Health Insurance Portability and Accountability Act of 1996

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HIPAA is a federal law that governs the use, disclosure, and protection of individuals’ health information, referred to as protected health information (PHI). HIPAA applies to healthcare providers, health plans, and healthcare clearinghouses, as well as any business associates that handle PHI on their behalf. The law consists of two main components: the Privacy Rule and the Security Rule. The Privacy Rule sets forth the standards for the use and disclosure of PHI, while the Security Rule outlines the requirements for safeguarding the confidentiality, integrity, and availability of electronic PHI.

The purpose of HIPAA is to protect the privacy and security of individuals’ health information, while also promoting the efficiency and standardization of the healthcare industry. By establishing national standards for the use and disclosure of PHI, HIPAA helps to ensure that individuals’ health information is protected, regardless of where they receive healthcare services. The law also promotes the use of electronic health records (EHRs), which can help to improve the accuracy and accessibility of individuals’ health information.

Importance of HIPAA in the healthcare industry:

HIPAA is crucial to the healthcare industry because it helps to maintain the confidentiality and privacy of individuals’ health information. It provides individuals with greater control over how their health information is used and disclosed, which can help to build trust between patients and healthcare providers. Additionally, HIPAA helps to ensure that healthcare organizations are held accountable for protecting individuals’ health information, which can help to prevent data breaches and other security incidents. Finally, HIPAA helps to promote the use of EHRs, which can improve the quality and coordination of healthcare services, while also reducing costs and administrative burdens for healthcare organizations. Overall, HIPAA is a vital component of the healthcare industry, helping to protect individuals’ health information and promote better healthcare outcomes.

Questions To Consider

Why was the Health Insurance Portability and Accountability Act (HIPAA) established?

  • The focus of the statute is to create confidentiality systems within and beyond healthcare facilities.
  • The goal of keeping protected health information private.

Whom does HIPAA cover?

  • All persons working in a healthcare facility or private office
  • Students
  • Non-patient care employees
  • Health plans (e.g., insurance companies)
  • Billing companies
  • Electronic medical record companies

What are basic HIPAA goals?

  • To limit the use of protected health information to those with a “need to know.”
  • To penalize those who do not comply with confidentiality regulations.

What health information is protected?

  • Any health care information with an identifier that links a specific patient to healthcare information (name, social security number, telephone number, email address, street address, among others)

Differentiate between HIPAA privacy rules, use, and disclosure of information?

  • Use: How information is used within a healthcare facility
  • Disclosure: How information is shared outside a health care facility
  • Privacy rules: Patients must give signed consent for the use of their personal information or disclosure

What are the legal exceptions when health care professionals can breach confidentiality without permission?

  • Gunshot wound
  • Stab wound
  • Injuries sustained in a crime
  • Child/Elderly abuse
  • Infectious, communicable, or reportable diseases

What types of data does HIPAA protect?

  • Written, paper, spoken, or electronic data
  • Transmission of data within and outside a health care facility
  • Applies to anyone or any institution involved with the use of healthcare-related data
  • Data size does not matter

What types of electronic devices must facility security systems protect?

  • Both hardware and software
  • Unauthorized access to health care data or devices such as a user attempting to change passwords at defined intervals

What is the job of a HIPAA security officer?

  • IT background
  • Document and maintain security policies and procedures
  • Audit the systems
  • Risk assessments and compliance with policies/procedures

What does a security risk assessment entail?

  • Should be undertaken at all healthcare facilities
  • Assess the risk of virus infection and hackers
  • Create safeguards against risks

What are physical safeguards?

  • Secure printers, fax machines, and computers
  • Locks on computer and record rooms
  • Destroy sensitive information

What type of employee training for HIPAA is necessary?

  • Ideally under the supervision of the security officer
  • The level of access increases with responsibility
  • Annual HIPAA training with updates mandatory for all employees
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What type of reminder policies should be in place?

  • E-mail alert, posters
  • Log-on, log-off computer notices

How should a sanctions policy for HIPAA violations be written?

  • Clear, non-ambiguous plain English policy
  • Apply equally to all employees and contractors
  • Sale of information results in termination
  • Repeat offense increases the punishment

What discussions regarding patient information may be conducted in public locations?

  • None
  • Conversational information is covered by confidentiality/HIPAA
  • Do not talk about patients or protected health information in public locations

How do you protect electronic information?

  • Point computer screens away from public
  • Use privacy sliding doors at the reception desk
  • Never leave protected health information unattended
  • Log off workstations when leaving an area

How do you ensure password protection?

  • Do not share the password
  • Do not write down the password
  • Do not verbalize password
  • Do not email your password

How do you select a safe password?

