A Guide to HIPAA Violation Fines: What You Need To Know

hipaa violation fines

Are you worried about incurring HIPAA violation fines? With the following information, you can stay vigilant about your compliance efforts and avoid costly fines.

If you need to better understand the role of HIPAA in medical billing, contact PracticeForces today.


The Importance of HIPAA Regulations

Also known as the Health Insurance Portability and Accountability Act, HIPAA sets a standard for protecting sensitive patient data, such as health records. Any company that handles healthcare records, from the doctor’s office to hospitals, must abide by these regulatory standards. As part of these regulations, these companies must outsource their protected health information (PHI) to a HIPAA-compliant company.


Types of HIPAA Violations

The Department of Justice (DOJ) classifies HIPAA violations into two categories: criminal and civil. If the Office for Civil Rights within the U.S. Department of Health and Human Services believes a medical provider violated HIPAA compliance, they investigate. 

Sometimes, the department will offer the company the chance to become compliant before they officially file charges. If the organization still doesn’t fix the problem, they can refer the case to federal law enforcement for investigation. 


Civil Violations

Civil violations occur when HSS determines the violations occurred without malice or knowledge but still finds the healthcare organization at fault. These investigations don’t involve the Department of Justice but still incur heavy fines.

HIPAA violation fines for civil violations include:

  • $100 to $50,000 per violation if the organization unknowingly violated compliance
  • $1,000 to $50,000 per violation if the company had reasonable cause to violate compliance
  • $10,000 to $50,000 if the compliance issue resulted from willful neglect, but the company fixed it within the required time
  • $50,000 per violation for willful neglect the organization didn’t remedy in time

The most common civil HIPAA violations include failure to enter into a HIPAA-compliant business associate agreement, failure to implement proper access controls and device theft.


Criminal Violations

The DOJ handles criminal violations of HIPAA, and if found guilty, covered entities or specific organizations face fines ranging from $50,000 to $250,000 and between one and 10 years in prison, depending on the severity of the crime. The DOJ categorizes offenses into three tiers, including knowingly obtaining or disclosing individually identifiable health information, offenses committed under false pretenses, and crimes committed with the intent to sell or use individual health information for personal gain or harm.

Covered entities include: 

  • Health plans
  • Healthcare clearinghouses
  • Healthcare providers using electronic forms
  • Medicare prescription drug card sponsors

Many providers ask how the DOJ defines the term “knowingly.” Rather than knowing that a specific act is illegal when a person commits it, they only require knowledge that the act occurred. In other words, you don’t have to know the act itself is wrong for the government to hold you liable.


PracticeForces Helps Mitigate HIPAA Violations

Now that you better understand HIPAA violation fines, you can take steps to avoid them. PracticeForces can help you navigate HIPAA identity verification requirements or even recommend a coding quiz to make your medical billing more accurate.

To learn more, call (727) 202-5429 today.

Parul Garg, CEO and co-founder of PracticeForces, has significantly contributed to the growth of over 1,000 U.S. medical practices through her expertise in medical billing and coding since the company’s inception in 2003. With a background in Computer Science and an MBA in Human Resources, her leadership and AAPC-certified coding skills have been pivotal in managing the company’s operations effectively.

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