HIPAA

Overview

Info

HIPAA (Health Insurance Portability and Accountability Act) is a U.S. federal law enacted in 1996 that establishes national standards for the protection of health information.

It is primarily designed to protect patients’ medical records and personal health information (PHI) and to improve efficiency in the healthcare system through secure data handling.

Key Objectives

• Protect the privacy and security of health information
• Ensure data portability for health insurance coverage
• Combat waste, fraud, and abuse in health insurance and healthcare
• Improve administrative efficiency through standardization

Core Rules

1. Privacy Rule

   • Governs how PHI can be used and disclosed
   • Applies to covered entities and business associates
   • Gives individuals rights over their health information

2. Security Rule

   • Sets standards for securing electronic PHI (ePHI)
   • Requires administrative, physical, and technical safeguards

3. Breach Notification Rule

   • Requires covered entities to notify affected individuals, HHS, and in some cases the media, in the event of a data breach

4. Enforcement Rule

   • Outlines penalties for violations and procedures for investigations and hearings

5. Omnibus Rule (2013 update)

   • Expanded HIPAA obligations to business associates
   • Strengthened enforcement and breach penalties

Who Must Comply

• Covered Entities: Health plans, healthcare providers, healthcare clearinghouses
• Business Associates: Vendors and third parties handling PHI on behalf of covered entities

Compliance Requirements

Note

HIPAA does not prescribe exact technologies but expects organizations to implement reasonable and appropriate safeguards.

• Conduct risk assessments
• Develop and enforce security and privacy policies
• Train staff on HIPAA requirements
• Implement technical safeguards (encryption, access control, audit logs)

Penalties

Violations can result in fines ranging from $100to$50,000 per violation, with a maximum annual penalty of $1.5 million per type of violation. Criminal penalties may apply for willful neglect or malicious misuse.

Summary

Tip

HIPAA is not just a legal requirement—it’s a foundation for trust in the handling of sensitive health data. It intersects with frameworks like HITRUST CSF and standards like NIST for implementation guidance.

• Ensures health data protection and individual rights
• Applies to a broad range of entities in healthcare and adjacent sectors
• Requires ongoing compliance and risk-based security practices