HIPPA
HIPAA: Health Insurance Portability Accountability Act
What is HIPPA?
There are various resources available online that offer best practices for HIPAA compliance tips for nurses. Here are a few examples:
1. The U.S. Department of Health and Human Services (HHS) provides a comprehensive HIPAA training program that includes guidance for nurses. The program covers the basics of HIPAA regulations, including the privacy and security rules, and provides best practices for compliance. You can access the training program at:
https://www.hhs.gov/hipaa/for-professionals/training/index.html.
Other items are available at this site, but we provided you with the security risk assessment tool to assess your risk of a security breach.
2. The Health Information and Management Systems Society (HIMSS) offers a variety of resources on HIPAA compliance, including webinars, white papers, and articles. HIMSS also provides a self-assessment tool that helps healthcare professionals evaluate their compliance with HIPAA regulations. You can access the HIMSS resources at https://www.himss.org/resources/hipaa-compliance.
By utilizing these resources, nurses can stay up-to-date on best practices for HIPAA compliance and ensure they protect patient health information to the best of their ability.
Why is it important to nurses?
HIPAA facts
If not followed, could more than financial loss occur? How Can HIPAA Violations Hurt Healthcare Providers?
Financial Penalties:
There can be both civil and criminal penalties for violating HIPAA. The consequences of violating HIPAA depend on the violation's nature and the violator's classification (e.g., covered entity, business associate, or workforce member). This time in the conversation is an excellent time to point you to the HIPAA Enforcement Rule, the actual section that imposes the penalties and serves as the source of truth. The following are some of the potential consequences of a HIPAA violation. Civil Penalties:
If the act is an unknowing violation, the minimum penalty is $100 per violation, with the possibility of an annual maximum of $25,000 for repeat violations.
If the act is for a reasonable cause, the penalty ranges from $1,000 to $50,000 per violation and reaches an annual maximum of $100,000 for repeat violations.
If the act is willful neglect, but the violation is corrected within the required time period, the penalty range is $10,000 – $50,000 per violation, with an annual maximum of $250,000 for repeat violations.
If willful neglect and violation are not corrected, there is a Minimum penalty of $50,000 per violation, with an annual maximum of $1.5 million.
There are maximum penalty caps of up to $1.5 million for all violations of an identical provision during a calendar year.
Criminal Penalties:
Offenses committed under pretenses carry a penalty of up to a $100,000 fine and up to 5 years in prison.
If the act was committed with willful or malicious intent, the defendant could be sentenced to up to 10 years in prison.
In addition to financial penalties and even imprisonment, HIPAA violations can result in loss of income, termination of employment contracts, and sanctions. It’s important to note that the Department of Health and Human Services’ Office for Civil Rights (OCR) may refer complaints to the Department of Justice for investigation if they describe actions that could violate the criminal provision of HIPAA.
Criminal Charges:
In addition to monetary penalties, some individuals who violate HIPAA Rules can go to jail for up to 10 years. The penalties for criminal violations of HIPAA are substantial, and the federal government is willing to prosecute HIPAA violations at every level.
Civil Lawsuits:
HIPAA violations do not provide for a private cause of action, so patients cannot sue for a HIPAA violation. However, patients can sue healthcare providers or specific healthcare professionals for violating state laws involving HIPAA, under ERISA, or other legal theories or causes of action, such as tort law. Patients can sue and ask for money if a “harmful” violation of their medical history or medical privacy exists. Civil penalties for HIPAA violations can range from $100 for an “unknowing” violation to $1.5 million for “willful neglect”.
Loss of Medicare or Medicaid Certification:
If healthcare providers violate HIPAA regulations, they may lose their certification to participate in Medicare or Medicaid programs. This loss of Medicare and Medicaid programs is a significant loss for healthcare providers, as they are primary sources of revenue for many healthcare facilities. Losing certification can also damage healthcare providers' reputations and make it difficult to attract new patients.
HIPAA definition
HIPAA Privacy Rule: This section provides an overview of the privacy rule, including who it applies to and what it covers.
The Privacy Rule is a set of standards established by HIPAA to protect the privacy of individuals' protected health information (PHI). It gives individuals certain rights regarding their PHI and requires covered entities to obtain written consent before disclosing PHI except in certain circumstances. Covered entities must also implement administrative, physical, and technical safeguards to protect the privacy of PHI. The Privacy Rule protects the confidentiality of PHI while ensuring appropriate safeguards are in place.
HIPAA Security Rule: This rule protects your patients from ePHI disclosure to the wrong personnel and helps you deliver good care to them. It provides an overview of the security rule, including the safeguards nurses must follow to protect patient health information.
The Security Rule is a set of standards established by HIPAA to protect electronic protected health information (ePHI). It requires healthcare providers, health plans, and healthcare clearinghouses to implement administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and availability of ePHI.● Common identifiers, such as name, address, birth date, and SSN ● The patient’s past, present, or future physical or mental health condition ● Health care you provide to the patient ● The past, present, or future payment for health care you provide to the patient The Security Rule also requires risk assessments, contingency plans, and employee training to address potential risks and vulnerabilities to ePHI. Overall, the Security Rule protects against unauthorized access, use, or disclosure of ePHI
HIPAA Breaches: Explanation of what constitutes a breach, the reporting requirements, and the potential consequences for violations.
