HIPAA Enforcement: What You Need to Know
What is HIPAA?
HIPAA: Health Insurance Portability and Accountability Act
It was passed by Congress in 1996
It includes requirements for:
Transfer and continuation of health insurance coverage for millions of American workers and their families when they change or lose their jobs
Reducing healthcare fraud and waste
Industry-wide standards for healthcare information on electronic billing and other processes
The protection and confidential handling of protected health information
Whom Does HIPAA Apply To?
Applies to:
Health Plans
Healthcare Providers
Healthcare Clearinghouses
How is HIPAA Enforced?
The Department of Health and Human Services, Office for Civil Rights (OCR) is responsible for administering and enforcing these standards and may conduct complaint investigations and compliance reviews.
Violations can lead to civil money and criminal penalties
Enforcement and Penalties –– New Definitions
Reasonable Cause: An act or omission in which a covered entity or business associate knew, or by exercising reasonable diligence would have known, that the act or omission violated an administrative simplification provision, but in which the covered entity or business associate did not act with willful neglect.
Reasonable Diligence: Business care and prudence expected from a person seeking to satisfy a legal requirement under similar circumstances.
Willful Neglect: Conscious, intentional failure or reckless indifference to the obligation to comply with the administrative simplification provision violated.
Criminal Penalties
A person who knowingly obtains or discloses individually identifiable health information in violation of the Privacy Rule may face a criminal penalty of up to $50,000 and up to one-year imprisonment.
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