The Top Three Risk Factors for Potential HIPAA Violations

If thought-leaders could wrap a one-word blanket about what it means to stay HIPAA compliant, it would be without a doubt – PRIVACY. Avoiding costly HIPAA violations boils down to one key principle and that is to protect and advocate for patient-privacy rights at all costs. In order to facilitate this tall objective, Congress issued clear guidance surrounding three major entities:

Health Care Plans

This encompasses the healthcare provider and any entity that transmits healthcare records or any relative transactions electronically. These transactions include claims, benefit eligibility inquiries, and referral authorization requests.

Health Care Clearing Houses

These include entities that cover the cost of medical care. These said health plans detail coverage for health, dental, and vision. They include prescription drug insurers; health maintenance organizations (HMOs); Medicare, Medicaid, Medicare+Choice, and Medicare supplement insurers; and long-term care insurers (excluding nursing home fixed-indemnity policies).Additionally, these said health plans also include employer-sponsored group health plans, government- and church-sponsored health plans, and multi-employer health plans. The exception to this rule would be a group health plan with fewer than 50 participants that is administered solely by the employer that established and maintains the plan is not a covered entity.

Health Care Providers

These are entities that process nonstandard information they receive from another entity into a standard (i.e., standard format or data content), or vice versa. In most instances, healthcare clearinghouses will receive individually identifiable health information only when they are providing these processing services to a health plan or healthcare provider as a business associate.

Within the outlined constructs, lies the biggest potential risk factors for receiving a HIPAA violation. Streamlining an organization to maintain regulatory standards begins with a solid education of all that HIPAA entails. All employees and representatives of these entities must become well-versed in HIPAA compliant behaviors and screened for adherence. Common practices typically denote the need for an active current HIPAA certification and concurrent training from a reputable agency.However, it is important to understand that certification does not protect against a violation according to HHS. In fact, according to the HHS website, since inception in 2003, they have received over 245,000 complaints. Of which, 1028 complaint cases have resulted in compliance reviews.  The penalties of violating the HIPAA guidance rules can result in employee termination, hefty fines for the provider, lawsuits, and significant harm of reputation.

Understanding the Top Three Risk Factors

  1. Human Error is the greatest threat to staying in compliance and translates to the need for continuous education and training. It is notable how hard this task may be during the pandemic. Many employees are working remotely making it difficult to monitor. Experts cite simple efforts such as disciplined reporting, awareness, continuous monitoring, and training can assist in lowering your overall risk.
  2. Theft and/or Hacking Incidences contribute significantly to HIPAA violations. Effective management of IT department is strongly advised with special attention to outside freelance workers. Keeping the information flow automated and making notations of any potential breach may pay dividends when it comes to avoiding a full breakdown along the information gateways. As our technology improves, encryption solutions and advanced monitoring systems assist to ensure and protect privacy in these hard to manage areas.
  3. Third Party Disclosure Issues can get a little tricky and, as such, place high when it comes to being at risk HIPAA violations. Third party apps are commonplace for violating sharing of information practices, having inadequate client-based encryption, and failure of obtaining an e-PHI authorization on file from the requesting provider or client. Also, the lack of transparency and storage practices of user-data by third party apps is noted to be equally problematic for maintaining HIPAA compliance.  For greater clarification, we advise revisiting the HIPAA Notification Breach Rule as often as necessary.

Using Regology as a Resource for Staying Compliant

As an active partner for those in highly regulated industries, we know the value of staying current on best practices. Our goals are to provide our industry thought leaders with the most up to date information. By shadowing your business with up-to the-minute and at your fingertip's global legal guidance and documents, we take the stress out of audits and compliance issues.

We know that by understanding what puts you at risk for potential HIPAA violations, we may be able to help your organization stay in compliance thereby avoiding violation fines and headaches. Guidance laws and regulation practices are always in motion and actively evolving such as those surrounding the COVID-19 pandemic.

Contact us today to automate regulatory changes management with out AI-powered platform, or check out our free Resources page to learn more.

Further Reading: https://www.hhs.gov/hipaa/for-professionals/breach-notification/index.htmlhttps://healthitsecurity.com/news/majority-of-health-apps-share-user-data-without-transparencyhttps://www.calyptix.com/hipaa/discover-the-top-3-causes-of-hipaa-violations-and-their-simple-solutions/https://www.hbma.org/uploads/content_files/Billing_Jul_Aug10_SafeguardSnooping.pdfhttps://www.hhs.gov/hipaa/for-professionals/breach-notification/guidance/index.html