The Health Insurance Portability and Accountability Act of 1996 (HIPAA or the Kennedy–Kassebaum Act) is a United States federal measure that was passed by the 104th Congress and signed into law by President Bill Clinton on August 21, 1996. It was primarily intended to improve the flow of healthcare information, to establish rules for the security of personally identifiable information held by the healthcare and healthcare insurance industries against fraud and theft, and to address coverage restrictions in healthcare insurance.

It established policies such as the Standards for the Privacy of Individually Identifiable Health Information (commonly referred to as the Privacy Rule), which established national standards for the protection of private health information, or PHI, and established mechanisms for medical practises to be held accountable for security.

Recently, there has been a significant increase in interest in HIPAA as a result of the global increase in data breaches.

What is HIPAA?

HIPAA is the acronym for the Health Insurance Portability and Accountability Act that was passed by Congress in 1996. HIPAA does the following:

Provides the ability to transfer and continue health insurance coverage for millions of American workers and their families when they change or lose their jobs;
Reduces health care fraud and abuse;
Mandates industry-wide standards for health care information on electronic billing and other processes; and
Requires the protection and confidential handling of protected health information

What does the Health Insurance Portability and Accountability Act do?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that mandated the development of national standards to guard against the disclosure of sensitive patient health information without the patient’s consent or knowledge. To implement HIPAA’s obligations, the US Department of Health and Human Services (HHS) published the HIPAA Privacy Rule. The HIPAA Security Rule safeguards a portion of the data protected under the Privacy Rule.

Why Is HIPAA Important?

Personal healthcare information is widely sought after by identity thieves, and as criminals develop new, evasive methods for stealing huge volumes of data, the healthcare industry’s privacy and security safeguards have garnered considerable attention.

It is critical for healthcare practitioners to understand HIPAA since it established regulations that health institutions must follow or risk severe penalties.

• Inability to comprehend HIPAA regulations or willful violations of security procedures will result in significant penalties and forced structure rearrangement.
• Unknown Violation: $100 to $50,000 per record if the provider was unaware of the breach or could not have known about it.
• Reasonable Cause: $1,000 to $50,000 per record if the provider knew or reasonably should have known (like repeat violations)
• Willful Neglect: $10,000 to $50,000 per record if the provider acted willfully and promptly remedied the violation.
• Uncorrected Willful Neglect: Between $50,000 and $1.5 million if the provider acted willfully and failed to rectify the offence after 30 days.
• Each of these offences has a maximum annual penalty of $1.5 million.

Additionally, remember that HIPAA was created to increase the emphasis on security in healthcare and to keep patients safe. If avoiding a punishment is insufficient reason to safeguard your data, consider the people behind the statistics. The more precautions you take to safeguard your data, the safer your patients will be.

What Is the Importance of HIPAA Compliance?

HIPAA compliance regulations are critical. Failure to comply may jeopardise the security of patients’ health information. Breach may have a devastating effect on a business’s reputation, and you may face disciplinary action as well as harsh breach fines and penalties from CMS/OCR.

The Wannacry ransomware assault last year infected over 200,000 systems globally, including those of several healthcare organisations. Most notably, it impacted the United Kingdom’s National Health Service, creating widespread interruptions in the delivery of health care.

Hackers gained access to the systems by exploiting vulnerabilities in out-of-date versions of Windows that are still widely utilised by a large number of healthcare institutions. With medical software vendors providing insufficient support for new operating systems and medical devices such as MRIs missing security safeguards, the assault was very simple to execute.

The attack highlighted the power of today’s hackers, emphasising the extent to which out-of-date systems may cause problems in modern businesses. This is precisely why HIPAA governs some parts of information technology systems used to store, handle, and transfer healthcare data.

Institutions that do not establish sufficient mechanisms risk suffering major consequences. If a breach occurs, the legislation compels impacted companies to submit a variety of disclosure papers, which may include mailing a letter to each subject. Additionally, they may be compelled to provide a year of identity protection services to patients. This can quickly mount up to a substantial sum of money, even before the scope of the violation is determined.

What are HIPAA’s five primary components?

