Examples of HIPAA Violations Caused by Internal Threats Affecting PHI

HIPAA violations caused by internal threats can have serious consequences, including fines, penalties, and damage to reputation.

A healthcare employee accessed a patient's medical record without a legitimate reason, violating the minimum necessary rule, which requires access to only the information necessary to perform their job.

This is not an isolated incident, as an investigation revealed that the employee had a history of accessing patient records without authorization.

In another case, a healthcare organization's IT employee accidentally disclosed a patient's PHI to a third party while troubleshooting a technical issue.

Intriguing read: Minimum Necessary Rule in Hipaa

Insider threats can be a major concern for healthcare organizations, and understanding the causes is key to preventing them. Employees may access PHI data without authorization for various reasons, including curiosity, criminal intent, or underperforming employees trying to prove their competence.

Curiosity is a common reason for insider threats, as employees may access PHI data of celebrity patients or patients they know out of curiosity. This can also happen during divorce proceedings or a custody dispute, where employees may access PHI data to use as leverage.

You might like: Hipaa Violation Penalties for Employees

Criminal intent is another major reason for insider threats, with employees accessing PHI data for financial gain or to commit identity theft or fraud. This can be a serious issue, especially when employees access the information of well-known individuals to sell it.

Employees leaving an organization can also pose a risk, as they may copy PHI data to provide a patient list to their new employer. This can lead to unauthorized disclosure of PHI data, resulting in HIPAA fines for the original employer.

Underperforming employees may also access PHI data as a means to prove their competence, downloading or copying PHI to support wrongful termination claims. This can be a difficult situation for healthcare organizations to manage.

Here are some common reasons for insider threats:

To prevent insider threats, healthcare organizations must implement access management and asset management controls, such as unique login credentials and physical controls like locks in areas that contain PHI data. They must also have a list of devices that includes who uses the device and what protections are in place securing PHI data.

Additional reading: Data Security Issues That Must Be Addressed by Hipaa

Preventing HIPAA Violations is crucial for healthcare organizations to protect sensitive patient information. HIPAA violations can occur due to carelessness or ignorance of HIPAA laws.

Providing adequate HIPAA training for employees is essential to avoid potential headaches. Employers can take simple steps to prevent HIPAA violations, such as never sharing passwords or login credentials.

To stay vigilant, healthcare organizations should continuously monitor their network and devices. This can be achieved through system alerts that monitor when users excessively download data or access personal sites.

Access management and asset management are key controls that organizations can implement to limit the risk of a PHI breach. Each employee should have unique login credentials, and all devices used for business should be logged and monitored.

Healthcare organizations should also be aware of the consequences of not complying with HIPAA regulations. Failure to comply can result in fines and penalties, as well as damage to reputation.

Consider reading: Accidental Hipaa Violation

The following are some simple ways to avoid HIPAA violations:

By following these simple steps, healthcare organizations can prevent HIPAA violations and protect sensitive patient information.

A HIPAA violation can be as simple as an employee leaving a client's medical file on their computer screen while they step away for a cup of coffee. This is a serious breach of patient confidentiality and can result in fines and penalties for the organization.

Organizations must have physical, technical, and administrative measures to protect health information, as outlined in the HIPAA Security Rule. This includes restricting employee access to patient data and ensuring that sensitive information is properly secured.

Failure to comply with any of the provisions of the HIPAA rules is a HIPAA violation. This can include failing to provide timely breach notification to the OCR, as the health system did in the example above.

The OCR fined a nonprofit academic health system $2.15 million for its failure to detect the theft and sale of patient records, failure to notify OCR of lost patient records, and failure to protect PHI that was leaked to the media. The health system had multiple opportunities to correct these issues before the OCR investigation.

For more insights, see: Hipaa Employee Acknowledgement Form

To avoid HIPAA violations, organizations must properly secure PHI to protect data leaks and maintain systems to ensure PHI is only accessed by authorized employees for appropriate purposes. They must also notify the OCR and affected individuals as soon as possible in the event of a data breach.

Here are some key facts to remember about HIPAA violations:

HIPAA compliance and training are crucial to prevent internal threats from affecting Protected Health Information (PHI). Ignorance of HIPAA policies is not an excuse for violations, and employers can avoid potential headaches by providing adequate HIPAA training for their employees.

