Understanding Violations of Health Information Privacy
Learn what counts as a health information privacy violation, your rights under HIPAA, and how enforcement and penalties work.
Health information is among the most sensitive data people share. When that information is mishandled, exposed, or used without permission, the consequences can be deeply personal and legally significant. In the United States, the primary federal framework governing health information privacy is the Health Insurance Portability and Accountability Act (HIPAA), along with related rules and, in some cases, the Federal Trade Commission (FTC) Act.
This article explains what constitutes a violation of health information privacy, how HIPAA protects individuals, who must comply with the law, what happens when a breach occurs, and how enforcement and penalties work. It also offers practical guidance for patients and organizations seeking to prevent violations.
What Counts as Health Information Privacy?
To understand violations, it is essential to define the information being protected. Under HIPAA, privacy protections apply to individually identifiable health information, also known as protected health information (PHI).
- Health-related data: Information about a person’s past, present, or future physical or mental health condition; health care services; or payment for health care.
- Identifiers: Data that directly identifies a person (such as name, Social Security number, address) or can reasonably be used to identify them.
- Any format: PHI can exist on paper, electronically, or orally; privacy protections apply regardless of medium.
When this information is collected, stored, used, or disclosed, HIPAA’s Privacy, Security, and Breach Notification Rules set limits on who can access it, for what purposes, and under which circumstances.
Who Must Follow HIPAA?
Not every organization handling health-related information is subject to HIPAA. The law applies primarily to covered entities and their business associates.
- Covered entities typically include health care providers (such as doctors and hospitals), health plans, and health care clearinghouses that transmit health information electronically in connection with certain transactions.
- Business associates are vendors or service providers that perform functions involving PHI on behalf of covered entities, such as billing companies, cloud storage providers, or analytics services.
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Separately, some companies that handle consumer health records but are not covered entities—like certain health apps or personal health record vendors—may be regulated under the FTC Act and the Health Breach Notification Rule. These entities must also protect health information privacy and provide breach notifications when required.
Examples of Health Information Privacy Violations
A privacy violation occurs when PHI is used, accessed, or disclosed in a way that is not permitted by HIPAA or other applicable law. Common examples include:
- Unauthorized disclosure: Sharing patient information with individuals or organizations not authorized to receive it, such as sending records to an employer without consent.
- Improper access: Employees viewing records out of curiosity or for personal reasons without a legitimate work-related need.
- Inadequate safeguards: Failing to implement reasonable administrative, technical, and physical measures to secure PHI (for example, leaving files unlocked or failing to encrypt electronic data).
- Improper disposal: Throwing paper records in regular trash instead of shredding, or discarding unencrypted devices containing PHI without wiping them.
- Using data for marketing without authorization: Using patient information for sales calls or advertising without obtaining valid written authorization from the individual.
Violations can be intentional (such as selling patient data for financial gain) or unintentional (such as mistakenly emailing records to the wrong recipient). Both can trigger enforcement, although intent affects the level of penalties.
Individual Rights Under HIPAA
HIPAA’s Privacy Rule does more than impose obligations on organizations; it grants individuals specific rights over their health information.
| Right | What It Means |
|---|---|
| Access | You can inspect and obtain copies of your health records in a designated record set, with certain limited exceptions. |
| Amendment | You may request corrections or additions to records that are inaccurate or incomplete. |
| Restrictions | You can ask providers or health plans not to share your information with certain people, groups, or companies. |
| Confidential communications | You may request that information be communicated in specific ways, such as at a certain phone number or address. |
| Complaints | You have the right to complain to your provider or health plan and to the U.S. Department of Health and Human Services (HHS) if you believe your privacy rights were violated. |
Covered entities must provide a Notice of Privacy Practices describing these rights, explaining how PHI may be used and shared, and identifying a point of contact for questions and complaints.
Required Safeguards to Prevent Violations
HIPAA expects organizations to take proactive steps to prevent privacy and security violations. Covered entities and business associates must implement reasonable and appropriate safeguards in three key areas.
Administrative Safeguards
- Establish policies and procedures governing access to PHI.
- Assign responsibility for privacy and security oversight.
- Conduct risk assessments and update practices as needed.
