As a healthcare-focused organization, you must take patient privacy very seriously. Everyone who turns to you for care or insurance is trusting you with a lot of sensitive personal information, and they’re counting on you to keep that information safe.
HIPAA rules give healthcare organizations a clear set of rules to follow to protect patient privacy. HIPAA compliance is essential, and failure to comply can result in serious consequences. Use our HIPAA compliance checklist to ensure your compliance and learn how Mosey can help you ensure business compliance.
What Is HIPAA?
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was a first-of-its-kind federal law designed to protect patient privacy. HIPAA enforces standards to safeguard personal medical information about patients as collected by or reviewed by healthcare providers.
The United States Department of Health and Human Services (HHS) created HIPAA to address a lack of confidentiality surrounding patients. Prior to HIPAA, nearly anyone could ask for or obtain medical information about a person without proper permission or designation to do so.
The HIPAA Privacy Rule requires mandated businesses or healthcare providers to abide by set standards for the security and confidentiality of protected healthcare information (PHI).
Protected healthcare information needs to be handled appropriately, but access cannot be so restricted that other members of someone’s healthcare team cannot access the information they need to make an informed diagnosis or provide treatment.
HIPAA facilitates secure healthcare communications between care providers while shielding information from third-party entities that don’t have an essential reason to access someone’s protected healthcare information.
What Are the Requirements of HIPAA?
HIPAA outlines what medical care providers are required to do, but it doesn’t necessarily provide strict guidelines for how HIPAA goals are to be achieved. As long as someone who has access to someone’s personal healthcare information meets the requirements of the Privacy Rule, it doesn’t matter how they choose to implement privacy measures.
Information protection measures simply need to be effective enough to withstand the test of the rules.
All personal healthcare information must be kept secure, accurate, and confidential. Records must be available upon request from a patient’s other healthcare providers, which means that digital records are necessary for secure transmission.
Healthcare data needs to be protected against threats. Secure online storage is necessary. Most organizations that store healthcare data would benefit from secure backups and a data disaster recovery plan in the event of a data breach.
Have a plan to prevent unauthorized usage, collection, or data requests that would violate the HIPAA Privacy Rule. Understanding and anticipating data threats or fraudulent requests can prevent the unauthorized dissemination of private healthcare information.
Train all employees in HIPAA compliance. It’s easy to accidentally make an error that can lead to a HIPAA violation. Employees need to understand how to vet the legitimacy and necessity of requests for private healthcare information and the proper channels to disclose information when a legitimate request is made.
Who Needs To Comply With HIPAA?
HIPAA only applies to certain entities that would have access to healthcare information as a major part of their function. These types of businesses, called covered entities, are the only entities specifically bound to the HIPAA Privacy Rule.
Healthcare Providers
All healthcare providers that transmit information are bound to HIPAA privacy laws. This includes cosmetic medicine and alternative healthcare practitioners as well as conventional medical care providers.
Health Plan Providers
Any insurance company or private arrangement that offers health care benefits is bound to patient privacy standards. This includes all types of health insurance providers, including plans for vision or dental. Health plan provider rules apply to government-sponsored and employer-sponsored insurance as well as privately purchased insurance.
Business Associates of Covered Entities
Some healthcare providers or policy providers utilize third-party services for analytics, billing, and processing. Any third parties associated with covered entities must uphold the same responsibilities as covered entities when handling personal health care information. Note that there are dedicated third-party services that specifically work with HIPAA-covered entities.
Healthcare Clearinghouses
Anyone who processes healthcare data that contains specific individual patient information rather than anonymized or redacted statistics must regard that information with care for HIPAA rules. Healthcare clearinghouses should use practices similar to those of other business associates of covered entities.
When Can Healthcare Data Be Shared Without Someone’s Consent?
Healthcare data can be shared without someone’s express consent when required by law or law enforcement, such as when data is necessary to solve a crime (like domestic violence or spousal abuse) or to submit a Workers’ Compensation case.
Data can be shared postmortem to identify a deceased person or to assist with organ donation.
