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HIPAA · SECURITY RULE · PRIVACY RULE · ePHI · BREACH NOTIFICATION · OCR ENFORCEMENT

Protect patient data.Validate HIPAA controls.Beyond checkbox compliance.

Safeguard ePHI with technical and administrative control validation aligned to HIPAA Security Rule requirements. Risk analysis, workforce training, breach notification programme design, and Business Associate Agreement review.

HIPAA Overview

HIPAA enforcement is at
an all-time high.

The HIPAA Security Rule covers three categories of safeguards — technical, administrative, and physical — across all systems that create, receive, maintain, or transmit electronic protected health information.

0%
Increase in enforcement actions since 2020
0
PHI identifier categories under Privacy Rule
0 days
Maximum breach notification window
$0.0M
Annual penalty cap per violation category (Tier 4)
Technical Safeguards
Access Control
Audit Controls
Integrity Controls
Person/Entity Auth
Transmission Security
Administrative Safeguards
Security Management Process
Assigned Security Responsibility
Workforce Security
Information Access Mgmt
Security Incident Procedures
Physical Safeguards
Facility Access Controls
Workstation Use Policy
Workstation Security
Device & Media Controls

Security Rule Safeguards

Three categories. All required.
None optional.

Technology-based controls that protect ePHI and control access to it across all systems, networks, and devices.

Access ControlRequired

Unique user IDs, emergency access procedure, automatic logoff, encryption/decryption of ePHI

Audit ControlsRequired

Hardware, software, and procedural mechanisms to record and examine system activity accessing ePHI

Integrity ControlsRequired

Mechanisms to authenticate that ePHI has not been altered or destroyed in an unauthorised manner

Person/Entity AuthenticationRequired

Verify the identity of any person or entity seeking access to ePHI before granting access

Transmission SecurityRequired

Guard against unauthorised access to ePHI transmitted over electronic communications networks

88control coverage
Key Outcomes
Encryption at rest and in transit
MFA on all ePHI systems
Automated logoff policies
Immutable audit logs

Protected Health Information

18 PHI identifiers.
All require protection.

Any combination of health data with one or more of these identifiers constitutes PHI under the HIPAA Privacy Rule and requires full Security Rule protections for electronic PHI.

01
Names
PHI Identifier 01 of 18

Full name or any part of a name of the individual

Required Protection
When combined with health information, this identifier must be safeguarded under all three HIPAA safeguard categories — technical, administrative, and physical.

OCR Enforcement

Four civil penalty tiers.
Up to $1.9M per category.

HHS Office for Civil Rights (OCR) applies a tiered civil penalty structure based on culpability. Wilful neglect carries the most severe sanctions.

Tier 1
Did Not Know

The covered entity did not know, and by reasonable diligence could not have known, of the violation.

Example case: Unintentional employee access of a record
Penalty Structure
Per violation$100 – $50,000
Annual cap per category$25,000
Criminal (wilful disclosure)Up to $250,000 + 10 yrs
Investigation authorityHHS OCR + State AGs

Risk Analysis Methodology

The most cited OCR finding.
No risk analysis. Penalised.

HIPAA §164.308(a)(1) requires an ongoing, thorough risk analysis. Spakto's five-step methodology produces a defensible, documented risk register for OCR audit.

Step 1 of 5
01
Scope Definition
Wk 1

Identify all systems, applications, networks, and workforce members that create, receive, maintain, or transmit ePHI. Define the risk analysis boundary.

Key Outputs
Asset inventory with ePHI flows
System boundary documentation
Data flow diagrams

Business Associates & BAAs

Every vendor touching ePHI
needs a BAA.

A Business Associate Agreement is a mandatory contract under HIPAA. It must specify permitted uses, safeguard obligations, breach notification timelines, and sub-contractor requirements.

BA Categories
Cloud Providers
AWS, Azure, GCP hosting ePHI workloads
High Risk
Required BAA Controls
Data Processing Addendum
Encryption in transit/rest
SOC 2 Type II required
Spakto BAA Review Covers
Permitted use scope verification
Sub-contractor BAA chain audit
Breach notification SLA terms
Data return/destruction clauses
Audit right provisions
Termination trigger conditions

Breach Notification Rule

60-day clock. Three notification
channels. No exceptions.

The Breach Notification Rule requires covered entities to notify affected individuals, HHS, and in some cases the media following discovery of a breach of unsecured PHI.

Day 0
Discovery
Breach is discovered by covered entity or business associate. Clock starts.
≤24h
BA Notification to CE
Business associates must notify covered entity within 24 hours of discovery per BAA terms.
≤60 days
Individual Notice
Written notice to all affected individuals. Must include description, types of PHI involved, steps to protect, and contact information.
≤60 days
HHS Notice
Notify HHS Secretary of all breaches. Breaches of 500+ require immediate notice; smaller breaches reported in annual log.
≤60 days
Media Notice
If breach affects 500+ residents of a state or jurisdiction, must notify prominent media outlets in that state.
Breach Risk Assessment — 4 Factors
1
Nature & Extent of PHI
Types of identifiers involved; likelihood of re-identification if de-identified data is exposed
2
Unauthorised Person Involved
Who impermissibly used or received the PHI; whether they are obligated to protect the data
3
PHI Actually Acquired or Viewed
Whether the PHI was actually accessed or only had the opportunity to be; technical evidence required
4
Extent of Mitigation
Degree to which risk to PHI has been mitigated — e.g., data returned, recipient agreement to not use
Notification Requirements by Breach Size
Individual written noticeRequired
Threshold: Any size
First-class mail or email if consented. Must include specific content per §164.404.
HHS SecretaryRequired
Threshold: Any size
Breaches 500+: immediate. Under 500: add to annual log submitted to HHS within 60 days after year end.
Prominent mediaRequired
Threshold: 500+ in a state
Notify prominent media outlets serving the affected state or jurisdiction.
HHS breach portalPublic posting
Threshold: 500+ nationally
HHS publishes all breaches of 500+ on its public 'Wall of Shame' portal.

Implementation Lifecycle

Eight phases. Risk-driven.
Evidence at every step.

Phase 1 of 8
1
Risk Analysis
Wk 1–4

Comprehensive assessment of potential risks to ePHI across all systems. Threat identification, vulnerability assessment, and documented risk register aligned to HIPAA Security Rule §164.308(a)(1).

Upcoming phases

Why Spakto

Evidence-led. Technically validated.
OCR-defensible.

Evidence-led risk analysis: every threat mapped to actual system configurations and access logs
Technical validation of all controls against live ePHI systems — not interviews alone
Policies reviewed against system settings to confirm enforcement — not just documentation
BAA audit includes sub-contractor chains and ePHI flow verification for each BA
Role-based training with comprehension assessments and completion tracking per workforce member
Ready to close your HIPAA gaps?
Get an evidence-led Security Rule assessment with a documented risk register and 60-day remediation roadmap.
Request HIPAA Assessment

Frequently Asked

Frequently asked
questions.

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