Lesser-Known Violations of the Security Rule Many Practices Miss

Even well-run clinics can stumble on lesser-known violations of the HIPAA Security Rule. The risk is real: unexpected gaps lead to breaches, fines, and operational disruptions. Use this guide to surface blind spots and apply pragmatic fixes that strengthen your program without slowing care.

Conduct Comprehensive Risk Analyses

A frequent violation is treating the Security Risk Analysis as a one-time IT task instead of a living process. If you don’t inventory every system that creates, receives, maintains, or transmits ePHI—then score and address risks—you’re out of alignment with the Security Rule.

• Expand scope beyond the EHR: imaging, e-fax, patient portals, e-prescribing, VoIP, chat, and custom spreadsheets all count.
• Include networked peripherals with storage (copiers, scanners, bedside monitors), telework setups, and third-party connections and APIs.
• Map data flows from intake to archive; identify where ePHI lands, moves, and exits.
• Test controls with vulnerability scanning, patch verification, password audits, and log reviews.
• Update after material changes (new vendor, merger, major software update) and at least annually.

Produce a written plan that documents each risk, its owner, target date, and treatment (mitigate, transfer, accept). This disciplined approach turns a Security Risk Analysis into measurable action rather than paperwork.

Encrypt PHI Communications

Unencrypted transmission remains a top overlooked issue. If you send ePHI by email, text, or telehealth without implementing Protected Health Information Encryption—or without documented justification and compensating controls—you risk violation.

• Email: enforce TLS for all domains, use automatic triggers (keywords, attachment types) to encrypt, and prevent forwarding to personal accounts.
• Texting: prohibit consumer messaging apps; use a secure, logged, policy-controlled platform with remote wipe and device verification.
• Telehealth: secure signaling and media streams, restrict recording, protect voicemail and transcripts, and store session data in approved systems.
• Backups: encrypt at rest and in transit; separate encryption keys from the data and restrict key custodian access.

Never rely on disclaimers alone. Train staff when to switch to secure channels, and monitor for downgrade failures, misrouted messages, and forwarding to outside domains.

Dispose of PHI Properly

Improper disposal is a classic “it won’t happen to us” problem. PHI Disposal Methods must address paper and every kind of media that can store ePHI—including hidden drives in office equipment and clinical devices.

• Before decommissioning or service, sanitize devices (clear, purge, or destroy) and track serial numbers, method, date, and witnesses.
• Use locked shred bins and vetted destruction vendors; require certificates of destruction and include disposal in vendor oversight.
• Secure removable media (USB, SD cards, dictation devices) or ban them; avoid “freebie” drives entirely.
• Don’t forget copier/printer hard drives, voicemail servers, workstation caches, and labels/packaging with PHI.

Make disposal a documented workflow, not an ad-hoc task. A simple chain-of-custody log prevents most mistakes.

Control Employee Access

Excessive permissions and stale accounts create quiet, ongoing violations. Effective Employee Access Controls enforce the minimum necessary standard—and prove it with audit trails.

• Abolish shared accounts; assign unique IDs and enable multi-factor authentication for remote and privileged access.
• Define a role matrix by job function; review access quarterly to remove privilege creep and orphaned accounts.
• Automate offboarding so accounts, VPN, email, and badge access disable within hours of departure.
• Set session timeouts and automatic logoff for workstations and clinical kiosks; monitor “break-glass” use with alerts.
• Centralize audit logs and review for impossible travel, after-hours spikes, and bulk exports.

Document each review and remediation step. Auditors care as much about evidence as they do about controls.

Ensure Signed Business Associate Agreements

Sharing ePHI with third parties without a fully executed BAA is a common, high-impact mistake. Business Associate Agreement Compliance extends to subcontractors and “non-obvious” vendors.

• Common misses: cloud storage/sync, e-fax, telehealth, dictation/transcription, IT managed service providers, copier service, couriers, shredding and records storage, call centers, translation, patient engagement apps, and survey tools.
• Centralize BAA tracking; require a BAA before any data exchange and re-verify on renewal or when services change.
• Review clauses on permitted use, safeguards, breach reporting timelines, subcontractor flow-downs, data return/destruction, and termination.
• Pair BAAs with vendor due diligence: security certifications, encryption posture, data location, uptime commitments, and incident response capabilities.

A BAA is necessary but not sufficient; you still must validate the vendor’s controls and monitor ongoing risk.

Secure Cloud Storage Solutions

Cloud misconfigurations are a leading source of exposure. Cloud Service HIPAA Compliance requires the right tenant settings, strong identity controls, and continuous monitoring—on top of a BAA.

• Disable public links and “anyone with the link” sharing; allow external sharing only by exception and log every event.
• Encrypt at rest with managed keys; separate key management duties and consider customer-managed keys or HSM-backed KMS.
• Require SSO with MFA, device compliance checks, and conditional access (location, risk signals).
• Enable versioning, retention, legal hold, and immutable backups to mitigate ransomware and accidental deletion.
• Deploy DLP and content scanning to detect PHI patterns; quarantine or auto-encrypt on detection.
• Turn on detailed audit logs and alerting; baseline configurations and continuously assess drift.

Treat cloud storage like any other regulated system: planned configuration, hardening, monitoring, and tested restore procedures.

Manage Portable Devices Safely

Lost or lightly managed endpoints remain a breach driver. Robust Portable Device Security prevents small mistakes from becoming reportable incidents.

• Require full-disk encryption on laptops and mobile devices; manage with MDM/EMM for remote wipe, app controls, and OS compliance.
• Restrict local storage of ePHI; use secure containers, disable copy/paste to personal apps, and block unapproved cloud backups.
• Harden BYOD: enforce screen locks, short timeouts, and device encryption; prohibit unmanaged messaging and email clients.
• Watch for hidden leaks: car infotainment sync, smartwatch notifications, home printers, and offline caches in email apps.
• Maintain endpoint protection and timely patches; define a lost-device playbook with hour-by-hour actions and notifications.

Bringing it all together: lesser-known violations of the Security Rule often stem from blind spots—unscoped systems, weak encryption practices, poor disposal, loose access, vendor gaps, cloud misconfigurations, and unmanaged devices. Close these gaps with a rigorous Security Risk Analysis, enforce encryption and access controls, formalize PHI disposal, verify BAAs, harden cloud services, and manage endpoints with MDM and monitoring.

FAQs

What are common overlooked HIPAA Security Rule violations?

Top misses include incomplete Security Risk Analysis, failing to enforce Protected Health Information Encryption for email/text/telehealth, weak PHI Disposal Methods, excessive or stale user access, missing or outdated BAAs, misconfigured cloud storage, and unmanaged portable devices lacking encryption and MDM.

How can small practices improve risk analysis?

Start with an asset inventory and data-flow map, then score risks by likelihood and impact. Document owners, deadlines, and treatments; validate with basic technical tests (scan for vulnerabilities, review logs, confirm patches). Revisit after any material change and at least annually, and keep signed evidence of reviews.

What steps secure cloud storage under HIPAA?

Execute a BAA, restrict sharing by default, require SSO with MFA, encrypt at rest with managed keys, enable logging and alerts, apply DLP for PHI patterns, enforce device compliance, and maintain backups with versioning and immutability. Periodically audit settings against a hardened baseline.

How important are Business Associate Agreements?

Critical. A BAA is your contractual foundation for safeguarding ePHI with vendors. It sets permitted uses, required safeguards, breach notifications, subcontractor obligations, and data-return/destruction terms. Pair BAAs with vendor due diligence and ongoing monitoring to ensure controls work in practice.