When we visit the doctor, we expect for our doctor’s entire medical staff to professionally handle our sensitive and private information. The Health Insurance Portability and Accountability Act (HIPAA) establishes specifics on how medical staff and insurance providers must do this. While HIPAA violations are not necessarily issues of medical malpractice, they have been found to be relevant in certain cases where they occurred due to a doctor failing to properly uphold the standard of care.
Injuries and violations that happen during medical care can be extremely personal and devastating. If you find yourself in this difficult situation, speak with one of our skilled Chicago medical malpractice lawyers right away about a possible HIPAA violation.
A physician can be sued for medical malpractice if they fail to provide the standard of care for their patient that is reasonably expected. If you feel that you are a victim of a doctor’s negligence, then you would argue that the treatment you received was below this standard. The law does not establish specific technical rules or criteria which spell out when a case is determined malpractice.
HIPAA provides the standards for the confidentiality, security, and transmission of a patient’s personal health information. Unlike with malpractice, the criteria for a HIPAA violation are specifically spelled out. If found to have violated a patient’s rights under HIPAA, a physician or insurance company could face sanctions in addition to a large fine. If there is an occurrence of repeated privacy violations, the FBI could conduct a criminal investigation.
Medical malpractice occurs when a doctor or healthcare provider fails to meet the accepted standard of care, causing harm to a patient. In these cases, you must prove that the treatment you received was below what a reasonably competent provider would have delivered under similar circumstances. There are no hard-and-fast rules for what constitutes malpractice; it is often determined on a case-by-case basis.
HIPAA violations are clearly defined under federal law. They involve the mishandling, unauthorized sharing, or insecure storage of protected health information (PHI). Unlike malpractice, HIPAA breaches do not require harm to be shown, just that the rules were broken.
Healthcare providers or insurers who violate HIPAA may face civil fines, loss of licenses, or even criminal charges if the misconduct is intentional or repeated. The FBI may investigate serious breaches.
Although most HIPAA violations don’t qualify as malpractice, there are exceptions. In one case, a Walgreen’s pharmacist was held liable for medical malpractice after improperly disclosing a patient’s private health details. The court found that compliance with HIPAA was part of the expected standard of care.
Many readers conflate two separate processes. Filing a HIPAA complaint and filing a medical malpractice lawsuit are different actions with different goals, and one does not replace the other.
A HIPAA complaint is filed with the U.S. Department of Health and Human Services Office for Civil Rights (HHS OCR), the federal agency that enforces HIPAA. You can submit a complaint through the OCR Complaint Portal within 180 days of when you knew or should have known about the violation. OCR may investigate, require corrective action, and impose fines on the provider, but it does not award compensation to you as the patient.
A medical malpractice lawsuit is filed in Illinois state court (most often the Cook County Circuit Court for Chicago-area cases) and seeks money damages for the harm you suffered. Illinois has statutory requirements for medical malpractice claims, including a written report from a qualifying health professional under 735 ILCS 5/2-622, before the case can proceed. The Illinois statute of limitations for medical malpractice is generally two years from the date you knew or should have known about the injury. If a HIPAA violation contributed to a breach of the standard of care, that conduct may support a malpractice claim, but the lawsuit itself is the only path to recover damages.
It can be argued that any HIPAA violation is a case where the reasonably expected standard of care was not met, and therefore a malpractice suit can follow. However, often times HIPAA violations occur in scenarios where malpractice doesn’t even come to mind, and therefore, a malpractice suit will likely not be the route pursued by your attorney on your behalf. Some common reasons for HIPAA violations include:
HIPAA violations are not usually considered medical malpractice, but there is always the possibility that they can be used to show that your doctor failed to meet the standard of care in your treatment, and therefore, you may also be a victim of medical malpractice. A violation of your privacy can be devastating and overwhelming, and it’s important to seek legal counsel immediately if this happens to you.
No. A HIPAA violation involves the mishandling of protected health information under federal privacy rules. Medical malpractice means a doctor or healthcare provider failed to meet the accepted standard of care and caused harm. The two can overlap when a privacy breach is part of treatment that fell below the standard of care, as the courts found in the Walgreens pharmacist case described above, but most HIPAA violations are not malpractice on their own.
HIPAA itself does not give patients a private right to sue. You can file a complaint with the HHS Office for Civil Rights, and if the breach also violates the Illinois standard of care or another Illinois law (such as a privacy tort), you may have grounds for a separate civil lawsuit. Our Chicago medical malpractice lawyers can review the facts and tell you whether a malpractice or related claim is viable.
A federal HIPAA complaint does not produce a personal payout. OCR can fine the provider but does not compensate you. To recover damages such as medical bills, lost wages, emotional distress, and pain and suffering, you generally need to bring a medical malpractice or related civil claim in Illinois state court. The dollar value depends on how the privacy breach harmed you and what evidence supports the claim.
Submit a complaint to the HHS Office for Civil Rights through the OCR Complaint Portal within 180 days of learning about the violation. Keep dated records of what happened, who was involved, and any harm that followed. If you suspect the breach is tied to substandard medical care, contact a Chicago medical malpractice lawyer before the Illinois statute of limitations runs out, since reporting to OCR does not stop that clock.
Pursuing a HIPAA violation requires that you act quickly, and follow the protocol that is established by this federal law. At Staver Accident Injury Lawyers, P.C., our Chicago medical malpractice lawyers understand how HIPAA claims are handled by the courts, and we know how to protect your rights as you seek to recover damages.
Contact us today at (312) 236-2900 or fill out our online contact form for a free consultation today.
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