12 Apr, 2023

Health Insurance Portability and Accountability Act (HIPAA)

Compliance and Governance Service

Helps organizations meet regulatory requirements and industry standards.

Healthcare information of a patient is crucial for providing appropriate medical care and treatment. It includes a patient’s medical history, diagnoses, treatments, medications, and test results, among other things. This information is typically stored in electronic health records (EHRs) or paper-based records, and it is shared among healthcare providers to ensure that patients receive the best possible care. 

However, healthcare information is also sensitive and personal, and its confidentiality must be safeguarded. The security of healthcare information is more vital than ever due to the increasing use of digital systems for managing and sharing patient data. 

Safeguarding the security of healthcare information is essential to protect patient privacy and prevent unauthorized access, theft, or misuse of this data. When healthcare information falls into the wrong hands, it can lead to identity theft, insurance fraud, and other types of criminal activity. It can also harm patients by exposing their medical conditions, treatments, and other sensitive information to unauthorized individuals. This is why the Health Insurance Portability and Accountability Act (HIPAA) was introduced. In this article we will discuss HIPAA and its implications in deep detail. 

What is HIPAA? 

HIPAA (Health Insurance Portability and Accountability Act) is a federal law in the United States that sets national standards for protecting the privacy and security of individuals’ health information. HIPAA applies to covered entities, which include healthcare providers, health plans, and healthcare clearinghouses, as well as their business associates who handle health information on their behalf. The law provides patients with certain rights regarding their health information, including the right to access, request corrections to, and control the use and disclosure of their health information. It also requires covered entities to implement administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and availability of health information. 

Objectives of HIPAA 

The objectives of HIPAA (Health Insurance Portability and Accountability Act) are to protect the privacy and security of individuals’ health information and to improve the efficiency and effectiveness of the healthcare system. Specifically, HIPAA aims to: 

1. Improve the portability and continuity of health insurance coverage for individuals who change or lose their jobs. 

2. Set national standards for the electronic exchange of healthcare information to improve the efficiency and effectiveness of healthcare delivery. 

3. Protect the privacy and security of individuals’ health information by establishing rules for the use and disclosure of protected health information (PHI). 

4. Provide individuals with certain rights regarding their PHI, including the right to access, request corrections to, and control the use and disclosure of their health information. 

5. Ensure that covered entities implement administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of PHI. 

6. Establish civil and criminal penalties for violations of HIPAA’s privacy and security rules. 

What is Protected Health Information (PHI)? 

Protected Health Information (PHI) is any information about a patient’s health status or healthcare that can be linked to them. This information is created, received, maintained, or transmitted by a covered entity or a business associate of a covered entity. 

PHI includes a wide range of health information, such as medical records, laboratory test results, medical images, and billing and payment information. It also includes any other information that identifies the patient or can be used to reasonably identify them, such as their name, address, birth date, social security number, and other identifying information. 

Under HIPAA, covered entities and their business associates are required to protect the confidentiality, integrity, and availability of PHI. They must use administrative, physical, and technical safeguards to prevent unauthorized access, use, or disclosure of PHI. Covered entities and their business associates must also obtain written authorization from the patient before using or disclosing their PHI, except in certain circumstances, such as for treatment, payment, or healthcare operations. 

What entities are affected by HIPAA? 

HIPAA applies to “covered entities” and their “business associates” who handle “protected health information” (PHI). 

Covered entities are defined as: 

• Health plans: This includes group health plans, health insurance issuers, HMOs, Medicare, and Medicaid. 

• Healthcare providers: This includes doctors, hospitals, clinics, pharmacies, dentists, chiropractors, and other healthcare providers who transmit PHI electronically. 

• Healthcare clearinghouses: This includes entities that process nonstandard health information into a standard format, such as billing services or claims processing. 

Business associates are defined as any entity or person that performs a function or service on behalf of a covered entity that involves the use or disclosure of PHI. This can include: 

• Third-party administrators: This includes entities that manage or administer health plans, such as claims processing or utilization review. 

