The Healthcare Insurance Portability and Accountability Act (HIPAA) has been the gold standard for healthcare regulations and HIPAA patient rights since it was passed in 1996 by the U.S. government. Over the past 22 years, HIPAA has been updated multiple times to ensure that patients and their personal health information (PHI) remain secure.
Today, more healthcare organizations are leveraging innovative technology to store and manage patient PHI. This allows doctors and patients to access medical information when needed. However, if PHI is not stored securely, it can put sensitive patient information at risk. HIPAA is designed to prevent these risks and protect patients’ privacy.
From 2009 to 2017, there were 2,181 healthcare data breaches, exposing nearly 177 million healthcare records. This highlights why adherence to HIPAA is crucial for healthcare organizations. Understanding HIPAA patient rights empowers patients to ensure their information is protected. In this article, we’ll explore the key aspects of HIPAA, the HIPAA Privacy Rule, and practical steps healthcare organizations can take to maintain compliance and safeguard patient information.
Why Does HIPAA Exist?
Understanding HIPAA patient rights starts with knowing why HIPAA was created. Passed by the U.S. Congress in 1996, HIPAA was designed to give patients greater access to health insurance while ensuring their personal healthcare data remains private and secure.
HIPAA also helps healthcare organizations operate more efficiently and standardizes procedures for handling sensitive health information. By providing a clear framework for privacy, security, and compliance, HIPAA protects patients’ information and gives them confidence that their healthcare data is in safe hands.
In short, HIPAA exists to safeguard patient privacy, enhance data security, and promote trust between patients and healthcare providers. Understanding this foundation is essential to fully grasp HIPAA patient rights.
Patient Rights Under HIPAA
The HIPAA Privacy Rule was created to protect HIPAA patient rights by holding healthcare providers accountable for how protected health information (PHI) is accessed, used, and shared. Healthcare providers are required to implement safeguards that keep PHI private and ensure any disclosure is appropriate and lawful.
HIPAA contains numerous rules that can sometimes seem complex for both patients and healthcare providers. To make it easier to understand, this section breaks down the key areas of HIPAA that protect patient rights. By understanding these rights, patients can ensure their PHI is handled correctly and securely.
The Right to Notice of Privacy Practices (NPP)
One of the key HIPAA patient rights is the right to receive a Notice of Privacy Practices (NPP). The NPP explains how a healthcare provider may use or disclose your protected health information (PHI). It also informs patients when their PHI may be used for promotional or marketing purposes, which requires their authorization. Some NPPs may include an optional section allowing providers to notify friends or family about scheduled treatments.
Healthcare organizations that post NPPs online must notify patients in their next annual mailing of any updates to avoid HIPAA fines. Patients should also receive the NPP during their first visit and see it prominently displayed in the office or facility.
Healthcare providers are required to ask patients to acknowledge in writing that they have received and understood the NPP. If a patient refuses to sign, they still retain their rights, and the provider can continue to use or disclose PHI as permitted by HIPAA. However, the provider must document any refusal to sign. Failure to properly document refusals can result in significant HIPAA penalties.
The Right to Access PHI
Another important HIPAA patient right is the right to access your protected health information (PHI). Patients can request copies of their medical and billing records in either electronic or paper formats. Healthcare providers must honor these requests and provide the PHI in the format requested whenever possible.
If the requested format is not available, the provider must supply the PHI in a readable electronic format agreed upon by both parties. Additionally, patients can direct their provider to send their PHI to another individual. Such requests must be submitted in writing, clearly identifying the designated recipient.
Once a request is received, healthcare providers are required to fulfill it within 30 days. This right ensures that patients have timely access to their medical information, empowering them to manage their healthcare effectively and exercise control over their personal data.
The Right to Amend PHI
As part of HIPAA patient rights, patients have the right to request amendments to their protected health information (PHI). This includes the ability to:
- Inspect and obtain copies of their PHI.
