Doctors, nurses and other healthcare practitioners have access to highly confidential information regarding patients’ health and medical history. This information is necessary to make diagnoses and treatment decisions that are in patients’ best interests, and practitioners must adhere to strict rules to protect patients’ privacy. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law governing uses of individually identifiable health information. Violating HIPAA guidelines can have serious consequences.
Civil penalties for HIPAA violations are imposed at the discretion of the Secretary of the Department of Health and Human Services, who will evaluate the circumstances of the violation and the harm it caused to the patient. The practitioner may be required to pay a fine as outlined below:
- Violation was unknowingly committed and would not have been discovered through due diligence: $100 minimum fine per violation ($25,000 annual maximum); $50,000 maximum fine per violation ($1.5 million annual maximum)
- Violation due to reasonable cause, not willful neglect: $1,000 minimum fine per violation ($100,000 annual maximum); $50,000 maximum fine per violation ($1.5 million annual maximum)
- Violation due to willful neglect, corrected within required period: $10,000 minimum fine per violation ($250,000 annual maximum); $50,000 maximum fine per violation ($1.5 million annual maximum)
- Violation due to willful neglect, not corrected: $50,000 fine per violation ($1.5 million annual maximum)
In cases where an unwillful violation is corrected within 30 days, there can be no civil penalties imposed.
HIPAA violators may also face criminal charges, which can include fines of up to $50,000 and one year of imprisonment. These penalties can increase to $100,000 and up to five years in prison if the violation was committed under false pretenses, and may further increase to $250,000 and 10 years in prison if the individually identifiable information was obtained or disclosed in order to profit financially or cause malicious harm. Covered entities such as health insurance companies, health care clearinghouses, health care providers and Medicare prescription drug card sponsors, as well as individual employees who were not directly responsible for the violation, may also be subject to criminal penalties.
Nature of Offense Determines Severity of Penalty
The penalties differ substantially based on whether or not an offense was committed “knowingly.” According to the Department of Justice, an individual “knowingly” violates HIPAA when he or she is familiar with the actions that constitute an offense. He or she does not need to know that the specific action they have taken is in violation of HIPAA in order to be held accountable.
HIPAA also includes provisions to standardize how medical information and transactions are electronically managed and coded, which are closely monitored by the Centers for Medicare & Medicaid (CMS) and carry their own set of penalties. If a health care provider is not in compliance with the transaction and code set standards, the Department of Health and Human Services may exclude them from participation in Medicare.
Philadelphia Health Care Lawyers at Sidney L. Gold & Associates Protect Interests of Medical Personnel
If you are facing a HIPAA violation, do not fight it alone. The knowledgeable, experienced Philadelphia health care lawyers at Sidney L. Gold & Associates understand the complexities of HIPAA and will prepare a sound legal strategy to get you the best possible outcome. With offices conveniently located in Center City, Philadelphia, we serve clients throughout Pennsylvania, New Jersey and New York. Call us today at 215-569-1999 or contact us online to review your case with a qualified health care lawyer.