• Data storage providers: This includes entities that store or maintain PHI, such as cloud storage providers. 

• Consultants and contractors: This include individuals or companies that provide services to covered entities, such as IT support or legal services. 

• Other subcontractors: This includes individuals or companies that perform services on behalf of business associates, such as subcontractors of a cloud storage provider. 

Covered entities and their business associates must comply with HIPAA’s Privacy, Security, and Breach Notification Rules. They must implement administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of PHI. They must also obtain written authorization from the patient before using or disclosing their PHI, except in certain circumstances, such as for treatment, payment, or healthcare operations. 

What are the standards for HIPAA compliance? 

The regulation sets several compliance requirements for covered entities and their business associates who handle protected health information (PHI). These requirements are intended to ensure the confidentiality, integrity, and availability of PHI and to protect patients’ rights to privacy and security of their health information. The primary compliance requirements under HIPAA include: 

Privacy Rule: The HIPAA Privacy Rule governs the use and disclosure of PHI by covered entities and their business associates. This rule requires entities to obtain written authorization from the patient before using or disclosing their PHI, except in certain circumstances, such as for treatment, payment, or healthcare operations. The Privacy Rule also requires entities to provide patients with notice of their privacy practices, and to implement administrative, physical, and technical safeguards to protect the confidentiality of PHI. 

Security Rule: The HIPAA Security Rule requires covered entities and their business associates to implement administrative, physical, and technical safeguards to protect the confidentiality, integrity, and availability of electronic PHI (ePHI). This rule outlines specific security standards that entities must meet, such as access controls, encryption, and audit controls, to protect ePHI from unauthorized access or disclosure. 

Breach Notification Rule: The HIPAA Breach Notification Rule requires covered entities and their business associates to notify patients and the Department of Health and Human Services (HHS) of any breach of unsecured PHI. This rule outlines the specific requirements for breach notification, including the timing and content of the notification. 

Enforcement Rule: The HIPAA Enforcement Rule outlines the procedures and penalties for enforcing HIPAA’s Privacy, Security, and Breach Notification Rules. This rule establishes civil and criminal penalties for violations of HIPAA and outlines the procedures for investigating and resolving complaints. 

How to comply with HIPAA? 

Complying with HIPAA can be a complex process that involves implementing a range of administrative, physical, and technical safeguards to protect the PHI from breach. The following steps can help covered entities and their business associates comply with HIPAA: 

Conduct a risk assessment: Covered entities and their business associates should conduct a risk assessment to identify potential threats concerned with PHI. This includes assessing risks to electronic PHI (ePHI), such as from cyber-attacks, as well as risks to physical PHI, such as from theft or loss. 

Develop and implement policies and procedures: Based on the results of the risk assessment, covered entities and their business associates should develop and implement policies and procedures to protect the privacy and security of PHI. This includes policies and procedures for accessing and using PHI, training on HIPAA requirements, and implementing security measures to protect PHI. 

Train workforce members: Covered entities and their business associates must train their workforce members on HIPAA’s requirements. This includes training on how to handle PHI, how to recognize and report breaches, and how to implement security measures to protect PHI. 

Implement physical and technical safeguards: Covered entities and their business associates must implement physical and technical safeguards to protect PHI. This includes implementing access controls, encryption, and other security measures to prevent unauthorized access to ePHI. 

Develop a breach response plan: Covered entities and their business associates must have a breach response plan in place to identify and report breaches of unsecured PHI. This includes conducting a risk assessment to determine if a breach has occurred, notifying patients and the Department of Health and Human Services (HHS) of the breach, and implementing measures to prevent future breaches. 

Monitor compliance: Covered entities and their business associates should regularly monitor their compliance with HIPAA’s requirements. This includes conducting periodic risk assessments, reviewing policies and procedures, and conducting audits of their security measures. 

Who is qualified to examine the HIPAA standards’ compliance? 

HIPAA compliance can be examined by several entities, including covered entities themselves, their business associates, and government agencies such as the Department of Health and Human Services (HHS), the Office for Civil Rights (OCR), and the Centers for Medicare & Medicaid Services (CMS). 

