Blogs

18th February 2025

Reporting HIPAA Violations: What HR and Legal Professionals Need to Know

In today’s healthcare environment, the Health Insurance Portability and Accountability Act (HIPAA) plays a critical role in safeguarding sensitive patient data. However, despite the stringent regulations, HIPAA violations are still a significant concern for healthcare organisations.
As an HR or legal professional, understanding the importance of reporting HIPAA violations is crucial not just for compliance but also for protecting the integrity of your organisation and its employees.
In this blog, we’ll explore the importance of HIPAA compliance, the types of violations that need reporting, the consequences of non-compliance, and the steps you should take to ensure that HIPAA violations are handled appropriately within your organisation.

What is HIPAA?

HIPAA, enacted in 1996, aims to improve the efficiency and effectiveness of the healthcare system by protecting sensitive patient information. It establishes rules and standards for healthcare providers, insurance companies, and other entities that handle patient data, ensuring that patient records remain confidential and secure.
There are two primary components of HIPAA that all healthcare organisations must adhere to:

1.    The Privacy Rule: This governs the use and disclosure of an individual’s protected health information (PHI).
2.    The Security Rule: This establishes standards for securing electronic PHI (ePHI) through safeguards, such as encryption and access control.

Why is Reporting HIPAA Violations Important?

HIPAA violations can have serious consequences, both for the individuals involved and for the organisation. Failure to report a violation can lead to significant financial penalties, damage to your organisation’s reputation, and potential legal action. For employees, reporting violations ensures that they can protect themselves from repercussions and hold the responsible parties accountable.

Furthermore, proactively reporting and addressing HIPAA violations demonstrates your organisation’s commitment to compliance, patient privacy, and ethical standards. For HR and legal professionals, it is essential to have clear, structured processes in place to address and report these violations in a timely manner.
 

Types of HIPAA Violations That Require Reporting

HIPAA violations can occur in many ways, from intentional misconduct to unintentional lapses in judgement. Some common violations that require reporting include:

1. Unauthorized Access or Disclosure of PHI

This occurs when someone accesses or shares a patient’s protected health information without proper authorisation. This can happen when staff members access medical records of individuals they are not treating or disclosing PHI to unauthorised individuals or organisations.

2. Lack of Adequate Safeguards for ePHI

Organisations are required to implement technical and physical safeguards to protect ePHI. A failure to ensure secure systems, such as using weak passwords or not encrypting sensitive information, can result in violations.

3. Inadequate Training of Employees

Employees must be trained on how to handle PHI properly and securely. If training is not provided, employees may unintentionally commit violations by mishandling patient data.

4. Failure to Provide Access to PHI

Under HIPAA, individuals have the right to access their health records. If your organisation denies a patient’s request to view or obtain their health information, it can result in a violation.

5. Improper Disposal of PHI

Failing to properly dispose of paper records or securely delete ePHI can also constitute a violation. Organisations must implement protocols for securely disposing of sensitive information to avoid breaches.

6. Business Associate Violations

HIPAA’s rules extend to third parties or business associates who handle PHI on behalf of healthcare organisations. If a business associate fails to comply with HIPAA regulations, the primary organisation is still held responsible.
 

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Reporting HIPAA Violations: A Step-by-Step Guide
As an HR or legal professional, it is your responsibility to ensure that any HIPAA violations are reported and addressed properly. Here’s a step-by-step guide on what needs to be done when a violation occurs:

1. Ensure Internal Reporting Channels Are in Place
To foster a culture of compliance, ensure that your organisation has clear, confidential reporting channels in place. This can include an anonymous reporting hotline, a digital platform, or an internal grievance mechanism for employees to report violations without fear of retaliation.

2. Conduct an Investigation
Once a violation is reported, a thorough internal investigation must be conducted to determine the extent of the breach, how it occurred, and who was responsible. The investigation should follow strict protocols to ensure that all facts are gathered and documented accurately. HR and legal professionals should be involved in this process to maintain impartiality and compliance.

3. Notify the Affected Individuals
If the violation involves a breach of PHI, affected individuals must be notified immediately. According to HIPAA guidelines, individuals should be informed of the breach within 60 days of the discovery. Notifications should include the nature of the breach, the information that was disclosed, and steps individuals can take to protect themselves.

4. Report to the Department of Health and Human Services (HHS)
HIPAA requires that certain breaches be reported to the HHS Office for Civil Rights (OCR). This applies to breaches involving more than 500 individuals. For smaller breaches, organisations are required to report them annually. Failure to report a violation promptly can result in substantial penalties.

5. Take Corrective Action
After the investigation, it’s essential to implement corrective actions to prevent similar violations in the future. This may involve updating policies, providing additional staff training, improving data security measures, or taking disciplinary action against those responsible for the violation.

6. Document the Incident and Response
Document everything related to the violation—how it was reported, the investigation process, corrective actions taken, and any communications sent. This documentation is crucial for compliance purposes and can also be used to protect your organisation if any legal action is taken.

Consequences of Not Reporting HIPAA Violations
Failure to report HIPAA violations can have severe consequences, including:

•    Fines and Penalties: Depending on the severity of the violation, HIPAA penalties can range from $100 to $50,000 per violation. The total fine can reach up to $1.5 million per year for unintentional violations. Intentional violations can result in criminal charges, with fines up to $250,000 and possible jail time.
•    Reputational Damage: A failure to report a violation can damage your organisation's reputation, leading to a loss of trust from patients, partners, and regulatory authorities.
•    Legal Action: In addition to penalties from regulatory bodies, your organisation could face civil lawsuits from individuals whose PHI was compromised. These lawsuits can result in significant financial losses.
•    Loss of Accreditation: For healthcare providers, HIPAA violations can result in the loss of accreditation or certification, which can severely impact business operations and patient trust.

Statistics on HIPAA Violations

HIPAA violations are an ongoing concern for the healthcare industry. According to a 2020 report by Protenus, there were over 35 million healthcare records exposed in data breaches. Moreover, the OCR has levied more than $100 million in fines over the past decade due to HIPAA violations. These statistics underscore the importance of reporting violations quickly to mitigate risks.

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Conclusion

For HR and legal professionals in healthcare, understanding the importance of reporting HIPAA violations is essential for ensuring your organisation remains compliant and avoids costly penalties. Whether the violation involves the unauthorised disclosure of patient information, inadequate training, or failure to provide access to records, having clear processes in place to report and resolve violations can safeguard your organisation and protect its reputation.

By fostering a culture of transparency and accountability, organisations can not only comply with HIPAA regulations but also protect their most valuable asset—trust with patients and employees.

For more detailed information on HIPAA compliance and reporting violations, visit the HHS Office for Civil Rights (OCR) website.