Staying up to date with Health Insurance Portability and Accountability Act (HIPAA) rules and regulations is vital for all healthcare organizations. While compliance is necessary for avoiding costly fines, it’s also vital for protecting an organization’s reputation in the face of a breach or lawsuit. A proactive compliance program also reflects an organization’s ethics, making it appealing to high-quality staff members, patients, and the community.

What Constitutes a HIPAA Violation?

HIPAA violations occur when the access, acquisition, disclosure, or use of protected health information (PHI) results in significant patient risk. Examples include:

  • Lack of proper data encryption.
  • System hacking or phishing.
  • Unauthorized access to patient information.
  • Theft or loss of electronic devices.
  • Information sharing.
  • Improper patient information disposal.
  • Accessing data from an unsecured location.

HIPAA Violation Classifications

The consequences for breaking a HIPAA rule depend on the violation’s severity. While minor violations might involve training, education or meeting compliance standards, more severe infractions can incur significant financial penalties. The four penalty structures include:

  • Tier 1: These violations typically involve an employee without HIPAA knowledge in a situation that was likely unavoidable.
  • Tier 2: Tier 2 violations surround an employee with knowledge of the rules. This tier is also known as reasonable cause.
  • Tier 3: This tier involves violations from willful neglect in cases where the employee has attempted to correct the violation.
  • Tier 4: Tier 4 constitutes willful neglect with no attempt to correct the violation.

What Happens If Your Organization is Not HIPAA Compliant?

Each violation tier typically incurs a separate HIPAA penalty. The Office for Civil Rights (OCR) considers multiple factors when determining penalties like the length of time a violation persisted, the nature of the breached data, and the number of people affected. The OCR also takes into consideration the organization’s willingness to cooperate and assist in the investigation.

The fines for each tier rise for multiple violations of the same type. The penalties are as follows:

  • Tier 1: A minimum $100 fine per violation up to $50,000.
  • Tier 2: A minimum $1,000 fine per violation up to $50,000.
  • Tier 3: A minimum $10,000 fine per violation up to $50,000.
  • Tier 4: A minimum $50,000 fine per violation.
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