Reporting a HIPAA Violation

Reporting a HIPAA violation is  important as it serves as a proactive measure to safeguard the privacy and security of individuals’ sensitive health information, ensure adherence to legal requirements, initiate thorough investigations to identify the root causes of the breach, implement necessary corrective actions to prevent future incidents, minimize potential harm to affected individuals, uphold ethical standards in healthcare practices, and foster a robust culture of compliance and responsible handling of protected health information.

When healthcare or insurance worker think that a violation of HIPAA has taken place, the incident should be reported to a supervisor, the group’s Privacy Officer, or to the individual responsible for HIPAA compliance in the group. Accidental HIPAA violations take place even when great care is taken by employees. The HIPAA complaint will have to be reviewed internally and a decision made about whether it is a reportable breach under provisions of the HIPAA Breach Notification Rule. Some times, minor incidents are so inconsequential that they do not need notifications to be issued, such as when minor mistakes are made in good faith or if PHI has been shared and there is little risk of knowledge of PHI being retained. If you have made a mistake, accidentally accessed PHI of a patient that you are not authorized to view, or another person in your group is suspected of breaching HIPAA Rules, you should report HIPAA violations promptly. The failure to do so is likely to be considered unfavorably if it is later discovered.

If you become aware of a HIPAA violation, there are several steps you can take to report it:

1. Document the Details: Gather all relevant information about the violation, including the date, time, location, individuals involved, and a description of the incident or breach. Document any evidence or supporting documentation that you may have.
2. Internal Reporting: If you are an employee or affiliated with the organization where the violation occurred, report the incident internally to the designated HIPAA compliance officer or the appropriate authority within your organization. Follow the established reporting procedures and provide all the necessary details to facilitate an investigation.
3. Contact the Privacy Officer: If your organization has a privacy officer responsible for HIPAA compliance, reach out to them to report the violation. They can guide you on the next steps and ensure that the incident is addressed promptly and appropriately.
4. Reporting to the Office for Civil Rights (OCR): The OCR is the federal agency responsible for enforcing HIPAA regulations. If the violation involves a covered entity or business associate and you believe it warrants external reporting, you can file a complaint directly with the OCR. Complaints can be submitted online, by mail, or by fax, and should include as much detailed information as possible.
5. State Reporting: In some cases, state laws may require reporting HIPAA violations to the state regulatory authorities or agencies responsible for overseeing healthcare practices. Research the specific state laws where the violation occurred to determine if additional reporting is necessary.
6. Whistleblower Protection: If you are an employee reporting a HIPAA violation, familiarize yourself with any whistleblower protection laws that may apply in your jurisdiction. These laws safeguard employees from retaliation for reporting violations and provide legal remedies in case of retaliation.

Reporting a HIPAA Violation to HHS’ Office for Civil Rights

It is also allowable for employees and patients to bypass notifying the covered entity and make a HIPAA complaint directly with OCR if it is though that a Covered Entity has violated the HIPAA Privacy, Security, or Breach Notification Rules. In all instances, serious breaches of HIPAA rules including potential criminal violations, willful/widespread neglect of HIPAA Rules, and multiple suspected HIPAA violations should be made known to the Office for Civil Rights directly. HIPAA complaints can be file on OCR’s Complaint Portal online,  although OCR will also accept complaints via fax, mail, or email. Contact information for HIPAA violation reporting can be located on the above link. In order for OCR to determine whether a violation is likely to have taken place, the reason for the HIPAA complaint should be written stated along with the potential breach. Information will need to be given regarding about the covered entity (or business associate), the date when the HIPAA violation is suspected to have taken place, the address where the violation occurred – if known, and when the complainant learned of the possible HIPAA breach.

Complaints should be filed within 180 days of the violation being noticed, although in certain instances, an extension to the HIPAA violation reporting time limit may be granted if there is good cause. While complaints can be submitted anonymously, it is important to remember that OCR will not investigate any HIPAA complaint if a name and contact information is not given. All complaints will be reviewed and assessed, and investigations into HIPAA complaints will be initiated if HIPAA Rules are suspected of being breached and the complaint is submitted inside the 180-day timeframe. Not all HIPAA breaches lead to settlements or civil monetary penalties. Some times, the issue is settled through voluntary compliance, technical guidance, or if the covered entity or business associate agrees to take corrective measures.

Why Reporting a HIPAA Violation is Important

Reporting a HIPAA violation is important because it helps protect the privacy and security of individuals’ sensitive health information, upholding their rights and maintaining trust in the healthcare system. Secondly, reporting ensures legal compliance and prevents potential penalties and legal consequences for covered entities or individuals responsible for the breach. It triggers investigations that identify the root cause of the violation, leading to corrective actions and the prevention of further harm. By reporting violations promptly, the potential impact on affected individuals can be minimized, and necessary safeguards can be implemented to prevent future breaches. Ultimately, reporting a HIPAA violation promotes accountability, ethical practice, and a culture of compliance, safeguarding patient privacy and strengthening the integrity of the healthcare industry.