In some cases, healthcare data can be shared in the interest of public health or safety or to prevent a danger to others. For example, if someone has a highly communicable deadly disease and they are knowingly putting others at risk, a healthcare provider can share that information for the safety of others.
General anonymized statistical healthcare data can be shared for public health insights. For example, a clinic can state how many new cases of hepatitis they’ve diagnosed in a year as long as they don’t release names or identifying information about the people they’ve diagnosed.
What Are the Consequences of Failing To Comply With HIPAA?
There are criminal and civil HIPAA violations:
Civil HIPAA Violations
Civil violations are most common and are usually due to a misunderstanding or ignorance of the HIPAA guidelines. Examples can include the following:
Someone is unaware they have violated HIPAA rules even after due diligence (i.e. an uninformed employee) — minimum $100 fine, maximum $25,000 in fines per year.
Someone had a reasonable cause for violation, and the disclosure was not willfully neglectful — minimum $1,000 fine, maximum of $100,000 in fines per year.
Willful neglect of HIPAA laws during disclosure violation, but the disclosing party made an attempt to reconcile the situation — minimum $10,000 fine, maximum of $250,000 in fines per year.
The disclosure was made through willful neglect, and the disclosing party did not attempt to reconcile the situation — minimum $50,000 fine, maximum of $1.5 million in fines per year
Criminal HIPAA Violations
Criminal violations occur when someone blatantly and deliberately misuses personal information without a clear cause. Examples include:
Deliberately obtaining or disclosing HIPAA-protected information without consent — $50,000 fine and up to one year in jail.
Fraudulently obtaining HIPAA-protected information or accessing information through false pretenses — $100,000 fine and up to five years in prison.
Obtaining HIPAA-protected information for personal gain, blackmail, or other malicious purposes — $250,000 fine and up to ten years in prison.
Criminal HIPAA violations are treated very seriously, and civil violations can come with penalties high enough to significantly damage a small business. It’s important to carefully respect all HIPAA rules to avoid a significant fallout from non-compliance.
HIPAA Compliance Checklist
If your organization is a HIPAA entity, it’s a good decision to streamline the process of compliance and security maintenance. Having a clear picture of the type of data you handle, who will be responsible for overseeing that data, and how you will keep that data secured can help to avoid leaks or breaches that can compromise the safety of your clients or patients.
Outline Data That Requires Protection
Make an inventory of each type of HIPAA-protected data you collect. Have clear definitions of what is considered to be protected and how certain information should be protected. Teach everyone who has access to data how to be mindful of sensitive data.
Hire a HIPAA Officer
A HIPAA officer is a dedicated professional who will ensure full-time compliance with HIPAA laws. This person’s presence should relieve your workplace of some weight and responsibility. With an expert on staff, you’ll have fast access to best practices and crucial information.
Create a Data Roadmap
Protected healthcare data will travel around your business and sometimes to other relevant businesses as part of patient care, billing, or referrals. Each stop along the way poses a potential security threat.
Having a clear outline of where data can be sent and how it can be received can help you identify security risks that may occur in transit. It can also prevent people from accidentally sending data through unsecured channels.
Implement Security Measures
Cybersecurity is an absolute necessity for all businesses that collect data or process payments. If you collect HIPAA-protected data, it’s important to be sure that your cybersecurity strategy meets the latest standards and is prepared to handle all known or imminent types of data attacks.
Establish a Notification System
If a HIPAA policy is violated, you need a system in place to notify individuals who may have been impacted. Promptly notifying victims of a data breach or people whose information may have been mishandled can reduce your liability if you face HIPAA noncompliance penalties.
It’s a wise business decision to always have your notification system ready to go. Consider creating a template you can fill out quickly and immediately send to people in the event of a data breach or information leak.
Do You Need Assistance With Compliance?
Businesses in the healthcare industry are subject to many regulations and compliance issues. Federal and state compliance issues are equally important. Mosey’s compliance automation dashboard can track state and local compliance tasks that impact your business.
You can focus on providing excellent care and improving patient experience while Mosey’s compliance platform works in the background to help you keep track of technicalities. Schedule a demo with Mosey to learn how we can simplify your healthcare business.
