The Health Insurance Portability and Accountability Act, frequently referred to as HIPAA, has been on the books since 1996 to establish standards and guidelines for maintaining the confidentiality and security of patient health information. Healthcare providers and their office personnel that violate the rules of HIPAA can find themselves facing serious consequences.

Even though HIPAA compliance is nothing new for the healthcare industry, violations are still quite common. This stems from a variety of circumstances, including staff that is either undertrained or simply unaware of the potential consequences of a HIPAA violation. To help you and your office staff better understand the law, here is what can happen when a violation has been committed.

What Happens When You Break a HIPAA Rule?

The consequences of a HIPAA violation depend significantly on the nature and severity of the offense. In other words, a practice that has received a relatively minor consequence for a HIPAA violation in the past can’t automatically assume that a violation isn’t a significant issue going forward.

Deciding how a HIPAA violation will be handled can involve multiple players, including employers, professional boards and in some cases, even the Department of Justice. The elements of the violation that authorities will look at include the overall nature of the violation, along with details like whether or not there was knowledge that a HIPAA rule was being violated, if there was malicious intent, and if the violation involved the criminal provision of the act.

Depending on the nature of the violation, and the position of the person or operation that committed the offense, possible consequences could include termination, removal from professional boards, fines and criminal charges.

Understanding the Civil Penalties of a HIPAA Violation

Civil penalties for a HIPAA violation can be issued by the Department of Health and Human Services Office for Civil Rights. When a HIPPA violation has been committed, they will consider the circumstances of the offense and issue a penalty based on a four-tiered system.

  • Tier 1: A fine ranging from $100 to $25,000 for violations where it was determined that the individual was unaware of a HIPAA law being violated or where exercising a reasonable level of due diligence could have prevented the violation.
  • Tier 2: A fine ranging from $1,000 to $100,000 for violations where reasonable cause was established.
  • Tier 3: A fine ranging from $10,000 to $250,000 where willful neglect of HIPAA rules is evident, but the violation has been corrected within a specified amount of time.
  • Tier 4: A fine ranging from $50,000 to $1.5 million where willful neglect of HIPAA rules is evident and no attempt to correct the violation has been made.

Criminal Penalties for a HIPAA Violation

Although rarer, a HIPAA violation can fall into the hands of the Department of Justice if there has been a criminal violation of rules. Criminal penalties for a HIPAA violation come with a fine and potentially a prison sentence of up to 10 years. Criminal offenses can include violations that involve false pretenses or were made with personal gain or malicious intent.

Protect Your Patient’s Data

One of the effective ways to prevent your practice from an accidental HIPAA violation is by investing in medical practice management software that’s been developed with patient security and privacy in mind. Contact Raintree Systems today to learn more about our software solutions for your medical practice.