Covered Entity
What is a Covered Entity?
A Covered Entity is any organization or individual who must comply with HIPAA regulations due to their role in handling Protected Health Information (PHI). The three main categories of Covered Entities include Healthcare Providers, Health Plans, and Healthcare Clearinghouses.
The Healthcare Providers consist of physicians, clinics, dentists, psychologists, hospitals, pharmacies, etc. They are usually the primary caretakers of PHI and offer direct healthcare services. Health Plans include insurance companies, HMOs, Medicare, and Medicaid. Finally, the Healthcare Clearinghouses include entities that process nonstandard health information into standard formats (e.g., billing services).
What are the HIPAA Rules for Covered Entities?
Covered Entities are legally responsible for maintaining the confidentiality, integrity, and availability of PHI. They must implement internal policies that align with the HIPAA Privacy and Security Rules. This includes access control, secure data storage, proper disposal procedures, and the use of HIPAA compliant email systems when transmitting PHI.
HIPAA places a strong emphasis on training and education. Covered Entities must provide HIPAA compliance training to all employees who access or manage PHI. Training should be updated regularly and tailored to the specific roles within the organization. It should also cover topics such as data handling best practices, use of secure communication channels, and identifying potential breach scenarios.
In the event of a data breach, such as unauthorized access to or disclosure of PHI, Covered Entities must conduct a breach risk assessment and notify affected individuals, as well as the HHS Office for Civil Rights (OCR), depending on the scale of the breach. Ignoring these responsibilities can lead to significant HIPAA breach penalties.
To avoid such outcomes, many Covered Entities also work with vetted vendors and Business Associates who are contractually obligated to comply with HIPAA rules. The combined efforts of all parties involved ensure that patient data is handled with care and in accordance with legal standards.
Related Terms
Two Factor Authentication
End-to-End Encryption
Privacy Policy