The Cost of a HIPAA Violation

September 3, 2021

We’ve all seen enough news headlines to know that the going rate for a HIPAA violation isn’t cheap. This past year has tallied up more than a handful of fines with numbers that might not have Jeff Bezos doing a double-take, but certainly have us seeing dollar signs. Not to mention that the first fine of 2021 brought in $5.1 million alone. And although not every HIPAA violation warrants front-page news status, even the minimum fine amount can do some major damage – especially when it’s a small, independent practice footing the bill.

So if you’re looking for an exact dollar amount, to date the Office for Civil Rights (OCR) has collected on 101 settlements to the tune of $135,328,482. We all know that a check that size doesn’t just add up without reason but what caused it to accumulate and why so high? Well back when HIPAA law was first introduced in 1996, the hope was to establish a set of standards to protect sensitive health information in the medical industry. But as the later published Privacy and Security Rules provided a laundry list of requirements for covered entities to follow, many failed to fully comply. So in 2006, the government came up with a solution and that’s where the HIPAA Enforcement Rule was born. It was this ruling that essentially started the tab on that billion-dollar bill, granting the OCR the right to hold covered entities and their business associates accountable with fines and other penalties for noncompliance.

Now just as the repercussions for speeding are understandably different than they are for a case of highway robbery, HIPAA fines also come with a “prices may vary” label attached. Each penalty is determined based on the extent to which the organization was aware that HIPAA rules were being violated and is broken down into the following four tiers:

Tier One: If the covered entity was found to be unaware of the violation, they could receive a fine ranging anywhere from $100 – $50,000 per incident with a maximum penalty of $25,000 per year.
Tier Two: If there’s reasonable cause that the covered entity knew or should have known about the violation, they could receive a fine ranging from $1,000 – $50,000 per incident and a $100,000 maximum penalty per year.
Tier Three: If it was found that there was willful neglect of HIPAA rules BUT the violation was corrected within 30 days of discovery, the fines could range anywhere from $10,000 – $50,000 per violation with $250,000 maximum per year.
Tier Four: If the covered entity acted with willful neglect AND failed to make a timely correction, they could face a total of $50,000 per violation with a maximum fine of $1.5 million per year.

If you were wondering, that “per incident” statement is the reason why we see those multi-million dollar fines – and what comes with HIPAA’s many different rules is a lot of different ways to break them. But it’s not just the monetary penalties that violators have to worry about. HIPAA settlements are usually a package deal including a corrective action plan that typically involves anywhere from two to three years of OCR monitoring. And if hefty fines and the government breathing down your back aren’t enough to prove just how costly violations can be – in the case that the HHS decides that there was deliberate malicious intent, the Department of Justice can step in and also assign criminal penalties with maximum jail time of 10 years.

We know that the mention of hefty fines and possible jail time definitely puts a damper on things, but with every “bad news” there’s typically good to follow. So the good news is there are ways to help avoid these worst-case scenarios, and recently passed legislation like the Safe Harbor Law to protect against incidents like data breaches that aren’t as easily avoidable. But the best protection? Having a full understanding of your organization’s responsibilities and a complete HIPAA compliance program to check all the governments’ boxes. Because after all – with how high the cost of a violation can be, you can’t put a price tag on the peace of mind that comes with being compliant.

Location-Specific SRAs: A Must-Have for Healthcare Organizations

December 17, 2024 Penelope Schweitzer No comments yet

December 17, 2024 Keeping all locations in line with HIPAA regulations can be quite a challenge, especially when managing a multi-location practice. It’s a complex puzzle that requires careful attention to detail and a proactive approach to ensure compliance across the board. And we hate to break it to you, but a blanket Security Risk Analysis for your organization isn’t enough. A Security Risk Analysis, or SRA, is a thorough review of your organization’s physical, administrative, and technical safeguards to protect patient data. Even when you’re managing compliance at a single location within a multi-location organization, you are responsible for ensuring an SRA is completed for your location. The Office for Civil Rights (OCR) is serious about this requirement, as indicated by a recent significant fine. A penalty of over $500,000 was recently announced for the Children’s Hospital of Colorado system. While this investigation was sparked by a phishing attack, one of the major findings was missing SRAs for all locations. Completing this SRA is imperative. As the OCR spearheads new enforcement and initiatives, it’s time to get compliant. What is a SRA? The SRA is an in-depth review of everything your practice does to ensure patient data is safe. This means everything from whether your practice utilizes alarms and codes on doors to the servers you use and even how your staff handles patient intake, like how the sign-in sheet process works. The SRA is the first step of a compliant practice because it allows you to review your vulnerabilities and make changes to uphold your commitment to keeping data safe. The SRA is also a requirement for MIPS. Unfortunately, the SRA is a commonly missed requirement for medical practices. In fact, 86% of all practices could not show an adequate SRA in the last round of random HIPAA audits. Completing a sufficient Security Risk Assessment (SRA) is essential for maintaining a compliant medical practice. This process is closely linked to the Office for Civil Rights (OCR) Risk Analysis Initiative, which mandates that medical practices and organizations carry out this required assessment. Recently, the Bryan County Ambulance Authority was fined $90,000 for failing to conduct an SRA, marking the first enforcement action under this new initiative. This incident demonstrates the OCR’s commitment to this initiative and its dedication of resources to ensure compliance. Importance of Location-Specific SRAs When conducting a SRA, assessing every location within your organization is vital. While performing a single SRA for the entire entity might seem easier, compliance is more intricate and requires ongoing attention rather than being a one-off endeavor. Each location has distinct vulnerabilities that must be acknowledged and addressed. For instance, one location might have different vendors than another, and another location might be in an older building, with different security to keep Protected Health Information (PHI) safe. Although some overarching requirements may come from the main location, capturing each site’s specific conditions is essential. This thorough documentation demonstrates that every location takes compliance seriously, addresses vulnerabilities, and keeps patient data safe. How to Complete an SRA With the right resources, managing and completing an SRA for a multi-location practice can be simplified. Organization is key: ensuring each location completes all SRAs and can be easily accessed in a centralized location. Your organization can efficiently complete this requirement by having a tailored set of questions for each location. To learn more about streamlining your multi-location SRAs for your organization, schedule a consultation with a HIPAA expert today.

