Things You Need To Know If You Break One Of The Federal Healthcare Laws

Things You Need To Know If You Break One Of The Federal Healthcare Laws

Several laws in the United States commit to promoting access to healthcare and protecting the public by ensuring medical professionals understand and follow regulations and standards.  

Unfortunately, administrative staff, healthcare workers and support staff may fall foul of the complex and strict laws governing healthcare provision, therefore for anyone in such a situation it is essential to understand the consequences and relevant regulations which you can read more about below. 

HIPAA

The Health Insurance Portability and Accountability Act (1996) applies to anywhere providing healthcare services including chiropractors, dentists, hospitals, nursing homes, pharmacies, and psychologists. Almost every kind of practice will have a pharmacy on-site or be partnered with one so it is vital to read the full info here on how compliance attorneys can ensure your pharmacy passes audits and clears investigations. In addition to regular audits, the activities of business associates and partners you work with are also subject to HIPAA regulations; these include accountants, administrative staff, billing, and transcription companies, and pharmacy benefit managers. 

HIPAA was originally enacted to protect health coverage for people who lost or changed employment. However, nowadays it is more widely applied to protect patient’s privacy and set boundaries on how medical records can be used and shared. HIPAA provisions state that any healthcare provider that uses, stores, maintains, or shares information relating to a patient must do so only when being fully compliant. The main purpose is to provide safeguards that protect patients’ private and personal details and information by clearly setting out potential civil and criminal penalties for any violations. 

Due to the increased digitization of patient records, the risk of data breaches has gone up markedly in recent years so health care practices are required under HIPAA regulations to ensure the safe storage of records whether it is online or offline. 

How Are HIPAA Breaches Discovered?

There are several ways that HIPAA breaches and violations are identified: 

  • During risk assessments by business associates
  • In HIPAA audits by the DHHS 
  • Patients can report unauthorized disclosure of their private information
  • Third-party security firms can find vulnerable applications and insecure storage servers used for patient information

Compliance Attorneys Can Help You

If you are an employee at a medical practice then they probably already work with compliance attorneys to plan programs and training as well as respond to audits and investigations. For individuals facing a HIPAA rule violation, it is essential to seek the counsel of a lawyer who fully understands every healthcare law. Oftentimes, if the lawyer can prove that the violation wasn’t by willful intent and corrective action was attempted, then a penalty is unlikely to be applied. 

There are Several Outcomes 

If you have broken a healthcare law or regulations you can expect a few different potential outcomes that are determined by several factors. There are a few possible consequences for violating HIPAA rules, these are: 

  • The violation is handled internally by an employer
  • An attorney proves compliance
  • The clinic or individual is barred from practicing medicine
  • Sanctions could be imposed from professional medical boards
  • Hearing the case in a civil court
  • The accused could face criminal charges

When a HIPAA violation case is being heard the severity of the judgment is determined by multiple elements including the amount of harm caused, the number of people affected, the seriousness of the violation, whether corrective action was taken, and if the person knew regulations were being broken. 

HIPAA Violations: Civil Penalties

For individuals that were aware they were violating a HIPAA regulation or failed to carry out due diligence must pay a civil penalty of at least $100 per infraction. However, fines can be as large as $25,000 for repeated violations.  

In cases where there was no intent to break HIPAA regulations and corrective action was taken within 30 days of the violation, civil penalties are usually enforced. 

HIPAA Violations: Criminal Penalties 

Some HIPAA violations such as gross negligence, malpractice and illegally obtaining private patient data are considered criminal violations which are much more severe than civil cases. For individuals found guilty of more serious violations, the minimum fine is $50,000 whilst the maximum is $250,000. In addition, those who commit criminal violations of HIPAA rules may also be required to pay compensation to the victims and serve a jail term. 

The penalties for criminal violations are tiered depending on the severity of the violation: 

  • Gross negligence may result in a one-year jail sentence
  • Stealing or falsely acquiring protected patient data can result in a 5-year jail term.
  • Active and malicious intent to break HIPAA rules for nefarious reasons or personal gain carries a maximum jail sentence of 10 years.  
  • Identity theft carries a mandatory two years jail sentence. 

Violations Caused by Lack of Training

Occasionally an individual will violate a HIPAA rule because of a lack of initial or continued training in compliance guidelines and regulations. Under the law, it is the employer’s responsibility to ensure all staff has received training in HIPAA compliance, furthermore, the employer should provide training certificates and documents to prevent disputes about if appropriate training was provided.

Clinics are Responsible for IT Security

It is the responsibility of business associates and management to implement administrative, physical, and technical safeguards and security measures to ensure patient data isn’t altered, lost, misplaced, or stolen. In cases that management has failed to ensure data safeguards are used or the staff was not trained to use the software properly then the clinic is responsible for the violation. 

Regulations in the HITECH Act

To provide greater enforcement for provisions under HIPAA, the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed in 2009. The purpose of the law is to promote the adoption of information technology by healthcare providers by giving financial incentives to those who switch to electronic health records in addition to stricter data security requirements and harsher penalties for providers and their associates in the case of violations. 

Under HITECH rules it is mandatory to inform patients of unauthorized access or use of their details or medical information. 

It is vital that any healthcare organization, big or small, follows regulations and guidelines to comply with HIPAA and HITECH as the fines for non-compliance can be up to $1.5 million every year per violation. 

At times employees of healthcare providers may knowingly or unknowingly break a U.S healthcare law, there are a range of outcomes for such violations so if you have broken a rule then it is worth knowing about the laws and how an attorney can help you.


Posted 1 month ago by Allen Brown

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