The Purpose of HIPAA Regulations and Why They Matter
If your organization employs health workers that use, process, or handle patient health information, they should comply with HIPAA regulations. Indeed, malicious or unintentional misuse of HIPAA-protected patient data can result in severe penalties for the organization.
Our guide details the purpose of HIPAA regulations, lists the most common violations to avoid, and reviews the probable violation penalties. That way, we give you information to help your organization and healthcare workers remain HIPAA compliant.
Highlights
- HIPAA, the Health Insurance Portability and Accountability Act, aims to prevent unauthorized access to patient health information, which includes 18 identifiers such as names, email addresses, social security numbers, and more.
- Covered entities under HIPAA include health plans, healthcare providers, and healthcare clearinghouses. Business associates who perform functions or services involving access to PHI are also required to comply with HIPAA regulations.
- The three central HIPAA compliance rules are the Privacy Rule, Security Rule, and Breach Notification Rule.
What is HIPAA?
HIPPA is an acronym for the Health Insurance Portability and Accountability Act of 1996.
The purpose of HIPAA regulations is to prevent unauthorized access or misuse of protected health information (PHI).
The standard protected health information falls into 18 main categories, also known as HIPAA identifiers:
- Names
- Email addresses
- Physical addresses
- Fax numbers
- Phone numbers
- Account numbers
- Social security numbers
- Health record numbers
- Health plan beneficiary numbers
- License or certificate numbers
- Web URL
- IP addresses
- Fingerprints and voice prints
- Personal device serial numbers and identifiers
- Auto serial numbers and identifiers
- Individual photographic images
- All unique elements identifiable to an individual, except years
- Any other unique characteristics identifiable to an individual
The HIPAA Compliance Rules
HIPAA policies and compliance rules are designed to keep the 18 PHIs from being lost, stolen, or misused.
That is, they protect patient data privacy, integrity, and security. The HIPAA compliance rules fall into three main categories:
Privacy Rule
The HIPAA Privacy Rule requires organizations that deal with HIPAA identifiers to limit unauthorized data disclosure.
Instead, it instructs these organizations to inform patients whenever they plan to use their data in upcoming medical research or products. The organizations are obliged to share the gathered data with the respective patients if requested.
Security Rule
The Security Rule defines the administrative, technical, and physical safeguards organizations have to implement to protect patient data. These safeguards vary depending on the nature of PHIs and the risk of exposure to unauthorized access.
Breach Notification Rule
Finally, the breach notification rule guides organizations on how to react and who to inform in the event of a data breach.
Who Is Covered by HIPAA Privacy and Security Rules?
The HIPAA Privacy and Security Rules apply to entities defined as covered entities, which include:
- Health Plans: These include health insurance companies, health maintenance organizations (HMOs), company health plans, and government programs that pay for health care, such as Medicare, Medicaid, and military and veterans' health programs.
- Health Care Providers: This encompasses physical or mental health providers who conduct certain financial and administrative transactions electronically, such as electronic billing and fund transfers. These include doctors, clinics, psychologists, dentists, chiropractors, nursing homes, pharmacies, and others who transmit health information in electronic form in connection with transactions for which the Department of Health and Human Services (HHS) has adopted standards.
- Health Care Clearinghouses: These are entities that process nonstandard health information they receive from another entity into a standard (i.e., standardized electronic format or data content) or vice versa. Examples include billing services and community health management information systems.
In addition to covered entities, the rules also extend to what are known as "business associates." These are persons or entities, other than a member of the workforce of a covered entity, who perform functions or activities on behalf of, or provide certain services to, a covered entity that involve access to protected health information (PHI).
The Privacy Rule requires that covered entities and their business associates enter into contracts to ensure that the business associates safeguard the PHI they receive or create on behalf of the covered entities. Business associates themselves can also be directly liable for compliance with certain provisions of the HIPAA Rules.
Penalties for Violating HIPAA Compliance Rules
Organizations that do not comply with HIPAA rules risk paying hefty fines along with operational, reputational, and financial losses. The HIPAA Journal estimates these settlements to be between $100 and $50,000 per violation, depending on the risk.
Apart from the outright targeting of healthcare organizations by hackers and data thieves, most of the violations of HIPAA compliance rules are due to mistakes by health workers in the course of their practice.
The highest penalty for non-compliance with HIPAA requirements was in 2018 when Anthem, Inc. was charged a $16 million fine for the largest health data breach in history.
Six Most Common Causes of HIPAA Violations
Here are the six most common triggers of HIPAA violations you should know and avoid:
1. Inadequate Employee Training
Did you know that recent surveys show that up to 24% of healthcare workers lack proper training on HIPAA regulations and compliance? The lack of employee education increases the chances of them violating these regulations.
2. Improper Records Handling
Mishandling patient records exposes HIPAA identifiers to misuse. Health institutions using manual data capture systems are more susceptible to unauthorized access. Yet, simple measures like digitizing medical records and creating strong computer passwords can safeguard patient health information.
3. Adoption of Obsolete or Insecure Technologies
Healthcare institutions should stay abreast of technological advancements and avoid preventable medical breaches. Likewise, they should update their servers with antiviruses, anti-malware, and firewall software to protect medical records from hackers, malware, scammers, and authorized staff.
4. Authorization and Patient Signature
Ideally, healthcare workers can use and disclose PHI via written consent from an authorized person, especially if the requesting individual does not intend to use the medical records for treatment, healthcare operations, or payment.
5. Releasing Wrong Patient Information
The healthcare environment has demanding shifts, leading to worker fatigue. When this happens, a healthcare worker may make critical mistakes, like releasing patient information to the wrong person.
6. Poor Disposal of PHI
How does your medical institution get rid of unwanted patient health information? Whereas we do not expect anyone to search the garbage bins for PHI, organizations should opt for permanent data disposal options like shredding sensitive paper records and wiping hard drives.
Frequently Asked Questions
Who’s Responsible for Administering and Enforcing HIPAA Standards?
HIPAA standards are administered and enforced by the Department of Health and Human Services, Office for Civil Rights (OCR). As such, it may conduct complaint investigations and compliance reviews.
What Are the Three Main Purposes of HIPAA?
The three main purposes of HIPAA are:
- Providing users access to their individually identifiable health information and controlling its use.
- Standardizing the exchange of electronic protected health information.
- Protecting the security and confidentiality of health records.
Conclusion
The purpose of HIPAA regulations is to guide organizations whose healthcare workers deal with the 18 PHIs in protecting sensitive patient data from misuse. In turn, organizations should exercise due diligence when handling protected health information.
Better still, they should require their employees to sign and abide by the HIPAA Employee Confidentiality Agreement. Otherwise, they can face hefty penalties for violating any HIPAA regulations.
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