Triple-S to Pay $3.5 Million Plus Adopt a Robust Corrective Action Plan

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Office of Civil Rights (OCR) Director Jocelyn Samuels has made it clear that the “OCR remains committed to strong enforcement of the HIPAA Rules.” The latest settlement announced on 11/30/15 concerning Triple-S, an insurance holding company offering a wide range of insurance products and services, demonstrates just how committed the OCR is when it comes to HIPAA compliance. This settlement included payment of $3.5 Million and adopting a corrective action plan to implement a robust and comprehensive HIPAA compliance program pursuant to the Resolution Agreement entered by Triple-S.

Here’s what went wrong – this OCR settlement resulted following an OCR investigation initiated after Triple-S reported multiple breach notifications to the OCR. The investigation revealed “widespread non-compliance” with HIPAA including:

  • Failure to implement appropriate administrative, physical, and technical safeguards to protect PHI;
  • Impermissible disclosures of PHI to an outside vendor that did not have an appropriate Business Associate Agreement with Triple-S;
  • Use or disclosure of more PHI that was necessary to carry out mailings;
  • Failing to conduct an accurate and through risk analysis incorporating all IT equipment, applications and data systems using ePHI; and
  • Failing to implement security measures sufficient to reduce risks and vulnerabilities to ePHI to a reasonable and appropriate level.

As noted above, here’s what the OCR required from Triple-S to settle the potential violations – payment of $3.5 Million plus entering into a Plan of Correction to implement a comprehensive HIPAA compliance program.
Here’s what the comprehensive compliance program will include to protect the security, confidentiality, and integrity of the PHI Triple-S collects from its beneficiaries:

  • Risk analysis and a risk management plan;
  • Procedure to evaluate and address any environmental or operational changes that affect the security of the ePHI the company holds;
  • Policies and procedures to ensure compliance with HIPAA Rule requirements;
  • Training program covering Privacy, Security and Breach Notification Rules requirements, for all workforce members and business associate providing services at Triple-S premises.

The OCR has once again clearly demonstrated its commitment to enforcing the HIPAA Rules. In this case, repeated breach notifications brought an OCR investigation to Triple-S. That investigation uncovered potential violations of HIPAA that resulted in this settlement to correct the potential violations the investigation uncovered.

So what’s a Covered Entity to do?  It’s quite simple – be in compliance with HIPAA. Even with the best compliance programs, breaches happen and must be reported to the OCR. The best protection for a Covered Entity undergoing an investigation following the report of a breach is to have a vital HIPAA compliance program already in place. As Triple-S learned, not having a HIPAA compliance program can be costly. In addition to a large payment to the OCR, now Triple-S will have a HIPAA compliance program under the added scrutiny of a Resolution Agreement with the OCR.

In order to avoid the fate of Triple-S, health care providers must bring their HIPAA compliance programs in line with the Privacy and Security Rules. Consult a qualified legal counsel for assistance.

By Denise Bloch

Denise Bloch

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