- Provide regular HIPAA compliance training for employees.
Technical Safeguards
- Limit access to electronic PHI (ePHI) to authorized users only.
- Use strong authentication and secure communication methods.
- Encrypt data at rest and in transit where appropriate.
- Maintain audit logs to track access and detect suspicious activity.
Physical Safeguards
- Secure paper records and electronic systems with locks or passcodes.
- Control physical access to areas where PHI is stored.
- Shred or securely destroy documents containing PHI before disposal.
Failure to implement these protections can itself be a violation, even if a specific breach has not yet occurred, because HIPAA requires preventive measures, not only reactive responses.
How Health Information Privacy Complaints Are Filed
Individuals who believe their HIPAA privacy rights have been violated can file a complaint with the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services. Anyone may file a complaint, including on behalf of someone else.
Complaints can be submitted:
- Online through the OCR Complaint Portal for HIPAA or related confidentiality issues.
- In writing, by mail, fax, or email, using forms provided by HHS.
To be effective, a complaint generally should include:
- The name of the covered entity or business associate involved.
- A description of what happened and how you believe the privacy rules were violated.
- Relevant dates and any documentation supporting your claim.
There are time limits for filing complaints, but OCR can extend them in appropriate circumstances. The agency investigates complaints, conducts compliance reviews, and engages in education and outreach to promote adherence to HIPAA rules.
Enforcement of Health Information Privacy Rules
Enforcement of HIPAA’s Privacy and Security Rules is primarily handled by HHS OCR. The OCR:
- Investigates complaints and may initiate compliance reviews.
- Assesses whether covered entities or business associates are in compliance.
- Negotiates corrective action plans, which may include policy changes, employee training, and improved safeguards.
- Imposes civil monetary penalties when warranted.
Additionally, the Department of Justice (DOJ) handles criminal prosecutions for certain serious HIPAA violations, especially those involving knowing misuse or disclosure of identifiable health information.
For organizations not covered by HIPAA but handling sensitive health information, the FTC can enforce privacy protections under the FTC Act and the Health Breach Notification Rule, including actions against unfair or deceptive practices and failures to report breaches.
Civil and Criminal Penalties for HIPAA Violations
HIPAA uses a tiered penalty structure that considers an organization’s level of culpability and efforts to correct the problem. Penalties can be significant.
Civil Monetary Penalties
Civil penalties are usually imposed when covered entities or business associates fail to comply with HIPAA requirements. There are four general levels of culpability:
- No knowledge: When the organization did not know and could not reasonably have known of the violation, there is a lower minimum penalty per violation.
- Reasonable cause: When the violation is due to reasonable cause but not willful neglect, penalties are higher.
- Willful neglect, corrected: When the organization acted with willful neglect but corrected the issue within the required time period, penalties increase again.
- Willful neglect, not corrected: When willful neglect is not remedied, penalties reach the maximum level, with per-violation fines and annual caps that can reach up to $1.5 million for identical violations in a calendar year.
Criminal Penalties
Certain intentional acts involving PHI can lead to criminal charges. For example:
- A person who knowingly obtains or discloses individually identifiable health information in violation of the Privacy Rule may face up to a $50,000 fine and one year of imprisonment.
- If the conduct involves false pretenses, penalties can increase to a $100,000 fine and up to five years in prison.
- If there is intent to sell, transfer, or use PHI for commercial advantage, personal gain, or malicious harm, fines can reach $250,000 and imprisonment up to ten years.
The DOJ determines when criminal prosecution is appropriate and handles those cases.
FTC Health Breach Notification Obligations
Organizations not covered by HIPAA may still have legal obligations if they handle consumer health information. Under the Health Breach Notification Rule, certain businesses—such as vendors of personal health records and related entities—must notify affected consumers, the FTC, and sometimes the media when a breach of security involving identifiable health information occurs.
Key obligations include:
- Notifying individuals about breaches so they can take steps to protect themselves.
- Reporting breaches to the FTC using the online Notice of Breach of Health Information, particularly when the breach involves 500 or more individuals.
- Maintaining strong privacy and security programs, including written policies, training, and safeguards around data retention and use limitations.
