What Are HIPAA Violations?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) helped improve the continuity of health insurance for covered workers. It also established strong privacy protection regarding patients' personally identifiable health care information.

HIPAA Violations

• Despite the strict civil and possible criminal penalties for violations of HIPAA, thousands of enforcement activities have been brought against those who violate the law. As of October 2009, the Office for Civil Rights (OCR) has resolved 9,501 cases of HIPAA privacy rule violations since the law was enacted.

Most Common HIPAA Violation

• According to OCR, the most common violation of HIPAA is the impermissible use and disclosure of protected health information. This usually refers to use and disclosure without the patient's authorization.

HIPAA Preexisting Conditions Violation

• An insurance company is in violation of HIPAA if it exceeds the established time limits on exclusions for preexisting medical conditions. Currently, an insurance company cannot exclude a preexisting condition for more than 12 months, and this time is reduced by any amount of creditable coverage.

HIPAA Nondiscrimination Violation

• An individual cannot be ruled ineligible for benefits or charged a higher fee for coverage due to any health factor. A health factor includes medical history or condition, genetic information, or disability.

HIPAA Notification Violation

• An insurance company is in violation of HIPAA if it reduces benefits or services and fails to notify plan participants within 60 days.