  • Do not select consecutive digits
  • Do not select information that can be easily guessed
  • Choose something that can be remembered but not guessed

Covered Entities

The following types of individuals and organizations are subject to the Privacy Rule and considered covered entities:

  • Healthcare providers: Every healthcare provider, regardless of size of practice, who electronically transmits health information in connection with certain transactions. These transactions include:
  • Claims
  • Benefit eligibility inquiries
  • Referral authorization requests
  • Other transactions for which HHS has established standards under the HIPAA Transactions Rule.
  • Health, dental, vision, and prescription drug insurers
  • Health maintenance organizations (HMOs)
  • Medicare, Medicaid, Medicare+Choice, and Medicare supplement insurers
  • Long-term care insurers (excluding nursing home fixed-indemnity policies)
  • Employer-sponsored group health plans
  • Government- and church-sponsored health plans
  • Multi-employer health plans

Exception: 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.

  • Healthcare clearinghouses: 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.
  • Business associates: A person or organization (other than a member of a covered entity’s workforce) using or disclosing individually identifiable health information to perform or provide functions, activities, or services for a covered entity.These functions, activities, or services include:
  • Claims processing
  • Data analysis
  • Utilization review
  • Billing

HIPAA Privacy Rule

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule establishes national standards for protecting individuals’ medical records and other personal health information. The rule applies to covered entities, which include healthcare providers, health plans, and healthcare clearinghouses.

The Privacy Rule protects all “individually identifiable health information” held or transmitted by a covered entity or its business associate, in any form or medium, whether electronic, paper, or oral. This information is known as “protected health information” (PHI), which includes information about a patient’s medical condition, treatment, and payment information.

The Privacy Rule gives patients several rights concerning their PHI, such as the right to access, correct, and obtain a copy of their health information. Patients also have the right to request that their health information be transmitted to another healthcare provider or entity.

Covered entities are required to implement appropriate safeguards to protect PHI, such as physical, administrative, and technical safeguards. They are also required to provide privacy notices to patients that explain how their PHI will be used and disclosed, and their rights concerning their PHI.

Non-compliance with the Privacy Rule can result in significant penalties. Covered entities that violate the Privacy Rule may be subject to civil and criminal penalties, including fines and imprisonment. Individuals may also file complaints with the Department of Health and Human Services if they believe their privacy rights have been violated.

HIPAA Security Rule

The Health Insurance Portability and Accountability Act (HIPAA) Security Rule sets the standards for safeguarding electronic protected health information (ePHI) that is created, received, maintained or transmitted by covered entities. The Security Rule complements the Privacy Rule and together, they establish the standards for protecting an individual’s personal health information.

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Covered entities under the Security Rule include healthcare providers, health plans, and healthcare clearinghouses, as well as their business associates that have access to ePHI. Business associates are individuals or entities that provide services to covered entities and have access to ePHI, such as third-party administrators, billing companies, and cloud storage providers.

The Security Rule requires covered entities to implement administrative, physical, and technical safeguards to protect ePHI. Administrative safeguards are policies and procedures designed to manage the selection, development, implementation, and maintenance of security measures to protect ePHI. Physical safeguards are physical measures, policies, and procedures to protect the physical access, integrity, and security of ePHI. Technical safeguards are the technology and security measures in place to protect ePHI and control access to it.

In addition, covered entities must conduct a risk analysis to identify potential vulnerabilities and implement measures to mitigate the risks. Risk management is an ongoing process that involves periodic review and assessment of security measures to ensure that ePHI remains protected.

Non-compliance with the Security Rule can result in significant penalties, including fines ranging from $100 to $50,000 per violation, and up to $1.5 million per year for each violation of an identical provision. Covered entities are encouraged to ensure they are compliant with the Security Rule and take the necessary steps to protect ePHI.

HIPAA Enforcement Rule

The Health Insurance Portability and Accountability Act (HIPAA) sets forth regulations regarding the privacy and security of individuals’ health information. The HIPAA Enforcement Rule establishes procedures for investigating and resolving complaints of violations of the privacy and security rules, as well as penalties for non-compliance.

Investigation and Resolution of Complaints

Under the HIPAA Enforcement Rule, the Department of Health and Human Services’ Office for Civil Rights (OCR) is responsible for investigating and resolving complaints of alleged HIPAA violations. Complaints can be filed by individuals, organizations, or even by the OCR itself if it has reason to believe that a violation has occurred. The OCR investigates the complaint, conducts interviews, and reviews relevant documents to determine whether a violation has occurred.

If the OCR determines that a violation has occurred, it may take enforcement action against the covered entity or business associate responsible for the violation. The OCR can require the entity to take corrective action to address the violation and can also impose penalties.