Failure to provide timely, accurate notifications or to maintain adequate safeguards can result in enforcement actions and significant civil penalties under the FTC Act.
Practical Steps to Avoid Health Information Privacy Violations
Organizations that handle health information can reduce the risk of violations by adopting a comprehensive privacy and security strategy.
For Health Care Organizations and Business Associates
- Conduct regular risk assessments to identify vulnerabilities in systems, workflows, and physical security.
- Develop and maintain written policies covering access control, data handling, disposal, and breach response.
- Train employees on HIPAA requirements and organization-specific procedures, emphasizing confidentiality and proper use of PHI.
- Implement technical safeguards such as role-based access control, encryption, secure messaging, and audit logging.
- Vet vendors and ensure business associate agreements are in place when third parties handle PHI.
For Patients and Consumers
- Review privacy notices from your providers and health plans to understand how your information may be used and shared.
- Ask questions if you are unsure why certain information is requested or how it will be protected.
- Safeguard personal records by shredding prescriptions, insurance forms, and other documents containing health details before disposal.
- Verify sources before sharing medical or insurance information online or over the phone to reduce the risk of fraud or misuse.
- Exercise your rights by requesting access, corrections, and restrictions as appropriate, and filing complaints when you believe your privacy has been violated.
Frequently Asked Questions (FAQ)
1. Is every disclosure of medical information a HIPAA violation?
No. HIPAA allows certain uses and disclosures without individual authorization, such as for treatment, payment, and health care operations, and in specific public policy situations (for example, public health reporting), as described in notices of privacy practices. A violation occurs when PHI is used or shared in ways that do not meet HIPAA’s rules or exceed what the law permits.
2. Can my employer access my medical records under HIPAA?
In general, HIPAA restricts sharing your health information with employers without your authorization. There are limited circumstances where information might be disclosed (such as workplace medical surveillance in certain industries), but routine access to your medical records by an employer is not permitted unless you give valid written consent.
3. What should I do if I suspect a privacy breach?
First, contact the health care provider, health plan, or organization involved to notify them and ask how they plan to respond. You can also file a complaint with HHS OCR if you believe a HIPAA-covered entity or business associate violated your privacy rights. If the issue involves a non-HIPAA entity like a health app, FTC guidance may apply, and consumers can report potential violations to the FTC.
4. Are mistakes treated the same as intentional misuse?
No. HIPAA’s penalty tiers distinguish between unintentional violations and willful neglect. However, even accidental breaches can lead to civil penalties, particularly if an organization failed to adopt reasonable safeguards. Intentional misuse of PHI, especially for profit or malicious harm, may result in criminal penalties.
5. Does HIPAA cover all health-related apps and wearable devices?
Not always. HIPAA applies primarily to covered entities and their business associates. Some consumer health apps and devices that are not connected to a health plan or provider may instead be regulated by the FTC under the FTC Act and the Health Breach Notification Rule. Users should review each service’s privacy policy and security practices carefully.
References
- Summary of the HIPAA Privacy Rule — U.S. Department of Health and Human Services. 2013-07-26. https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html
- HIPAA for Consumers — Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services. 2019-05-01. https://www.healthit.gov/privacy-security/hipaa-basics/hipaa-consumers/
- HIPAA Violations & Enforcement — American Medical Association. 2023-02-10. https://www.ama-assn.org/practice-management/hipaa/hipaa-violations-enforcement
- Penalties for Violating HIPAA — American Dental Association. 2022-06-15. https://www.ada.org/resources/practice/legal-and-regulatory/hipaa/penalties-for-violating-hipaa
- Filing a Health Information Privacy Complaint — U.S. Department of Health and Human Services, Office for Civil Rights. 2023-04-20. https://www.hhs.gov/hipaa/filing-a-complaint/index.html
- Collecting, Using, or Sharing Consumer Health Information? Look to HIPAA, the FTC Act, and the Health Breach Notification Rule — Federal Trade Commission. 2022-01-18. https://www.ftc.gov/business-guidance/resources/collecting-using-or-sharing-consumer-health-information-look-hipaa-ftc-act-health-breach
- 8 Common HIPAA Violations — Fortinet. 2021-02-11. https://www.fortinet.com/resources/articles/common-hipaa-violations
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