HIPAA Rules: Penalties and Criminal Liabilities

HIPAA was officially enacted in the year 1996 by the United States Congress. HIPAA has two titles–Title I of the rule is to protect individuals and families under the circumstances when they lose their jobs or when they change their jobs. Title II also known as the administrative simplification provision requires the establishment of electronic healthcare transactions to protect the identity of providers, health insurance plans, and employers. All Covered Entities and Business Associates must follow all HIPAA rules and regulations.

Title I has been a debated topic with health coverage of many individuals going under constant change looking at the job security of American individuals. Covering individuals under health care policy after significant breaks.

Title II is known as the background regulation of the healthcare industry as the industry moves toward the technologically vibrant sector.  Now with Information becoming the new currency, the law was made to protect the patients’ healthcare information.

According to the law here are some insights about the HIPAA Regulations

U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) takes up the initiative of implementing the HIPAA security and privacy laws. OCR checks the following during the investigation process

  1. Investigating complaints filed with it.
  2. Conduct a compliance audit to determine whether the covered entities are in compliance.
  3. Educating and reaching out to foster compliance.

In the case of non-compliance where the doctor’s office is not resolving the matter satisfactorily, OCR may decide to impose monetary penalties.

HIPAA Violation Minimum Penalty Maximum Penalty
Unknowing $100 per violation.

With an annual maximum of $25,000 for repeat violations.

$50,000 per violation.

With an annual maximum of $1.5 million.

Reasonable Cause $1,000 per violation.

With an annual maximum of $100,000 for repeat violations.

$50,000 per violation.

With an annual maximum of $1.5 million.

Intentional neglect but violation is corrected within the required time period $10,000 per violation.

With an annual maximum of $250,000 for repeat violations.

$50,000 per violation.

With an annual maximum of $1.5 million.

Intentional neglect and is not corrected within the required time period $50,000 per violation.

With an annual maximum of $1.5 million.

$50,000 per violation.

With an annual maximum of $1.5 million.

In some cases, the Office of Civil Rights (OCR) has taken the way of approaching criminal liabilities just to cope with violations.

The criminal violations of HIPAA are currently handled by DOJ. The person or organization that obtains and discloses individually identifiable health information can face a fine of up to $50,000 and imprisonment of up to 1 year.  Offenses committed under false presentence increased to a $100,000 fine with up to 5 years in prison. Finally, offenses committed with intent to sell or use for commercial advantage, personal gain, or malicious harm are fines of $250,000 and imprisonment of up to 10 years.

In most cases, the patient’s data is stolen from the hospitals to demand money or use the patient’s details for payment. In most cases, the offenders get away with the crime as the patients affected don’t pursue the matter to a higher level. It’s imperative for healthcare providers to understand the effect that any leak can underestimate the patients from different regions.

Medical Billers and Coders (MBC) is a leading medical billing company providing complete revenue cycle services. We can assist you in Medical billing to receive accurate reimbursements from private and government payers. To learn more about our HIPAA Regulation Services, contact us at info@medicalbillersandcoders.com/ 888-357-3226.