How HIPAA Violations Can Surprise You

How HIPAA Violations Can Surprise You

EDITOR’S NOTE: This is a fictional story that could become much too real.

In the bustling corridors of General Hospital USA, the heart of the administrative operations pulsed with urgency. The hospital’s CFO, Jennifer Morgan, was wrapping up a conference call when a soft knock on her door interrupted her train of thought.

“Come in,” Jennifer called out, her voice steady and authoritative.

The door opened to reveal the hospital’s Compliance Officer, Mark Davis. His usually calm demeanor was clouded with concern, a sight that made Jennifer’s own sense of unease grow.

“Mark, good to see you. What’s on your mind?” she asked, gesturing for him to take a seat.

“Jennifer, we have a serious issue that needs immediate attention,” Mark began, his tone grave. “It’s about our accounting system. I’ve discovered some invoices attached to it that contain patient information. This is a clear HIPAA violation.”

Jennifer’s face paled slightly as she absorbed the news. “How did this happen?” she asked, leaning forward, her eyes locked onto Mark’s.

Mark sighed, running a hand through his graying hair. “It seems that some of the invoices were uploaded by mistake. These invoices include patient names, treatment details, and other protected health information. Our accounting system isn’t HIPAA compliant, which means we’re in breach of the regulations.”

Jennifer took a deep breath, trying to process the implications. “How many invoices are we talking about?”

“From what I’ve seen so far, it’s about a hundred,” Mark replied. “But we need to conduct a thorough audit to identify the full scope of the issue.”

Jennifer nodded, her mind racing. “We need to act fast. The first step is to remove those invoices from the system immediately. Can you coordinate with IT to get that done?”

“Already on it,” Mark said, a hint of relief in his voice. “But we also need to inform the affected patients and report this breach to the Department of Health and Human Services. It’s crucial that we handle this by the book to mitigate any potential penalties.”

“Agreed,” Jennifer said, her tone resolute. “Let’s also ensure we have a team to review our current procedures and prevent this from happening again. We’ll need to provide additional training to our staff on handling patient information.”

Mark nodded. “I’ll get started on the breach notification and coordinate with our legal team to draft the communications for the affected patients. We need to be transparent about this mistake and reassure them that we’re taking all necessary steps to protect their information.”

While this is just a work of fiction, I want to demonstrate how easily hospitals and other healthcare providers can get caught in HIPAA violations when you assume that all of the systems in the organizations are HIPAA compliant.  Now is always a good time to talk to your compliance officer about which hospital systems are HIPAA compliant.  Even if certain software is compliant, you also need to make sure your organization has a “Business Associates” agreement with the vendor. 

Facebook
Twitter
LinkedIn

Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

The Cost of Ignoring Risk Adjustment: How HCCs Impact Revenue & Compliance

The Cost of Ignoring Risk Adjustment: How HCCs Impact Revenue & Compliance

Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals.  Don’t miss this chance to protect your hospital’s revenue and reputation!

May 29, 2025
I050825

Mastering ICD-10-CM Coding for Diabetes and it’s Complications: Avoiding Denials & Ensuring Compliance

Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!

May 8, 2025
2025 Coding Clinic Webcast Series

2025 ICD-10-CM/PCS Coding Clinic Update Webcast Series

Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.

April 14, 2025

Trending News

Featured Webcasts

Open Door Forum Webcast Series

Open Door Forum Webcast Series

Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.

June 11, 2025
Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Open Door Forum: The Changing Face of Addiction: Coding, Compliance & Care

Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025.  Register today and be a part of the conversation!

July 16, 2025
Open Door Forum: Vaccination Nation - Navigating New Rules, Risks & Reimbursement

Open Door Forum: Vaccination Nation – Navigating New Rules, Risks & Reimbursement

Vaccine policies, billing rules, and compliance risks are changing fast! How will your organization adapt? Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating new Medicare mandates, coding updates, and legal challenges in vaccination programs. Get expert answers on billing, compliance, outbreak risks, and operational strategies to protect your facility and patients. . Join us live and bring your questions to the table.

June 18, 2025

Trending News

Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →

CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24