7.2.3 Violation of the Enforcement Rule and Penalties

Penalties for violating the HIPAA Enforcement Rule are issued by the Department of Health and Human Services Office for Civil Rights (OCR). In case of financial penalties, covered entities are also required to introduce new procedures and policies to help prevent PHI losses.

As mentioned in module 5, HIPAA violation penalties are classified into four tiers, which are described as follows:

Tier 1 – When the entity is in a situation where they did not know about the breach, the penalty is $100 to $50,000 per violation.

Tier 2 – When the entity knew about the diligence but did not act with willful neglect, the penalty ranges from $1000 to $50,000.

Tier 3 – When an entity has acted with willful neglect, but the problem or issue has been corrected, the penalty ranges from $10,000 to $50,000.

Tier 4When the entity has acted with willful neglect and has failed to solve the issue, the penalty ranges from $50,000 to $1.5 million.

The Structure for Penalties

The OCR considers several factors before penalizing an organization. This includes information regarding the length of time a violation persisted, the number of people affected by a possible breach, and the nature of the exposed data.

The willingness of an organization to assist with the OCR investigation is considered as well.

HIPAA violations are divided into categories, each determining the financial penalty for the specific violation. They are described as follows:

Tier 1 – The minimum fine is $100 to $50,000 per violation.

Tier 2 – The minimum fine is $1,000 to $50,000.

Tier 3 – The minimum fine is $10,000 to $50,000 per violation.

Tier 4 – The minimum fine is $50,000.

Penalties usually depend on the breach, and sometimes, paying a fine is unnecessary.

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