Organizations within and adjacent to healthcare must comply with the HIPAA Rules to safeguard the privacy, confidentiality, and integrity of protected health information (PHI). Part of this compliance process requires reporting HIPAA violations promptly when they occur. Read on to learn all about HIPAA violation reporting and how it can protect the PHI you handle.
Breakdown of the Process for HIPAA Violation Reporting
HIPAA violation reporting is critical to minimizing the rate at which PHI is mishandled across your organization. However, this process is only effective when compliant with the HIPAA guidelines and your specific security policies. To demystify the process, this blog will cover:
- An overview of the HIPAA Rules pertaining to violations and reporting
- A guide to optimizing existing processes for reporting HIPAA violations
Implementing a robust process for HIPAA violation reporting will help you keep PHI safe from and avoid costly violation penalties, especially when guided by a HIPAA compliance advisor.
What Constitutes a HIPAA Violation?
Any procedure, process, or incident that poses risks to the privacy and integrity of PHI may be considered a HIPAA violation. However, the most accurate way to define these violations is to review the HIPAA guidelines, including those for HIPAA violation reporting.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) was established to standardize the safeguards for PHI in all contexts. HIPAA comprises four Rules, namely:
- The Privacy Rule, which defines the permitted uses and disclosures covered entities and their business associates must follow. Covered entities include:
- Health plans, which handle payments for healthcare services
- Healthcare providers, who deliver medical services at designated facilities
- Healthcare clearinghouses, which are contracted by other covered entities to standardize non-standard data
- The Security Rule, which lists the recommended controls for covered entities to safeguard electronic PHI (ePHI), including:
- Administrative safeguards, which oversee the implementation of security controls
- Physical safeguards, which keep physical locations of PHI safe
- Technical safeguards, which minimize cyber risks to electronic PHI (ePHI)
- The Breach Notification Rule, which stipulates the guidelines for covered entities and their business associates to report HIPAA violations.
- The Enforcement Rule, which outlines the non-compliance penalties associated with potential violations of the HIPAA Rules.
Any failure to follow any stipulation of the Privacy or Security Rules may constitute a breach, and any data breach that is not reported may constitute a violation, per the Enforcement Rule.
If you handle PHI during your business transactions, you may be required to comply with HIPAA. Non-compliance may put you at risk for breaches and HIPAA violation penalties.
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Examples of HIPAA Violations
Before you report a violation, you must determine the types of incidents considered violations. Per the HIPAA Privacy and Security Rules, prime examples of HIPAA violations may include:
- Disclosure of PHI without the data subject’s written authorization for reasons other than:
- Treatment of the data subject
- Processing payment for healthcare services
- Transactions involving healthcare operations
- Permitted uses and disclosures of PHI
- Poor access control practices such as:
- Use of outdated encryption standards to secure high-risk PHI environments
- Weak password use practices for workstations containing PHI
- Use of unsecured public networks to transmit PHI across entities
- Improper disposal of PHI resulting in its retrieval
Remaining compliant with HIPAA is the best way to avoid these examples of HIPAA violations, and any other similar cases, which may result in significant HIPAA violation penalties.
Processes for Reporting HIPAA Violations
The HIPAA Breach Notification Rule requires covered entities and their business associates to promptly report breaches when they occur, especially if there is a significant risk to PHI integrity.
Depending on how many individuals are impacted by the PHI breach, these entities must notify:
- Individuals whose PHI is affected—in all cases, no matter what
- The Secretary of Health and Human Services (HHS)—all cases
- A prominent media outlet—cases impacting 500 or more people
There are niche sub-rules, like alternative notice to impacted parties if the individuals cannot be reached. But the best practice is to exhaust all channels and notify people as soon as possible.
The Office of Civil Rights (OCR) in the HHS handles all complaints related to HIPAA violations.
How to Develop an Internal Process for Reporting HIPAA Violations
Although the Breach Notification Rule permits individuals to report potential violations directly to the OCR, some of these incidents might be minor and internally addressable. To prevent people from over-reporting suspected HIPAA violations to the OCR, even when they may not constitute actual breaches, you should develop internal processes for HIPAA violation reporting.
Ideally, an internal process for HIPAA violation reporting comprises:
- Educating staff about how to identify HIPAA violations per the Privacy Rule definitions
- Designating HIPAA privacy officers to handle internal reports of suspected violations
- Protecting individuals that internally report potential HIPAA violations
However, this process must be optimized for organizations at high risk for breaches of PHI.
For example, covered entities that handle large amounts of PHI on a day-to-day basis (e.g., health plans and healthcare providers) may be heavily impacted if delays in identifying and reporting HIPAA violations result in a breach. In instances where a HIPAA-covered entity is repeatedly non-compliant with HIPAA, presenting risks to PHI, staff should be permitted to bypass the internal HIPAA violation reporting process and directly report violations to the OCR.
Streamline HIPAA Violation Reporting Today!
Implementing a reliable process for HIPAA violation reporting will help you minimize risks to PHI in the short and long term. When you partner with a HIPAA compliance advisor like RSI Security, you will develop up-to-date security policies and identify gaps in compliance before they can impact data privacy and integrity. Contact RSI Security today to learn more!
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