HIPAA training should be thorough and comprehensive, not just a way to avoid incurring penalties and fines. Training should be a proactive step in helping health organizations prevent and minimize the likelihood of a data breach.

All HIPAA-covered entities are required to provide HIPAA-certified training to their staff and employees. This includes employees who handle PHI, such as business associates, nurses, office administrators, receptionists, hospital volunteers, interns, and doctors.

If this caught your attention, see: How to Avoid Hipaa Violations

HIPAA-certified training is necessary to prove that adequate training has been provided. Basic cybersecurity training will not suffice under HIPAA rules, and specific rules need to be adhered to.

Employees should receive training during the following times:

Report potential HIPAA infractions to prevent and minimize the likelihood of a data breach.

Improper handling of PHI can lead to serious consequences. A city failed to implement HIPAA privacy policies, resulting in a data breach after a terminated employee accessed a work computer and copied ePHI data onto a USB drive. This highlights the importance of maintaining tight controls over who can access sensitive information.

Employees often mishandle PHI, leading to unauthorized disclosure. In 2015, a health system committed multiple HIPAA violations for years, including an employee accessing and selling over 24,000 patients' records. This demonstrates the need for proper security measures to protect PHI.

Examples of improper handling of PHI include:

These breaches often involve human error, such as accidentally disclosing PHI through email mistakes or improper disposal of electronic media.

Employee misconduct is a major concern when it comes to the improper handling of PHI. Employees who intentionally or unintentionally mishandle PHI can put patients' sensitive information at risk.

Accidental disclosure of patient data to friends or family members in non-private settings is a common example of employee misconduct. Gossiping with coworkers about private and confidential patient data is also a serious issue.

Employee misconduct can also include viewing medical records for personal use or non-medical reasons. This is a clear violation of HIPAA rules and can result in severe penalties.

Posting photos on social media of instances where patients' PII is exposed is another example of employee misconduct. This can lead to a loss of trust in the healthcare provider and damage to their reputation.

To reduce employee misconduct and prevent the improper handling of PHI, healthcare providers should carry out regular employee training that covers proper handling of PHI. This should include maintaining best practices for security, such as not leaving a laptop unattended and implementing screen locks.

Explore further: Are Invoices Considered Private Information Hipaa

Here are some examples of potential incidents of employee misconduct:

Employee misconduct can have severe consequences, including fines and penalties. In one example, a former UCLA doctor and researcher was sentenced to four months in prison for intentionally violating HIPAA rules by viewing the medical records of celebrities.

Failure to Enter Business Associate Agreements can lead to HIPAA non-compliance. This is a common issue in healthcare organizations that work with third-party companies, which often have access to Protected Health Information (PHI).

Many third-party contractors don't typically handle sensitive patient data as their primary job, so they may not have the necessary data security protocols in place. This is why a Business Associate Agreement (BAA) is required before allowing access to PHI.

A BAA is necessary to ensure that third-party contractors comply with HIPAA standards. This is especially important in cases where vendors or suppliers may not be up to standard with their data security protocols.

Intriguing read: Business Associates Agreement Hipaa

Some common scenarios that can lead to failure to enter a BAA include:

To avoid HIPAA non-compliance, it's essential to appoint a specific individual to manage all third-party contracts. This ensures that the entire BAA process is complete and compliant with HIPAA.

Organizations can also use Third-Party Risk Management (TPRM) solutions to help oversee their vendors, contractors, and other third parties within the supply chain. TPRM solutions can identify immediate security risks, track security progress and implementation, and monitor compliance with HIPAA laws.

Suggestion: Third Party Hipaa Compliance

Improper PHI Disposal is a serious HIPAA breach that can result in heavy fines. In 2022, the New England Dermatology and Laser Center was fined a settlement of $300,640 for improperly disposing of PHI.

Many interns or new hospital staff don't realize the importance of properly disposing of medical records. They often discard or throw away complete physical copies of medical records without attempting to destroy the sensitive information.

See what others are reading: Phi Hipaa Stands for

HIPAA regulations mandate that all hospitals and clinics must have the proper procedures for disposing of both physical and digital medical data. This includes implementing comprehensive policies for handling expired PHI data and training employees on best practices.

To avoid the improper disposal of PHI and medical data, healthcare providers should regularly conduct shredding or pulping of physical paper copies that store PHI. Wipe or destroy portable devices like hard drives and USBs that store PHI.

Readers also liked: Physical Safeguards Are Hipaa