- Request corrections or updates to their PHI.
- Request restrictions on how their PHI is used or disclosed.
- Request communications at an alternative location or through alternative methods.
Amendment requests must be submitted in writing with a reason supporting the change. Healthcare providers must respond within 60 days. If additional time is needed, the provider may extend the response period by up to 30 days, provided they give a written explanation and a new expected response date.
If the amendment is granted, the provider must make the correction, notify the patient, and distribute the updated information to anyone currently in possession of the PHI or who has previously requested it. If the amendment is denied, the provider must give a timely written explanation in plain language. The denial must include the reason for the decision and inform the patient of their right to submit a written statement in response.
This right ensures patients can maintain accurate and complete health records, empowering them to protect their privacy and actively manage their healthcare.
The Right to an Accounting of Disclosures of PHI
Another important HIPAA patient right is the right to request an accounting of disclosures of your protected health information (PHI). This means patients can see a record of when their PHI has been shared with entities or individuals outside the healthcare organization.
This accounting includes disclosures related to treatment, payment, or healthcare operations. Patients do not need to sign authorization forms for these routine disclosures. Any PHI disclosures that are not part of treatment, payment, or operations and are not authorized by the patient must be tracked by the healthcare provider.
Patients can request an itemized list of disclosures going back up to six years. This ensures patients have full visibility into how their PHI has been shared and reinforces their ability to maintain control over their personal healthcare information.
The Right to Request PHI Usage Restrictions
A key HIPAA patient right is the ability to request restrictions on how your protected health information (PHI) is used or disclosed. This gives patients control over who can access their PHI and under what circumstances.
Patients can request restrictions for PHI related to treatment, payment, and healthcare operations, as well as disclosures to family members, friends, or others involved in their care. Healthcare providers, also known as covered entities, must comply with a patient’s request to restrict disclosures if the PHI pertains solely to items or services paid for out-of-pocket.
Additionally, covered entities cannot share a patient’s genetic information for insurance underwriting without the patient’s explicit consent. This right ensures that patients maintain control over sensitive personal and genetic health information.
Are There Solutions to HIPAA Compliance?
Ensuring HIPAA patient rights requires more than simply following regulations—it demands a proactive approach to protecting patient information. The U.S. Department of Health and Human Services Office for Civil Rights (OCR) oversees HIPAA compliance, and violations can carry significant fines. For example:
- In 2017, Memorial Healthcare Systems was fined $5.5 million for improperly accessing PHI of over 115,000 patients.
- In 2010, Cignet Health of Maryland was fined $4.3 million for ignoring patient requests for their medical records.
Since October 2009, more than 173 million patient records have been affected by data breaches, causing damage to both patients and healthcare organizations.
Trends in Healthcare Data Breaches
Between 2009 and 2017, healthcare providers experienced a significant increase in breaches, while breaches among health plans and business associates have leveled off or decreased. This demonstrates that more focus on HIPAA compliance and patient privacy is urgently needed across all healthcare organizations.
With 78% of U.S. healthcare providers experiencing successful email-related cyberattacks, employee education and awareness training are crucial. Healthcare organizations must move beyond basic HIPAA compliance checklists and develop comprehensive security and privacy programs. Leveraging advanced cybersecurity technologies, such as Personally Identifiable Information (PII) scanners, can help safeguard PHI and reinforce HIPAA patient rights.
Closing Thoughts
If you believe your HIPAA patient rights have been violated, you can file a complaint with the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS). OCR can investigate complaints and take action against covered entities that fail to comply with HIPAA regulations.
By standing up for their rights and by healthcare organizations maintaining strong PHI protection and HIPAA compliance, patients and providers can make the healthcare system safer for everyone.
For healthcare entities unsure about cybersecurity protocols or seeking to strengthen their HIPAA compliance, RSI Security offers comprehensive solutions to help protect patient information and meet regulatory requirements.
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