HIPAA is divided into five parts or titles:

• Title I: HIPAA Reform. Title I ensures that individuals who leave or change employment retain their health insurance coverage. Additionally, it prevents group health plans from refusing coverage to individuals with specified diseases or previous conditions, as well as establishing lifetime coverage limitations.
• Title II: Simplifying HIPAA’s administrative requirements. Title II authorises the United States Department of Health and Human Services (HHS) to create national standards for electronic health transaction processing. Additionally, it mandates healthcare institutions to implement secure electronic access to health data and to adhere to HHS-mandated privacy safeguards.
• Title III: HIPAA-Related Tax Provisions on Health Care. Title III contains tax provisions and medical care requirements.
• Title IV: Group Health Plan Requirements: Application and Enforcement Title IV describes health insurance reform in further detail, including rules for those with prior conditions and those wanting to maintain coverage.
• Revenue Offsets (Title V). Title V contains rules relating to company-owned life insurance and the tax status of individuals who lose their US citizenship.

In healthcare circles, most individuals refer to HIPAA compliance as complying to HIPAA Title II. Title II, sometimes referred to as the Administrative Simplification provisions, contains the following HIPAA compliance requirements:

• Standard for National Provider Identifiers: Individuals, businesses, health plans, and healthcare providers must all have a unique ten-digit National Provider Identifier, or NPI.
• Standard for Transactions and Code Sets: To file and process insurance claims, healthcare institutions must use a standardised electronic data exchange (EDI) protocol.
• Privacy Rule under HIPAA: Officially titled the Privacy Standards for Individually Identifiable Health Information, this rule provides nationwide standards for the protection of patient health information.
• HIPAA Security Requirement: The Security Standards for the Protection of Electronic Protected Health Information (ePHI) establishes minimum security requirements for patient data.
• HIPAA Compliance Rule: This regulation provides standards for conducting HIPAA compliance investigations.
• The HHS Office for Civil Rights (OCR), which is responsible for enforcing HIPAA, conducts audits and has the authority to impose fines for HIPAA violation. Violations of HIPAA may be extremely expensive for healthcare businesses.

HIPAA Privacy Regulations

The Privacy Rule’s requirements govern how businesses subject to the Privacy Rule use and disclose people’ health information (referred to as “protected health information”). Individuals and organisations that fall within this category are referred to as “covered entities.” Additionally, the Privacy Rule establishes rules for individuals’ rights to understand and regulate the use of their health information. The Privacy Rule’s primary objective is to guarantee that people’ health information is adequately secured while allowing for the flow of health information necessary to deliver and promote high-quality health care and to protect the public’s health and well-being. The Privacy Rule finds a balance between allowing critical uses of information and safeguarding the privacy of those seeking care and recovery.

Entities That Are Covered
Individuals and organisations classified as covered entities under the Privacy Rule include the following:

• Healthcare providers: Any healthcare practitioner, regardless of practise size, who communicates health information electronically in the course of specific transactions. These transactions include those for which HHS has established requirements under the HIPAA Transactions Rule, such as claims, benefit eligibility queries, and referral authorization requests.
• Health plans: Organizations that either offer or pay for medical treatment. Health insurers include those that provide health, dental, vision, and prescription drug coverage; health maintenance organisations (HMOs); Medicare, Medicaid, Medicare+Choice, and Medicare supplement coverage; and long-term care insurers (excluding nursing home fixed-indemnity policies). Employer-sponsored group health plans, government- and church-sponsored health plans, and multi-employer health plans are additional types of health plans.
• Exception: A covered entity is not a group health plan with less than 50 members that is entirely administered by the employer that formed and maintained the plan.
• Healthcare clearinghouses: Organizations that convert nonstandard information received from another organisation into a standard format or data content, or vice versa. Generally, healthcare clearinghouses will receive individually identifiable health information only if they are acting as a business associate for a health plan or healthcare provider.
• Business associates: A person or organisation (other than a covered entity’s employee) that uses or discloses individually identifiable health information in order to execute or provide tasks, activities, or services for the covered entity. Claims processing, data analysis, usage review, and billing are only some of the tasks, activities, or services included in this category.