Penalties for Non-Compliance

The HIPAA Enforcement Rule provides for both civil and criminal penalties for non-compliance with the privacy and security rules. Civil penalties can be imposed for each violation, with a maximum penalty of $1.5 million per year for each type of violation. Criminal penalties can also be imposed for certain HIPAA violations, such as knowingly disclosing or obtaining protected health information.

In addition to financial penalties, non-compliance with the HIPAA privacy and security rules can also result in reputational damage for covered entities and business associates. Compliance with the HIPAA regulations is not only required by law, but it also helps to build trust with patients and customers by demonstrating a commitment to protecting their sensitive health information.

HIPAA Breach Notification Rule:

The HIPAA Breach Notification Rule was established in 2009 as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act. The rule requires covered entities to notify affected individuals, the Department of Health and Human Services (HHS), and, in some cases, the media of breaches of unsecured protected health information (PHI).

Covered entities under the Breach Notification Rule include healthcare providers, health plans, and healthcare clearinghouses. Business associates of covered entities are also subject to the rule.

The Breach Notification Rule defines a breach as an impermissible use or disclosure of PHI that compromises the security or privacy of the information. This includes unauthorized access, acquisition, or disclosure of PHI that is not permitted under the HIPAA Privacy Rule.

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Notification requirements under the Breach Notification Rule mandate that covered entities must notify affected individuals of a breach of their PHI within 60 days of discovery. Notifications must include a description of the breach, types of PHI involved, steps individuals should take to protect themselves, and contact information for the covered entity.

Covered entities must also report breaches to the HHS Secretary, and in some cases, the media. Breaches affecting fewer than 500 individuals must be reported annually to the HHS Secretary, while breaches affecting more than 500 individuals must be reported to the HHS Secretary and the media.

Penalties for non-compliance with the Breach Notification Rule can be significant. Violations can result in fines ranging from $100 to $50,000 per violation, up to a maximum of $1.5 million per year. Civil and criminal penalties may also apply depending on the severity of the breach and the level of negligence involved.

Overall, the HIPAA Breach Notification Rule is an essential component of protecting the privacy and security of PHI, and covered entities must take appropriate steps to comply with the rule’s requirements to avoid significant penalties.

HIPAA and Electronic Health Records (EHRs)

Overview of EHRs:

Electronic Health Records (EHRs) are digital versions of patients’ medical records that can be easily accessed and shared among authorized healthcare providers. EHRs contain comprehensive and up-to-date information about a patient’s medical history, diagnoses, medications, test results, and other health-related data.

HIPAA regulations for EHRs:

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that regulates the use and disclosure of protected health information (PHI). When it comes to EHRs, HIPAA mandates that covered entities, such as healthcare providers and health plans, implement appropriate administrative, physical, and technical safeguards to ensure the confidentiality, integrity, and availability of PHI. These safeguards must include measures to protect against unauthorized access, use, or disclosure of PHI, as well as procedures for breach notification and risk analysis.

Benefits of EHRs in compliance with HIPAA:

EHRs offer several benefits in compliance with HIPAA regulations. For one, they provide a secure and centralized location for storing and managing PHI, which can help reduce the risk of data breaches and unauthorized access. EHRs also allow healthcare providers to quickly and accurately access patient information, which can improve the quality of care and patient outcomes. Additionally, EHRs can facilitate compliance with HIPAA’s requirements for documentation, privacy, and security, as they offer features such as audit trails, access controls, and encryption. By leveraging the capabilities of EHRs, covered entities can ensure that they are meeting HIPAA’s requirements while providing high-quality care to their patients.


In conclusion, HIPAA, or the Health Insurance Portability and Accountability Act, is a crucial piece of legislation that has had a significant impact on the healthcare industry since its enactment in 1996. HIPAA is designed to protect the privacy and security of individuals’ health information and has established guidelines for healthcare providers and organizations to ensure that this information is kept confidential and secure.

The importance of HIPAA cannot be overstated, as it has not only provided patients with greater control over their health information but has also facilitated the sharing of health information among healthcare providers, which is essential for providing high-quality patient care.

Looking to the future, HIPAA is likely to play an increasingly critical role in the healthcare industry. As technology continues to advance, there is a growing need to ensure that patients’ health information is protected from data breaches and other security threats. Additionally, as healthcare becomes more integrated, with multiple providers working together to provide comprehensive care, HIPAA will be essential in facilitating the secure sharing of patient information between providers.

In conclusion, HIPAA has been and will continue to be a critical component of the healthcare industry, ensuring that patients’ health information is protected, and that providers have the information they need to provide the best possible care.