HIPAA requires a risk assessment to determine if the impermissible use or disclosure of PHI poses a significant risk of harm to the individual. Suppose a breach is determined to have occurred. In that case, covered entities must notify affected individuals, the Department of Health and Human Services, and, in some cases, the media of the breach.
Best Practices for HIPAA Compliance: Tips for nurses on maintaining compliance with HIPAA regulations, including training, documentation, and patient education.
1. The U.S. Department of Health and Human Services (HHS) provides a comprehensive HIPAA training program that includes guidance for nurses. The program covers the basics of HIPAA regulations, including the privacy and security rules, and provides best practices for compliance. You can access the training program at:
https://www.hhs.gov/hipaa/for-professionals/training/index.html.
By utilizing these resources, nurses can stay up-to-date on best practices for HIPAA compliance and ensure they protect patient health information to the best of their ability.
Why is it important to nurses?
HIPAA compliance
Real-life Examples: There are case studies of HIPAA violations and their outcomes to help nurses understand the potential risks and consequences of non-compliance.
To find real-life examples and case studies related to HIPAA compliance, look at various online platforms, including: healthcare industry publications, legal databases, and professional organizations' websites. Some examples of sources for real-life examples and case studies related to HIPAA compliance include: the Department of Health and Human Services' Office for Civil Rights (OCR) website, which includes a section on HIPAA cases and investigations; and the American Health Information Management Association (AHIMA) website, which offers case studies and scenarios for healthcare professionals. Additionally, some healthcare industry publications, such as Healthcare IT News and HealthLeaders Media, often cover HIPAA-related news, including real-life examples of HIPAA violations and their consequences.
Identity Theft:
HIPAA violations can put patients’ private health information at risk, harming the patients it belongs to. Patients may feel violated and exposed if their sensitive information is lost in an unauthorized sharing, which may inadvertently lead to identity theft—something that can take years to remedy.
Stigma:
Individuals who violate HIPAA rules can go to jail for up to 10 years, and the stigma associated with jail time can be incredibly detrimental to a future in medical practice and care. This loss will impact a patient with a long-standing relationship with you and force them to find a new provider—not always an easy task. Overall, HIPAA violations can have severe consequences for patients, including privacy risks, loss of trust, financial harm, and legal consequences. Healthcare providers must protect patient privacy and comply with HIPAA regulations to avoid these adverse outcomes.
NewYork-Presbyterian Hospital agreed to a $2.2 million settlement with OCR after severely violating HIPAA Privacy Rules. NY-Presbyterian allowed an ABC reality TV program to film two patients in 2013 without consent or authorization, both of which were experiencing significant health issues. To make matters worse, one of the patients died during the filming of the TV show!
Conclusion: This is a recap of the importance of HIPAA compliance for nurses and a call to action for nurses to prioritize patient privacy and security in their practice. Nurses need to understand the importance of HIPPA and what can happen if it is not adhered to every time. This week's insight kits are actual forms to help you ensure HIPAA information is safe. Also, keep learning about HIPPA and your job as a nurse.
HIPAA compliance checklist
References for this blog are:
HIPAA Privacy and Security Rules: What's the Difference? - Axeleos Technology Consulting. https://axeleos.com/hipaa/hipaa-privacy-and-security-rules/
HIPAA Violation Consequences: What Every Healthcare Professional Should Know - Spruce Blog. https://sprucehealth.com/blog/hipaa-violation-consequences-what-every-healthcare-professional-should-know/
HIPAA Violation Consequences: What Every Healthcare Professional Should Know - Spruce Blog. https://sprucehealth.com/blog/hipaa-violation-consequences-what-every-healthcare-professional-should-know/
Safeguarding Confidentiality with HIPAA-Compliant Email Practices - Axeleos Technology Consulting. https://axeleos.com/hipaa/hipaa-compliant-email-practices/
Staff, H. (1987). The Hilltop 3-6-1987. https://core.ac.uk/download/234730576.pdf
You, N. Y. (2018). Developing the Comprehensive Quality of Life Model for the Elderly Based on Modality of Motions, Cognitive Ability, and Hearing Loss. https://core.ac.uk/download/154406117.pdf
How does HIPAA provide security? - Compliance Home. https://www.compliancehome.com/how-does-hipaa-provide-security/
5 Tips to Stay Compliant. https://www.emporiumdigital.online/5-tips-to-stay-compliant/
When was HIPAA Enacted? - Legally Firm. https://www.legallyfirm.com/when-was-hipaa-enacted
HITECH Breach Notification: A Blizzard of Activity | Insights | Davis Wright Tremaine. https://www.dwt.com/insights/2010/02/hitech-breach-notification-a-blizzard-of-activity
Top 20 Worst HIPAA Violation Cases in History | UpGuard. https://www.upguard.com/blog/worst-hipaa-violation-cases
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