What is the HIPAA Privacy Rule?

The HIPAA Privacy Rule (the Privacy Rule), empowers individuals to have a legal, enforceable right to see and request copies of their medical and other health records maintained by their health care providers and health plans upon request.

The Privacy Rule is part of the Health Insurance Portability and Accountability Act of 1996, commonly known as HIPAA. It is a set of federal regulations that govern the use and disclosure of Protected Health Information (PHI). PHI is any identifiable health information held or transmitted by a covered entity, such as a health insurance company or healthcare provider.

The HIPAA Privacy Rule establishes national standards for the protection of PHI. It gives patients the right to access and control their health information and limits how and when PHI can be used or disclosed without patient consent.

Why Is the HIPAA Privacy Rule Important?

The HIPAA privacy rule is important to patients, providers, and compliance officers for various reasons. First and foremost, the rule protects the confidentiality of patient medical records and other identifiable health information.

This is critical to maintaining trust between patients and their healthcare providers. Patients need to know that their personal health information will be kept private and will not be shared without their consent.

The HIPAA privacy rule also sets forth rules about when and how medical information can be disclosed. For example, the rule requires covered entities to get patient consent before disclosing protected health information (PHI) for most purposes.

The rule also establishes limitations on the use and disclosure of PHI by covered entities. These protections ensure that protected health information is used only for authorized purposes and is not inappropriately disclosed.

Compliance with the HIPAA privacy rule is also important from a business perspective. Covered entities that fail to comply with the rule can face significant penalties, including fines of up to $50,000 per violation. In addition, covered entities may be subject to civil or criminal liability if they knowingly violate the rule.

As a result, covered entities need to have procedures and policies in place to ensure compliance with the HIPAA privacy rule.

What Happens When You Violate HIPAA Regulations?

When providers disclose health information without the patient’s consent or in ways that do not comply with HIPAA rules, they violate patients’ rights and may also be breaking the law.

Depending on the severity of the violation, consequences can range from a warning to expulsion from the program. More serious penalties may include legal action and/or fines from enforcement agencies.

To protect patients’ rights and comply with HIPAA regulations, providers must understand the rules and ensure they follow them. Providers should err on the side of caution when in doubt and get patient consent before disclosing any health information.

How Does the Rule Protect Individuals’ Rights?

Individuals have certain rights under HIPAA. They have the right to access their health information. They also have the right to request changes to their health information if they believe it is inaccurate or incomplete. Individuals can file a complaint if they believe their rights have been violated.

The HIPAA Rule helps protect individuals’ rights by setting rules about how PHI can be used and disclosed. Organizations obligated to comply with HIPAA must have policies and procedures in place to protect the confidentiality of PHI.

What Information Is Protected?

The HIPAA Rule is designed to protect the rights of individuals concerning their medical care and records. HIPAA-compliant providers are required to comply with certain rules about disclosures of PHI, and patients have a right to expect that their medical information will be protected.

The Rule also establishes standards for how patient medical information can be used and disclosed and sets forth penalties for non-compliance. By ensuring that providers comply with the HIPAA Rule, patients can be assured that their rights will be protected. For more information on what HIPAA protects, download this pdf.

Covered Entities

There are four basic types of HIPAA entities under HIPAA regulations: covered entities, business associates, hybrid entities, and sole proprietors. Each type of entity is subject to different requirements under the HIPAA Privacy Rule and the HIPAA Security Rule standard.

Covered entities – the Rule requires covered entities to take reasonable steps to safeguard PHI from unauthorized use or disclosure. Covered entities must also provide individuals with rights to access and amend their PHI. Covered entities include health plans, healthcare clearinghouses, and healthcare providers who transmit identifiable health information electronically.
Business associates – are companies that provide services to covered entities and have access to protected health information (PHI).
Hybrid entities – are those that fall into both categories – they’re either covered entities or business associates. Sole proprietors are not subject to the requirements of the HIPAA Privacy Rule or the Security Rule.

