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

The Enigma of Sepsis

The Enigma of Sepsis

Sepsis is one of the most (if not the most) challenging concepts in the International Classification of Diseases, 10th Edition, Clinical Modification (ICD-10-CM), the Health Insurance Portability and Accountability

Read More

Leave a Reply

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

Featured Webcasts

2026 IPPS Masterclass 3: Master MS-DRG Shifts and NTAPs

2026 IPPS Masterclass Day 3: MS-DRG Shifts and NTAPs

This third session in our 2026 IPPS Masterclass will feature a review of FY26 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 14, 2025
2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

2026 IPPS Masterclass Day 2: Master ICD-10-PCS Changes

This second session in our 2026 IPPS Masterclass will feature a review the FY26 changes to ICD-10-PCS codes. This information will be presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 13, 2025
2026 IPPS Masterclass 1: Master ICD-10-CM Changes

2026 IPPS Masterclass Day 1: Master ICD-10-CM Changes

This first session in our 2026 IPPS Masterclass will feature an in-depth explanation of FY26 changes to ICD-10-CM codes and guidelines, CCs/MCCs, and revisions to the MCE, presented by presented by nationally recognized ICD-10 coding expert Christine Geiger, MA, RHIA, CCS, CRC, with bonus insights and analysis from Dr. James Kennedy.

August 12, 2025

Trending News

Featured Webcasts

The Two-Midnight Rule: New Challenges, Proven Strategies

The Two-Midnight Rule: New Challenges, Proven Strategies

RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.

June 19, 2025
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

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