthorized disclosure of protected health information (PHI): This violation tops the list and involves instances where PHI was shared with unauthorized individuals, groups, or the general public without proper authorization.
  • Neglecting to establish suitable protective measures: This violation encompasses failing to set up adequate policies and procedures to protect PHI from unauthorized access, use, disclosure, tampering, or destruction.
  • Failing to grant individuals access to their PHI: This breach refers to instances where individuals were not provided access to their medical records or were denied timely access as required by HIPAA regulations.

Common HIPAA Violations that trigger HIPAA Enforcement Rule

There are several common violations related to health care providers, to HIPAA’s Privacy and Security Rules. Covered Entities, including health care providers, often unbeknownst to themselves, fall into these violations, leading to criminal provision.

Violations of the Security Rule, which mandates safeguarding ePHI are prevalent. Common violations of the Security Rule include disregarding the HIPAA Privacy Rule, which governs the use and disclosure of individuals’ health information. Healthcare providers occasionally mishandle or disclose this sensitive data without authorization, violating patients’ privacy rights.

The OCR reviews complaints filed, describing alleged violations. They investigate to determine if there’s reasonable cause for a violation. Penalties, including criminal provisions and fines, can be imposed on entities found guilty. Criminal penalties might arise in cases where violations are intentional, especially for personal gain or under false pretenses.

Entities failing to comply with the rules might be required to take improvement initiatives. The HIPAA Omnibus Rule and Interim Final Rule further strengthen provisions relating to patient privacy and security. To avoid penalties and maintain compliance, covered entities must prioritize adhering to the stringent HIPAA regulations and guidelines set by the OCR.

Atlantic.Net HIPAA Complaint Hosting Services

The most cost-effective and successful way to become HIPAA compliant is to outsource to a HIPAA Compliant Hosting provider. Immediately upon onboarding, you will benefit from a service that has matured into a high-security, high-performing, HIPAA-compliant solution that meets and exceeds the mandatory administrative, physical, and technical safeguards of HIPAA.

Upholding the requirements of HIPAA is not an easy task to undertake, and it’s increasingly difficult to maintain compliance if you choose to go it alone. Atlantic.Net is committed to upholding the strict rules outlined in the HIPAA Business Associate Agreement (BAA).

The agreement binds Atlantic.Net and its clients To the HIPAA Privacy and Security Rule when dealing with electronic Protected Health Information (ePHI). All Atlantic.Net data centers are designed with security at the forefront. Strong physical and technical measures like firewalls, IPS systems to stop intruders, and access controls to stop unauthorized entry are in place.

Our systems are tested by external 3rd parties to ensure we keep our platform protected against all possibilities. Atlantic.Net uses encrypted VPNs to make sure data is safe when moving around, preventing others from listening in or taking it, and each customer’s data is protected with separate firewalls for added security.

Reach out to our HIPAA Compliance specialists to open discussions about what Atlantic.Net can do for your health business. Our hosting service and wide selection of HIPAA-compliant managed services are available for you to consume immediately.