Under the Health Insurance Portability and Accountability Act (HIPAA), it is primarily illegal to use or disclose an individual's protected health information (PHI) without their explicit authorization, except in specific circumstances permitted by law. HIPAA establishes national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.
Core Violations of HIPAA
The fundamental principle governing HIPAA's legality is the proper handling and safeguarding of Protected Health Information (PHI). PHI includes any identifiable health information, such as medical records, billing information, and even demographic data collected by healthcare providers, health plans, and healthcare clearinghouses, as well as their business associates.
Unauthorized Use and Disclosure of PHI
A central tenet of HIPAA is that an individual's health information cannot be used or shared without their written permission, unless specifically allowed by the law for purposes like treatment, payment, or healthcare operations, or other public interest and benefit activities.
Specific actions that are illegal without patient authorization generally include:
- Sharing PHI with Employers: A healthcare provider generally cannot give an individual's health information to their employer without explicit authorization.
- Marketing and Advertising: Using or sharing an individual's health information for marketing or advertising purposes without their authorization is prohibited.
- Selling PHI: The sale of an individual's health information without their express authorization is strictly illegal.
- Discussing PHI in Public: Disclosing PHI in public spaces where it can be overheard (e.g., discussing a patient's condition in a crowded waiting room).
- Improper Disposal of PHI: Failing to securely dispose of paper or electronic records containing PHI, leading to unauthorized access.
- Accessing PHI Without a Legitimate Need: Healthcare workers accessing patient records for reasons other than treatment, payment, or operations, or out of curiosity.
Failure to Safeguard PHI
Beyond unauthorized sharing, HIPAA also mandates that covered entities and their business associates implement robust safeguards to protect the privacy and security of PHI. Failure to do so can lead to violations.
Examples of security and privacy rule violations:
- Lack of Administrative Safeguards: Not having proper policies and procedures in place, or failing to train staff on HIPAA compliance.
- Insufficient Physical Safeguards: Leaving patient charts or computer screens visible to unauthorized individuals, or failing to secure physical files.
- Weak Technical Safeguards: Not encrypting electronic PHI, failing to implement strong access controls, or not regularly auditing system activity.
- Failure to Report Breaches: Not notifying affected individuals, the Secretary of HHS, and in some cases, the media, following a breach of unsecured PHI.
Patient Rights Violations
HIPAA grants individuals specific rights concerning their health information. Denying these rights without proper legal justification can also constitute a violation.
Examples of patient rights violations:
- Denying Access to Records: Refusing to provide an individual with a copy of their medical records upon request.
- Not Providing a Notice of Privacy Practices: Failing to inform patients about how their health information may be used and disclosed, and their rights regarding that information.
- Ignoring Amendment Requests: Refusing to consider or appropriately respond to a patient's request to amend their health records if they believe it is inaccurate or incomplete.
Summary of Illegal Actions Under HIPAA
The table below summarizes common illegal actions related to Protected Health Information (PHI) under HIPAA:
| Category of Violation | Description of Illegal Action |
|---|---|
| Unauthorized Disclosure | Sharing PHI without patient consent for non-permitted reasons (e.g., employers, marketing, selling). |
| Lack of Safeguards | Failing to implement adequate administrative, physical, and technical measures to protect PHI. |
| Improper Access | Accessing PHI without a legitimate "need-to-know" for job duties. |
| Patient Rights Denial | Refusing patients their right to access, amend, or receive an accounting of disclosures of their own PHI. |
| Breach Notification Failure | Not notifying affected individuals and authorities after a data breach of unsecured PHI. |
| Retaliation | Taking adverse action against individuals who file HIPAA complaints or participate in investigations. |
Who Is Affected?
HIPAA applies to Covered Entities, which include:
- Health Plans: Such as health insurance companies, HMOs, Medicare, and Medicaid.
- Healthcare Clearinghouses: Entities that process nonstandard health information into a standard format.
- Healthcare Providers: Doctors, clinics, hospitals, psychologists, chiropractors, nursing homes, pharmacies, and dentists, who transmit health information electronically.
It also applies to Business Associates, which are persons or entities that perform functions or activities on behalf of, or provide services to, a covered entity that involve access to PHI (e.g., medical billing companies, IT services, cloud storage providers). Both covered entities and business associates can face legal consequences for HIPAA violations.
For more detailed information on HIPAA and individual rights, you can visit the U.S. Department of Health & Human Services website.
