HIPAA Criminal Penalties: What Violations Include, Fines and Jail Time Explained

Criminal Penalties for HIPAA Violations

HIPAA makes it a federal crime to knowingly obtain, disclose, or use Protected Health Information (PHI) in violation of the HIPAA Privacy Rule. Criminal prosecution can target individuals—employees, clinicians, contractors, executives—and, in some cases, organizations and their agents.

Jail time and intent levels

• Knowing violation: up to 1 year in prison, plus criminal fines.
• False pretenses (misrepresenting identity or purpose to obtain PHI): up to 5 years in prison, plus fines.
• Intent to sell, transfer, or use PHI for commercial advantage, personal gain, or malicious harm: up to 10 years in prison, plus fines.

Related crimes (such as identity theft, fraud, or computer misuse) are often charged alongside HIPAA counts, increasing exposure. Attempts, conspiracies, and aiding-and-abetting can also lead to liability.

Examples of criminal conduct

• Snooping in medical records without a job-related need or authorization.
• Accessing PHI under false pretenses (for example, posing as a patient or staff member).
• Selling or bartering PHI for personal gain or to commit fraud.
• Stealing devices or credentials to obtain PHI for malicious purposes.

Civil Penalties for HIPAA Violations

Separate from criminal penalties, the Department of Health and Human Services (HHS) can impose Civil Monetary Penalties (CMPs) for noncompliance with the HIPAA Privacy, Security, and Breach Notification Rules. These penalties are assessed per violation and are subject to annual inflation adjustments and category-specific caps.

Four-tier civil penalty framework

• Unknowing: You did not know—and by exercising reasonable diligence would not have known—of the violation.
• Reasonable Cause: You knew or should have known, but the conduct did not involve Willful Neglect.
• Willful Neglect, corrected: Willful Neglect occurred, but you corrected the violation within the required time (generally within 30 days of discovery).
• Willful Neglect, not corrected: Willful Neglect occurred and you failed to correct within the required time; this carries the highest CMP exposure.

How civil penalties are applied

OCR may resolve matters through technical assistance, a voluntary resolution agreement with a corrective action plan, or by imposing CMPs. Penalties consider the number of violations (and days of continuing violation), the harm caused, and your organization’s compliance posture, with annual caps that vary by tier.

Common corrective actions

• Enterprise-wide risk analysis and risk management plan.
• Updated policies for minimum necessary use, access controls, and encryption.
• Workforce training, sanctions, and vendor (business associate) oversight.
• Incident response improvements, logging, and audit monitoring.

Factors Influencing Penalties

Enforcers weigh context to determine culpability and penalty size. Your actions before, during, and after an incident directly affect outcomes.

• Culpability: Was there Willful Neglect, reckless disregard, or reasonable cause?
• Intent and motive: False pretenses or personal gain elevate both criminal and civil exposure.
• Scope and impact: Number of individuals affected, sensitivity of PHI, and duration of the violation.
• Harm and risk: Financial, reputational, or physical harm to individuals and whether misuse is likely.
• Mitigation: Speed and effectiveness of containment, notification, and remediation.
• Safeguards: Existence and adequacy of security controls, policies, training, and monitoring.
• History and size: Prior violations, pattern or practice of noncompliance, and organizational resources.
• Cooperation: Timely, complete responses to investigators and good-faith corrective action.

Enforcement and Prosecution

HIPAA enforcement commonly starts with a complaint, breach report, or compliance review. The HHS Office for Civil Rights (OCR) investigates civil violations; when evidence suggests criminal conduct, OCR refers the matter to the Department of Justice (DOJ) for criminal prosecution.

Typical enforcement flow

• Intake and triage of complaints or breach notifications.
• Document requests, interviews, and technical assessment by OCR.
• Remedial guidance, resolution agreement, or CMPs for civil noncompliance.
• Referral to DOJ when facts indicate knowing misuse, false pretenses, or intent to obtain PHI for personal gain or malicious harm.

Parallel tracks are possible: your organization may negotiate civil remedies with OCR while individuals involved face criminal charges brought by DOJ.

Department of Justice Role

DOJ has exclusive authority to bring criminal HIPAA cases in federal court. U.S. Attorneys prosecute individuals who knowingly obtain or disclose PHI in violation of HIPAA and pursue enhanced penalties where false pretenses or personal gain are proven.

What prosecutors consider

• Evidence of authorization: whether access or disclosure violated the HIPAA Privacy Rule or other law.
• State of mind: knowledge of the facts, deception (false pretenses), or intent to profit or cause harm.
• Aggravators and companion offenses: identity theft, fraud, computer misuse, obstruction, or conspiracy.

Outcomes can include imprisonment, fines, restitution, and forfeiture. Even when an organization is the victim of a rogue employee, OCR may still examine systemic safeguards and impose civil remedies.

Office for Civil Rights Role

OCR administers the HIPAA Privacy, Security, and Breach Notification Rules, investigates suspected noncompliance, and imposes Civil Monetary Penalties where appropriate. OCR also issues guidance and monitors corrective action plans to verify sustained compliance.

OCR investigative and resolution tools

• Data requests, on-site visits, and interviews to evaluate policies, training, and technical controls.
• Technical assistance to quickly remediate low-risk issues.
• Resolution agreements with multi-year monitoring when gaps are significant.
• Civil Monetary Penalties when facts merit formal sanctions.

How OCR calibrates penalties

• Nature and extent of the violation and of the resulting harm.
• Whether Willful Neglect is present and whether timely correction occurred.
• History, size, and financial condition of the entity and the need for deterrence.
• Effectiveness and documentation of risk analysis, access controls, encryption, and training.

Key takeaways

• HIPAA criminal penalties focus on intent: 1 year for knowing violations, 5 years for false pretenses, and 10 years when PHI is used or disclosed for personal gain or malicious harm.
• Civil enforcement uses a four-tier model, with higher Civil Monetary Penalties for Willful Neglect and failures to correct.
• OCR leads civil investigations; DOJ handles criminal cases, often in parallel when warranted.
• Strong safeguards, rapid mitigation, and cooperation significantly reduce penalty exposure.

FAQs.

What are the criminal penalties for violating HIPAA?

Criminal penalties range from up to 1 year in prison for a knowing violation, up to 5 years when PHI is obtained under false pretenses, and up to 10 years when PHI is used or disclosed for commercial advantage, personal gain, or malicious harm. Fines may also be imposed alongside imprisonment.

How does willful neglect affect HIPAA fines?

Willful Neglect places you in the highest civil penalty tiers. If you correct within the required timeframe, exposure is reduced; failure to correct on time triggers the maximum tier, larger Civil Monetary Penalties, and often multi-year corrective action and monitoring.

Who enforces criminal penalties under HIPAA?

The Department of Justice enforces HIPAA’s criminal provisions, typically through U.S. Attorney’s Offices. OCR refers potential criminal matters to DOJ, and federal investigative agencies may develop supporting evidence.

What factors influence the severity of HIPAA penalties?

Penalties depend on intent (including false pretenses or personal gain), the presence of Willful Neglect, the number of individuals affected, the sensitivity of PHI, actual or likely harm, your mitigation and cooperation efforts, and the strength of your security safeguards and compliance program.