Permitted Uses and Disclosures

The Health Insurance Portability and Accountability Act (HIPAA) permits covered entities to disclose protected health information (PHI) to a patient, or to someone who is involved in the patient’s care, for the purpose of treatment, payment, or healthcare operations. HIPAA also permits disclosures for public health activities, research purposes, and when required by law.

In addition, HIPAA permits covered entities to disclose PHI to individuals who need the information to protect the patient’s life or safety. Covered entities must take measures to ensure that PHI is used and disclosed only in accordance with HIPAA rules.

HIPAA Privacy Rule Fact Sheet

Review our quick facts on the history of HIPAA below.

The HIPAA Privacy Rule was established in 1996 as part of the Health Insurance Portability and Accountability Act (HIPAA).
The purpose of the rule is to protect sensitive patient health information from being disclosed without appropriate consent or authorization.
Covered entities must use and disclose identifiable health information only for treatment, payment, healthcare operations, or other purposes specified by the rule.
Individuals have certain rights under HIPAA, such as requesting access to their data, restricting certain uses or disclosures, receiving confidential communications, filing a complaint if they believe their privacy rights were violated, and informing them in the event of a data breach involving personal data.
Violations can lead to civil monetary penalties, criminal fines up to $250,000 per violation, and possible jail time depending on the severity of the offense committed.

Get Perimeter81’s HIPAA Checklist

In summary, the HIPAA Privacy Rule is an important law that protects patients and their sensitive health information. Knowing how to comply with HIPAA helps ensure that healthcare providers can provide needed services while protecting individuals’ privacy rights.

The benefits of knowing about and adhering to HIPAA include ensuring patient trust in their healthcare provider, maintaining the confidentiality of personal medical data, and helping improve the quality of care by shielding sensitive health information from unnecessary use or disclosure; all can be found in our HIPAA compliance checklist.

Want to get the latest updated information on the HIPAA Privacy Rule? Download our checklist.

FAQs

Who enforces the HIPAA privacy rule?

The HIPAA Privacy Rule is enforced by the Department of Health and Human Services (HHS). The HHS Office for Civil Rights (OCR) investigates complaints and enforces the Privacy Rule. OCR can impose civil money penalties or exclude offenders from participating in Medicare, Medicaid, and other federal healthcare programs.

The Privacy Rule applies to all covered entities, including hospitals, clinics, doctor’s offices, nursing homes, pharmacies, insurance companies, and other health care providers that deal with protected health information.

Covered entities must comply with the Rule’s requirements to protect the privacy of patients’ medical records and other personal health information. Under the Privacy Rule, patients have certain rights concerning their protected health information.

For example, patients have the right to access their medical records, request amendments to their records, and receive notice of how their protected health information may be used and disclosed. Patients also have the right to file a complaint if they believe their privacy rights have been violated.

The Privacy Rule sets forth requirements for covered entities to safeguard patient privacy. Covered entities must ensure that only authorized individuals can access protected health information.

They must also put in place policies and procedures to protect against unauthorized use or disclosure of protected health information. In addition, covered entities must notify patients of their privacy rights and how their protected health information may be used or disclosed.

What is the purpose of the HIPAA privacy rule?

The HIPAA privacy rule’s purpose is to protect patient health information privacy. The rule sets out when and how medical information can be disclosed. The rule also requires covered entities to notify patients of their rights under the rule. The rule is designed to balance protecting patients’ privacy and allowing covered entities to comply with other laws requiring medical information disclosure.

Who is not covered by the HIPAA privacy rule?

The HIPAA Privacy Rule does have exceptions. It does not apply to state or local governments unless they administer a Medicaid program. The rule also does not apply to research studies conducted in compliance with other federal regulations.

Finally, the Privacy Rule does not cover information that is already public knowledge, such as birth and death records. In general, the HIPAA Privacy Rule is designed to protect the privacy of patients’ medical information. Covered entities must comply with the Rule to protect patients’ rights and maintain compliance with federal regulations.

Do you have more questions?