Health Care Provider Fined Millions for Failure to Protect Health Records

The U.S. Department of Health and Human Services (HHS) Office for Civil Rights (OCR) has settled a lawsuit with 21st Century Oncology, Inc. (21CO) involving their failure to protect health care records of millions of people.  The settlement includes a has $2.3 million fine which has been agreed to instead of possible civil money penalties which could have amounted to much more.  21CO has also agreed to put into place a complete corrective action plan to remediate current problems and prevent future violations of the Health Insurance Portability and Accountability Act (HIPAA) Privacy and Security Rules.

The case was initiated by the Federal Bureau of Investigation (FBI) who informed 21CO that they had determined that patient information had been illegally accessed by an unauthorized third party. They provided 21CO with patient files that an FBI informant had illegally bought. 21CO conducted an internal investigation, through an outside forensic auditing firm.  It was determined that the attacker accessed health care records through a Remote Desktop Protocol from an Server housed within 21CO’s internal network. The company learned that more than 2.2 million people had their medical information illegally accessed.  Information obtained by the attacker included patient names, social security numbers, physicians’ names, diagnoses, treatment and insurance information.

The HHS subsequent investigation determined that 21CO engaged in the following illegal activities:

• Unauthorized disclosure of Personal Health Information (PHI)
• Failure to thoroughly evaluate possible risks to confidentiality of PHI
• Failure to impose security measure that were effective in reducing the risk to PHI and to comply with HHS requirements
• Failure to hold regular review of system information activity including audit logs, access reports, and security incident tracking reports
• Disclosed information to individuals and entities it allowed to act as business associates without written business associate agreements

21CO provides cancer care and oncological radiation services. While their headquarters is located in Fort Myers, Florida, the company has 179 treatment centers which operate in 17 states and seven countries in Latin America.  Filing for Chapter 11 bankruptcy protection in May 2017, 21CO received permission from the bankruptcy court to agree to the settlement agreement.

Where Are All of These HIPAA Violations Coming From?

It seems like a pretty easy thing to avoid - HIPAA Violations.  Don’t gossip about patients, show records or disclose private information to those who shouldn’t see them and make sure you have the proper set up on your home computer or phone if either are used to access medical records.

If it’s really this simple (with a few other guidelines), then why was there in excess of $22,855,300 paid out in fines for HIPAA violations last year alone, a number of which were over $1,000,000?  Plus, this doesn’t include other remediation efforts for violations where it was determined a fine was not warranted.  So what’s going on?

Avoiding HIPAA violations means commitment to a number of things to prevent breaches and ensure appropriate confidentiality.   Of these, one of the most important boils down to training.  Now that we have been held responsible for following HIPAA regulations and documenting appropriately, some organizations that have been doing this for four of five years may have  become complacent in ensuring everyone in the organization knows what the need to in order to satisfy HIPAA regulations.  

One of the most frequently cited HIPAA violation is the failure to train  all individuals who have access to patient information.  This includes — interns, volunteers, contractors and other employees.  One problem is the failure to understand that all employees who can access medical information even when there is no plausible reason for them to do so must be fully trained on HIPAA compliance and avoiding breaches.  

The best way to avoid a breach based on lack of training is the train everyone.  It might seem inconvenient to train absolutely everyone with access to the ePHI in your company, but try to view it as an investment.  The time you put in now will pay off big when the auditors come your way.  Deciding your time frame for training lets you train in logical groups you choose to maintain the highest level of operation with the remaining employees.

Once you receive notification of an audit there is no time to do remedial work with every employee and stop gap measures are usually detectable during an audit.  This also leaves staff feeling anxious about information they have barely had time to learn which can lead to mistakes.  And where HIPAA compliance is concerned, mistakes can be costly.