HIPAA Security Requirement

While the HIPAA Privacy Rule protects protected health information (PHI), the Security Rule covers a subset of the Privacy Rule’s covered information. This subset includes any electronically stored personally identifiable health information that a covered entity generates, receives, retains, or transfers. This data is referred to as “electronic protected health information” (e-PHI). The Security Rule does not apply to oral or written transmissions of PHI.

All covered businesses must take the following steps to comply with the HIPAA Security Rule:

• Assure the privacy, integrity, and accessibility of all digitally protected health information
• Identify and protect against expected threats to the information’s security
• Defend against foreseeable unauthorised uses or disclosures
• Attest to their workforce’s compliance
• When assessing requests for certain permissible uses and disclosures, covered entities should use professional ethics and sound judgement. The HHS Office for Civil Rights is responsible for enforcing HIPAA standards, and any complaints should be sent there. Violations of HIPAA may result in civil monetary penalties or criminal consequences.

What types of information are covered under HIPAA?

The HIPAA Privacy Rule safeguards any personally identifiable health information that a covered business or a BA maintains or transmits. This data can be stored in a variety of formats, including digital, paper, or oral.

PHI encompasses the following but is not limited to:

a patient’s name, address, birth date, Social Security number, biometric identifiers, or other personally identifiable information (PII); an individual’s past, present, or future physical or mental health condition; any care provided to an individual; and information regarding the patient’s past, present, or future payment for care provided to the individual that identifies the patient or information fo

PHI excludes the following:

Employment records, including educational records, as well as other records covered by or defined by the Family Educational Rights and Privacy Act (FERPA); and deidentified data, which is data that does not identify or provide information that could identify an individual; its use and disclosure are unrestricted.
Medical records, laboratory reports, and hospital bills are all instances of PHI because they contain identifiable information — the patient’s name, for example — connected with health data.

Blood pressure or heart rate data obtained by a consumer health device, such as a smartwatch, is not considered PHI since it is not shared with a covered organisation.

Penalties under the HIPAA Privacy Rule

Under the HIPAA Privacy Rule, being a victim of a healthcare data breach or neglecting to provide patients with access to their protected health information may result in a fine from OCR.

Penalties for violating the privacy rule vary according on the gravity of the infringement. They are classified into four groups:

• Unintentional HIPAA breaches carry a fine of $100 per violation, with a maximum yearly penalty of $25,000 for multiple offences.
• A breach of HIPAA is punishable by a fine of $1,000 per infraction, with a maximum yearly fine of $100,000 for repeated offences.
• Willful disregard of HIPAA, although correction occurs within a certain time period, is $10,000 per violation, with a maximum yearly penalty of $250,000 for repeat violations.
• The penalty for willful disregard of HIPAA and failure to rectify the violation is $50,000 per violation, with a maximum yearly penalty of $1.5 million for repeat violations.
• Individuals and covered entities that knowingly access or disclose PHI in violation of the HIPAA Privacy Rule face a fine of up to $50,000 and up to one year in jail. If the HIPAA Privacy Rule is broken fraudulently, the penalty can be enhanced to a $100,000 fine and up to ten years in jail.

Through HIPAA compliance training programmes, organisations may mitigate their risk of regulatory action. OCR provides information on how to comply with privacy and security regulations through instructional programmes. Numerous consulting and training organisations also provide programmes. Healthcare providers may also develop their own training programmes, which often incorporate current HIPAA privacy and security regulations, the HITECH Act, mobile device management (MDM) protocols, and other pertinent requirements.

While there is no formal HIPAA compliance certification programme, training providers provide certification credentials that demonstrate knowledge of the act’s standards and requirements.

What Steps Can I Take to Avoid HIPAA Violations?

The best way to avoid violating HIPAA rules is to know how they apply to your organization. Health plans, healthcare clearinghouses, and healthcare providers that electronically transmit health information are all affected.

• Encryption Services: Data encryption is a way to protect data by translating it into another form that can only be read by the person or computer with the encryption code.
• Employee Training: Train your employees every year on digital security and what your company policies are.
• Know the Laws: HIPAA, HITECH, & FACTA are three laws that require careful compliance.
• Cloud-Based Data Storage: Your data can be safer than ever using a cloud-based data storage service since begins with scanning your records into electronic health records.
• Electronic Health Records: Electronic health records (EHR) make all your patients’ records compliant with HITECH and HIPAA.