Understanding Your Rights: Suing for HIPAA Violations Explained

HIPAA Enforcement Overview

HIPAA sets national standards for safeguarding protected health information (PHI). The Department of Health and Human Services Office for Civil Rights leads HIPAA Privacy Rule Enforcement and Security Rule oversight, ensuring that organizations handle PHI lawfully and securely.

HIPAA applies to Covered Entities—health plans, health care clearinghouses, and most health care providers—and to their business associates that create, receive, maintain, or transmit PHI. These organizations must implement administrative, physical, and technical safeguards, follow the minimum necessary standard, and honor patient rights such as access and amendment.

Enforcement is both proactive and reactive. OCR investigates complaints, breach reports, and patterns of noncompliance. Outcomes range from technical assistance to Resolution Agreements that include Corrective Action Plans and, in serious cases, Civil Monetary Penalties. Criminal matters are referred to the Department of Justice when appropriate.

Filing Complaints with OCR

If you believe your HIPAA rights were violated, you can file a complaint with OCR. Complaints generally must be submitted within 180 days of when you knew (or should have known) about the incident; OCR may extend this deadline for good cause. You do not need a lawyer to file with OCR.

Provide clear details: who was involved, dates, the type of information affected, and what happened. Attach any supporting documents or correspondence. You may file on your own behalf or for someone else with authorization. Filing is free, and OCR evaluates every complaint it receives.

After submission, OCR screens for jurisdiction and timeliness, then may open an investigation. Many matters are resolved through voluntary compliance or technical assistance. Where systemic gaps exist, OCR can require a Corrective Action Plan to remediate policies, training, and risk management, and in egregious cases may impose Civil Monetary Penalties.

State Law Claims and Legal Recourse

HIPAA itself does not provide a private right of action, so individuals generally cannot sue directly “under HIPAA.” However, the same conduct may support state-law claims. Courts often allow Privacy Breach Litigation based on negligence, invasion of privacy, breach of contract, or state consumer protection statutes.

HIPAA can still matter in court. Plaintiffs and experts sometimes use HIPAA standards as evidence of the applicable duty of care. If a provider’s practices fall below those standards, that shortfall may bolster state claims even though HIPAA is not the claim’s legal basis.

State Attorneys General may also enforce HIPAA and related state privacy laws, seeking injunctions, restitution, and penalties. If you suffered identity theft, financial loss, or emotional distress after a breach, consult counsel promptly to assess potential remedies under your state’s laws and any applicable medical privacy or data breach notification statutes.

Civil and Criminal Penalties

OCR can levy Civil Monetary Penalties for violations ranging from lack of policies to willful neglect. Penalties are tiered based on culpability and may be accompanied by Resolution Agreements and multi-year Corrective Action Plans that mandate risk analyses, policy revisions, workforce training, and monitoring.

Criminal penalties apply when someone knowingly obtains or discloses PHI in violation of HIPAA, with heightened penalties for false pretenses or actions taken for commercial advantage, personal gain, or malicious harm. The Department of Justice prosecutes these cases, which can result in fines and imprisonment for responsible individuals.

Reporting and Investigation Process

When a potential breach occurs, organizations must conduct a risk assessment to determine if PHI was compromised. If a breach is reportable, affected individuals must be notified without unreasonable delay and no later than the statutory deadline, and larger incidents must also be reported to HHS and, in some cases, the media. State notification rules may impose additional, stricter timelines.

OCR investigations typically include data requests for policies, risk analyses, training logs, and incident response records. Investigators assess whether safeguards were in place, whether the minimum necessary standard was applied, and how the organization responded. Outcomes range from closure with technical assistance to a Corrective Action Plan or Civil Monetary Penalties, and in rare cases referral for criminal enforcement.

Recent Enforcement Actions

Recent matters reflect recurring themes. OCR has prioritized patient Right of Access cases, securing settlements where patients faced unreasonable delays or denials. Investigations frequently address failures to conduct enterprise-wide risk analyses, gaps in encryption or access controls, and workforce “snooping” in electronic health records.

Other actions involve missing or inadequate business associate agreements, improper disposal of paper or electronic records, misdirected mailings or faxes, and insufficient vendor oversight. Resolutions often include Corrective Action Plans requiring robust policy updates, workforce retraining, ongoing monitoring, and sometimes Civil Monetary Penalties when noncompliance is serious or persistent.

Importance of HIPAA Compliance

Strong HIPAA compliance protects patients, preserves trust, and reduces operational and legal risk. For organizations, priorities include conducting regular risk analyses, enforcing role-based access, encrypting data at rest and in transit, managing vendors carefully, and documenting every step—from training to incident response.

For individuals, understanding your rights empowers you to act. You may request access to your records, ask providers how your information is protected, and file an OCR complaint if needed. If you suffer harm from a breach, explore state-law remedies in addition to regulatory reporting.

Key takeaways: OCR leads HIPAA Privacy Rule Enforcement and can mandate Corrective Action Plans or assess Civil Monetary Penalties; individuals generally cannot sue under HIPAA but may pursue state claims; and timely reporting, thorough risk management, and transparent patient communication are essential to prevent and remedy violations.

FAQs.

Can individuals sue directly for HIPAA violations?

No. HIPAA does not create a private right of action, so you cannot sue “under HIPAA” itself. You can file a complaint with OCR and, depending on your state, you may pursue claims such as negligence, invasion of privacy, or consumer protection violations based on the same facts.

How does the OCR handle HIPAA complaints?

OCR screens complaints for jurisdiction and timeliness, then may investigate by requesting documents and interviewing personnel. Many cases end with voluntary compliance or technical assistance; others result in Resolution Agreements with Corrective Action Plans and, when warranted, Civil Monetary Penalties. Criminal matters are referred to the Department of Justice.

What penalties exist for HIPAA violations?

Penalties range from technical assistance and negotiated settlements to tiered Civil Monetary Penalties. Organizations may be required to implement multi-year Corrective Action Plans. In egregious cases involving knowing misuse of PHI, the Department of Justice can seek criminal fines and imprisonment. State Attorneys General may also seek remedies under state law.

Are state laws applicable to HIPAA breach claims?

Yes. HIPAA generally preempts only less protective state laws; more stringent state privacy or breach notification statutes still apply. Many states recognize claims tied to data breaches, enabling damages for out-of-pocket losses and other harms. An attorney can evaluate which state-law claims fit your situation.