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How Does HIPAA Affect You?

Dr. Nina Radcliff Written by Dr. Nina Radcliff
SeniorLiving.Org Expert on Anesthesia | Pharmacology | Leadership

HIPAA What? HIPAA Who?

Have you wondered why every first visit with a doctor or admission to a hospital, you are made to sign a “Notice of Privacy Practices” form? Your healthcare provider does not hate trees but is complying with a federal requirement known as The Health Insurance Portability and Accountability Act (HIPAA for short).

What information is protected?

HIPAA protects all “individually identifiable health information” in verbal, written, and electronic forms to those who need to know. The following cannot be shared with others who are not involved with your care if it contains identifying demographics such as your name, social security number, birth date, or address:

  • Health or mental conditions in the past or present
  • Admissions, treatments and procedures
  • Billing and payment information

When can information be shared?

Your privacy needs to be balanced so it does not interfere with your care. The following information can be shared:

  • To enable treatment and care coordination
  • For billing and payment to doctors and hospitals
  • With family members, friends, or those who have been identified by you
  • With regulatory bodies that ensure appropriate care
  • With agencies in order to protect the public (e.g. contagious diseases)
  • With the police (e.g. violent crimes)

What are some examples of HIPAA violations?

“Personal health information” is commonly referred to as PHI.

  • Accessing PHI of family members, neighbors, coworkers, or celebrities.
  • Sharing PHI with those who do not need to know (e.g. other healthcare workers who are not involved in direct patient care)
  • Discussing PHI in public areas such as elevators, the lobby, or elevators where others can hear
  • Giving PHI to your employer
  • Marketing or advertising purposes without your consent
  • Leaving PHI unattended or throwing PHI into the trash.

What are the penalties?

The Office of Civil Rights (OCR) is a federal entity that is responsible for enforcing HIPAA regulations. Penalties include:

  • Fines: Each violation can be fined up to $100 (up to $25,000 in a calendar year)
  • Criminal penalties:
    • Entities and individuals who knowingly obtain and disclose PHI can face a fine of up to $50,000 and imprisonment up to 1 year.
    • If the offense is committed under false pretenses, the penalty can be increased to a fine of $100,000 and up to 5 years in prison.
    • If the offense is for “commercial advantage or malicious harm” the fine can reach up to $250,000 and imprisonment up to 10 years.

Some recent examples include:

  • In 2011, UCLA Health System agreed to pay a fine of $865,000 for violations by employees of celebrity medial records, including Britney Spears, Tom Cruise and Maria Shriver.
  • The pharmacy CVS Caremark paid a $2.25 million dollar fine.

How do I report a possible violation?

If you feel that your health information has been violated, you can contact the Compliance Hotline at 1-877-WE COMPLY or 1-877-932-6675 (toll free).


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