Most times, national recognition feels like a good thing. But if you’re one of the 300,000+ companies investigated by the federal government for breaking HIPAA compliance, the spotlight probably doesn’t feel as nice.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a set of standards designed to protect patient privacy.
Any company that collects, shares, or receives protected health information (PHI) is required to maintain HIPAA compliance, regardless of what they use the data for. However, HIPAA certifications are most commonly found within the healthcare industry.
While every member of an organization plays a role in keeping the company HIPAA compliant, IT departments shoulder much of the responsibility. To remain compliant organizations must follow three major IT rules:
- Systems storing PHI must automatically log users out after a certain period of time to prevent unauthorized access.
- Organizations must provide a unique login for anyone with access to PHI. The login can be audited based on individual usage.
- All PHI must be encrypted.
But what happens if you don’t follow these rules? And how do you know if you’re following them in the first place?
In this blog post, we’ll discuss the dangers organizations face for not following HIPAA’s compliance guidelines, the most common reasons for becoming non-compliant, and how to make sure your organization stays within the guidelines.
The Costs of HIPAA Non-Compliance
Let’s start with the scary stuff — what could happen if you aren’t HIPAA compliant? Quite a lot, actually. From jail time to hefty fines, here’s what organizations can expect if they don’t follow the rules.
Fines and Penalties
Non-compliance with HIPAA can lead to considerable civil monetary penalties (CMPs). These punishments are meant to warn other HIPAA-regulated organizations that non-compliance will not be tolerated. Fines for violating HIPAA compliance depend on the severity of the offense, but often range from $100 to $50,000 per violation.
The Department of Health and Human Services (HHS) Office for Civil Rights investigates all data breaches of 500 or more records — as well as some smaller breaches — to determine if they were caused by non-compliance with HIPAA. They then issue fines accordingly. State Attorneys General also have the authority to hand down civil monetary penalties for HIPAA violations.
In addition to financial penalties, individuals found guilty of HIPAA-related criminal offenses may face up to ten years in jail, plus two years if the case involves identity theft.
Lawsuits
Many times, non-compliance can lead to legal proceedings and investigations, both of which require organizations to pay significant legal fees. While organizations cannot be sued solely for a HIPAA violation, the individuals affected by healthcare data breaches can take legal action against the organization for violations of state consumer privacy and data protection laws.
Class action lawsuits have become increasingly common as well, with companies getting hit with attorney and settlement fees in the millions. CaptureRx, a third-party pharmacy management system, ended up paying a $4.75 million settlement following a 2021 data breach that resulted in multiple class-action lawsuits.
Data Breaches
Lack of adherence to HIPAA regulations can often directly lead to data breaches, as non-compliance increases the risk of cyberattacks and unauthorized access to patient information. Non-compliance with HIPAA can also result in inadequate incident response planning, making it less likely that the company will be able to quickly detect and mitigate breaches.
Healthcare organizations process a significant amount of sensitive information, which in turn makes them prime targets for cyber criminals. In 2023, more than 133 million patient records were exposed. Using outdated IT systems only increases the risk of phishing and ransomware attacks, and criminals seek out organizations with vulnerable defense systems. Data breaches can cause significant reputational damage for organizations, as patients lose trust in their healthcare provider and choose to seek treatment elsewhere.
Increased Oversight
Non-compliance with HIPAA can lead to increased regulatory oversight from the federal government’s Office of Civil Rights and other relevant authorities. While the most serious violations result in civil monetary penalties, some instances may require organizations to implement a Corrective Action Plan (CAP). These plans are meant to address deficiencies, resolve issues, and prevent future HIPAA violations — but they can also cost an organization ample time and money to put in place.
The federal government may also take note of a company’s HIPAA violations. Healthcare organizations that rely on government programs like Medicare and Medicaid risk losing critical funding if they fail to comply with HIPAA regulations.
Damaged Reputation
Trust and credibility mean everything in healthcare, and a breach of patient privacy can severely damage public perception. If patients don’t believe their healthcare providers can keep their sensitive information secure, they may choose to look elsewhere for treatment. Other potential partners or employees may end up severing ties if an organization has a history of non-compliance.