Covered entities and business associates are responsible for ensuring that they comply with HIPAA’s requirements and can conduct internal audits and risk assessments to identify potential vulnerabilities and gaps in their compliance efforts. 

In addition, the HHS, OCR, and CMS have the authority to audit and investigate covered entities and business associates to ensure their compliance with HIPAA’s requirements. These government agencies may request documentation, interview staff members, and conduct on-site inspections to verify compliance. If an entity is found to be in violation of HIPAA, they may be subject to penalties and fines. 

It’s important to note that HIPAA compliance is an ongoing process, and covered entities and their business associates should regularly review and update their policies and procedures to ensure continued compliance. 

Is there any certification offered to verify HIPAA compliance? 

While there is no official HIPAA certification, there are various certifications and audits that can help organizations demonstrate their HIPAA compliance. 

One such certification is the Certified HIPAA Privacy Security Expert (CHPSE) offered by the Compliance Certification Board (CCB). This certification is designed for individuals who have expertise in HIPAA privacy and security regulations and can help organizations demonstrate that their workforce members are knowledgeable in HIPAA compliance. 

Another certification is the HITRUST Common Security Framework (CSF) certification. HITRUST is a widely recognized security framework that includes HIPAA requirements as well as other security standards. The HITRUST CSF certification can help organizations demonstrate compliance with HIPAA and other security standards. 

In addition to certifications, organizations can also undergo audits by third-party auditors to assess their HIPAA compliance. These audits can help identify any potential vulnerabilities and provide recommendations for improving compliance efforts. 

It’s important to note that while certifications and audits can help demonstrate compliance, they are not a guarantee of compliance. Covered entities and their business associates are ultimately responsible for ensuring that they comply with HIPAA’s requirements and should regularly review and update their policies and procedures to ensure continued compliance. 

What are the most common HIPAA Violations? 

There are several common HIPAA violations that occur in the healthcare industry. Some of the most common violations are: 

• Unauthorized access to protected health information (PHI): This occurs when an individual accesses PHI without a valid reason or authorization. For example, a healthcare provider may access the medical records of a celebrity out of curiosity or for personal gain. 

• Disclosure of PHI to unauthorized individuals: This occurs when PHI is shared with individuals who are not authorized to receive it. For example, a healthcare provider may disclose a patient’s medical condition to a family member or friend without the patient’s authorization. 

• Failure to secure PHI: This occurs when PHI is not adequately protected from unauthorized access or disclosure. For example, a healthcare provider may leave a patient’s medical records on an unsecured desk or computer, making them accessible to unauthorized individuals. 

• Improper disposal of PHI: This occurs when PHI is not disposed of properly, which can result in unauthorized access to PHI. For example, a healthcare provider may throw away a patient’s medical records in a regular trash can instead of using a secure shredding or disposal method. 

• Failure to provide patients with access to their PHI: This occurs when patients are not provided with access to their medical records or other PHI. For example, a healthcare provider may deny a patient’s request to access their medical records. 

• Failure to notify patients of a breach of PHI: This occurs when patients are not notified of a breach of their PHI in a timely manner. For example, a healthcare provider may fail to notify patients that their medical records were stolen in a data breach. 

These are just a few examples of common HIPAA violations. It’s important for healthcare providers and covered entities to understand and comply with HIPAA regulations to avoid these violations and protect patients’ privacy and security. 

What are the penalties for non-compliance with HIPAA? 

Failure to comply with HIPAA can result in significant penalties, including: 

• Civil penalties: The Department of Health and Human Services (HHS) can impose civil monetary penalties ranging from $100 to $50,000 per violation, with an annual maximum of $1.5 million for repeat violations of the same provision. 

• Criminal penalties: Willful neglect of HIPAA can result in criminal penalties, ranging from fines of up to $250,000 and/or imprisonment for up to 10 years. 

It’s important for healthcare organizations to take HIPAA compliance seriously to avoid these penalties and protect the privacy and security of their patients’ health information. 

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