Abyde News, Best Practices, HIPAA

The Security Risk Analysis: Setting the Pace for MIPS and HIPAA Compliance

December 4, 2024 Penelope Schweitzer No comments yet

December 4, 2024 As a healthcare provider, tackling your daily to-do list probably feels like running a marathon without a finish line at times. You’re tasked with managing a successful business, keeping up with ever-changing legislation and new technology while ensuring that your top priority of patient care never falls behind. Despite the challenging course, there’s a benefit to keeping pace with both quantity and quality. Providers are rewarded for going the extra mile thanks to Value-Based payment programs like MIPS and other government incentives like the HIPAA Safe Harbor Law. What is MIPS? You’ve most likely heard of the Merit-based Incentive Payment System (MIPS) and might already be a participant in it. Whether it’s a Quality Payment Program or new legislation passed into law, the government continually emphasizes the importance of being proactive rather than reactive and providing incentives for doing so. This is why it’s valuable to know whether your organization is eligible to participate in government programs (you can check here). Many of these different program requirements align with the standards your practice already has to meet under HIPAA law—protecting your patients, checking off compliance requirements, and receiving incentives can often be done all in one stride. To take a quick step back, MIPS is one of two payment tracks under the Medicare Quality Payment Program. The Centers for Medicare and Medicaid Services (CMS) uses this system to measure eligible clinician performance and reward high-value, low-cost care. MIPS participants can receive a payment adjustment to their Medicare reimbursements based on their performance scores across four different categories: Quality: The type of care you deliver based on specific measures of performance. Promoting Interoperability: Focuses on patient engagement and electronic exchange of information using Electronic Health Record (EHR) technology to improve patient access to their health information and exchange of information between providers. Improvement Activities: Your participation in clinical activities that work towards improving care coordination and patient engagement and safety. Cost: Assesses the cost of care you provide in relation to your Medicare claims. The Importance of the Security Risk Analysis (SRA) Before you can engage with the various performance measures, you must first meet a prerequisite for participating in the MIPS Promoting Interoperability performance category. This requirement is crucial not only for achieving HIPAA compliance but also for benefiting from other government incentives: the Security Risk Analysis (SRA). Conducting an SRA involves evaluating any potential risks to your organization’s electronic Protected Health Information (ePHI) and implementing necessary security updates and safeguards to address any identified vulnerabilities. Your organization must complete an SRA at least once a year to comply with MIPS and HIPAA standards. Additionally, it’s important to review and update the assessment regularly throughout the year to reflect any changes in your processes. Getting Compliant for MIPS Beginning your compliance journey can be overwhelming, but it is essential to take advantage of government initiatives such as MIPS. Intelligent software solutions can help keep your practice on track by outlining the requirements for HIPAA compliance and offering a streamlined SRA that meets MIPS standards. To learn more about how to become compliant for MIPS, schedule a meeting with a compliance expert today.

Abyde News, Fines, HIPAA

The Price of Delay: A Costly HIPAA Lesson

December 2, 2024 Penelope Schweitzer No comments yet

December 2, 2024 Over a million dollars in HIPAA fines have been levied in the past few months, and like this winter’s snow, the fines continue to pile up, with a $100,000 fine recently announced. Last week, Rio Hondo Community Mental Health Center, an outpatient program managed by the Los Angeles Department of Health, was fined for a Right of Access violation. This marks the 51st enforcement of the Right of Access rule, highlighting the importance of handling patient records in a timely manner. What Happened? A patient requested a copy of their records on March 18, 2020. As we all know, March 2020 was marked by the beginning of the unprecedented COVID-19 virus, which led to the mental health center’s closure after the Governor of California put into action a “stay-at-home” order. However, the center reopened at the beginning of May 2020, allowing some staff to return to the facility. While the patient was told her records would be ready at this time, she was misinformed and began the summer with a flurry of calls and other forms of contact to request her medical records. After her requests were unfulfilled several times, the patient filed a complaint with the Office for Civil Rights (OCR) at the end of August 2020. The OCR then began investigating the Rio Hondo at the beginning of October. The medical records were finally sent on October 20, 2020, 216 days after the first request. The Right of Access rule requires Covered Entities to provide patients with their medical records within 30 days of the initial request. While the medical center was under a “stay-at-home” order during those 30 days, this was still significantly longer than the extension period of an additional 30 days and could have been handled when it was first deemed safe for staff to return to the medical center. This fine comes after a series of Right of Access fines, including another significant fine of $70,000 imposed at the end of October. The numerous fines issued this past year regarding the Right of Access initiative demonstrate the government’s commitment to this important aspect of patients’ rights. Protect Your Practice from Costly Mistakes Even during the peak of the global health crisis, HIPAA regulations stayed in effect. Implementing software solutions can help safeguard your practice. To ensure your staff remains compliant, it is highly recommended to use automated software that keeps you and your team in check, regardless of the circumstances. Schedule a consultation today to learn more about automated compliance for your practice.