What Causes Healthcare Organizations to Become Non-Compliant
Knowing the risk of failing HIPAA compliance might have you believing that healthcare organizations place all items HIPAA related at the top of their daily to-do lists. But in actuality, it’s incredibly easy to slip into non-compliance. Shockingly, the U.S. Department of Health and Human Services has found organizations non-compliant with HIPAA in 70 percent of its investigations. Here are some of the top reasons organizations become non-compliant:
Lack of Comprehensive Privacy Policy
To obtain — and maintain — HIPAA certification, organizations need to create a robust privacy policy that clearly states the types of patient data being collected, why the organization is gathering this information, and how this information will be used and stored within the organization. The privacy policy also needs to inform patients of their rights regarding their PHI, which includes the right to access and amend their records, as well as the right to request restrictions on the use or disclosure of their data.
Additionally, the policy should outline the security measures the organization has in place to protect patient information. This could include both physical safeguards, like locked file cabinets and restricted access to certain areas, and technical safeguards, such as encryption and firewalls. Finally, the policy needs to address employee training and education on data security practices to ensure the entire organization understands the importance of ongoing compliance.
Implementing New Technologies
With electronic health records, wearable devices, and telemedicine all becoming increasingly common in healthcare, IT departments are having to introduce new technologies into the workplace to streamline and optimize their workflow. However, they might not know if the new systems follow HIPAA’s compliance guidelines. While many products and services openly state whether or not they can help you maintain compliance, it’s important for organizations to do their own research to determine if they are following the most up-to-date procedures.
Keeping Improper Records
Due to the technical safeguards of the HIPAA Security Rule, IT security system reviews are considered HIPAA-related documents. This means organizations are required to retain records of IT security system reviews for a minimum of six years. These reviews show how the organization has continuously enforced IT security measures (like password policies and automatic log-off) and audit controls, even if the systems aren’t being used to access PHI.
Neglecting HIPAA Compliance Entirely
HIPAA certification does not have an official expiration timeframe. However, most third-party auditors will only issue certifications that are valid for one year. It can be easy to let your HIPAA certification fall to the backburner, but it’s critical to continuously adapt compliance programs to match the current best practices. Healthcare organizations often have limited staff, whose attention may be torn between other tasks like providing care, updating records, and growing the practice. This could prevent organizations from keeping compliance at the forefront — and that could cost them.
5 Tips to Remaining HIPAA Compliant
HIPAA compliance is more than just checking a box and forgetting about it — maintenance requires just as much time and effort. Here are a few tips to help keep your organization HIPAA compliant:
- Complete Routine Risk Assessments
Healthcare organizations should conduct annual risk assessments to identify any potential vulnerabilities and areas of non-compliance. Use the results of the assessments to implement the appropriate technical safeguards and controls to mitigate risks and further protect your organization’s PHI. - Regularly Review Your Security Measures
There’s no way to 100% prevent a data breach from happening, but regularly reviewing and updating your security measures will reduce the risk of a breach and becoming non-compliant. Healthcare organizations should continuously monitor their systems to remain compliant and simplify the process of identifying any security incidents early on. - Establish an Incident Response Plan
Having a strong incident response plan will keep your organization informed of which steps to take should a data breach occur. This plan should include actions like notifying affected individuals and regulatory authorities, conducting internal investigations, and implementing corrective actions as soon as possible. - Create a Privacy Policy
To ensure HIPAA compliance, organizations must create a robust privacy policy to serve as a guide on how to collect, use, and protect patient information. Your privacy policy should serve as a double-edged sword, as it both helps maintain compliance with HIPAA regulations and builds trust with organizations by showing them your commitment to safeguarding their confidential information. - Stay Informed
Make sure to stay informed about changes in HIPAA regulations and best practices so that your organization is always following the most current guidelines and requirements.
Need Help Remaining Compliant?
With IT teams already stretched thin, maintaining compliance of any kind can require more resources than healthcare organizations have access to internally.
Having worked with caregivers, specialty clinics, hospitals, and admin staff for over 30 years, our team at ISG knows how important technology is when it comes to providing top-notch patient care.
Our comprehensive IT services for healthcare makes it possible for healthcare providers to monitor security threats, protect sensitive patient information, and respond quickly should an event occur. By partnering with ISG, you’ll have a skilled team with decades of experience in your corner, protecting your healthcare organization from cyber attacks and data breaches. Offload some of your worries onto us and allow your IT resources to focus on producing better patient care.
Learn more about how ISG can help you stay compliant with regulations.