HIPAA (Health Insurance Portability and Accountability Act) establishes national standards for protecting sensitive patient health information. Understanding and implementing these requirements is essential for all healthcare providers.
Who Must Comply?
HIPAA applies to "covered entities" including:
- Healthcare providers who transmit health information electronically
- Health plans (insurance companies, HMOs)
- Healthcare clearinghouses
- Business associates of covered entities
The Privacy Rule
The Privacy Rule establishes standards for protecting Protected Health Information (PHI):
Key Requirements:
- Provide patients with Notice of Privacy Practices
- Obtain written authorization for most uses/disclosures
- Apply "minimum necessary" standard
- Allow patients to access and amend their records
- Track disclosures of PHI
- Implement privacy policies and train staff
The Security Rule
The Security Rule requires administrative, physical, and technical safeguards for electronic PHI:
- Administrative: Risk analysis, workforce training, security policies, contingency plans
- Physical: Facility access controls, workstation security, device controls
- Technical: Access controls, audit controls, encryption, transmission security
Breach Notification
If a breach of unsecured PHI occurs, you must:
- Notify affected individuals within 60 days
- Notify HHS (and media for breaches affecting 500+ individuals)
- Document the breach and response
Penalties for Non-Compliance
HIPAA violations can result in civil penalties from $100 to $50,000+ per violation, up to $1.5 million annually. Criminal penalties can include fines up to $250,000 and imprisonment.
Compliance Checklist
- Conduct regular risk assessments
- Implement written policies and procedures
- Train all workforce members
- Execute Business Associate Agreements
- Secure all electronic PHI
- Maintain documentation for 6 years