In relation to policing compliance with the Health Insurance Portability and Accountability Act Rules state Attorneys General play a major part.
State attorneys general have been given the power to initiate civil proceeding on behalf of state residents who have been affected by breaches of the HIPAA Privacy and Security Rules in the Health Information Technology for Clinical and Economic Health (HITECH) Act.
The first time this was done was by the Connecticut Attorney General during 2010 when it settled a case for $250,000 with Health Net Inc. following the loss of unencrypted hard drive containing the electronic protected health information 1.5 million people and delayed breach notifications. Not long after this in 2011 Health Net agreed a settlement with the Vermont Attorney General for $55,000 for a similar incident.
Legal actions like this are not common, there have only been 11 settlements agree with covered entities and business associates in relation to HIPAA breaches during the time period from 2010 to 2015. HIPAA enforcement by state attorneys general was increased during 2017 with five and then twelve during 2018 – leading to financial sanctions for breaches of the HIPAA Rules.
There were five financial penalties issued during 2019 and 2020 Including a number of multistate actions. These actions permit the various state attorneys general to join up their resources and investigate potential violations of HIPAA and state legislation more effectively.
When civil actions are taken against covered entities or business associates by state Attorneys General, they are done so outside of the remit of the Office for Civil Rights actions.
Many Several data breaches have lead to settlements being agreed at both the federal and state level and in many of the state AG enforcement actions listed here, the fines settle breaches of federal (HIPAA) and state laws. Throughout the years there have several cases where HIPAA Rules have been breached, but the decision was taken to bring actions for violations of equivalent provisions in state legislation.
HIPAA Enforcement by State Attorneys General during 2020
| Year | State | Entity | Amount | Individuals affected | Reason for Investigation | Findings |
| 2020 | Multistate (28 states) | Community Health Systems / CHSPSC LLC | $5,000,000 | 6.1 million | Hacked by Chinese APT group | Failure to implement and maintain reasonable security practices |
| 2020 | Multistate (43 states) | Anthem Inc | $39.5 million | 78.8 million | Phishing attack and major data breach | Multiple violations of HIPAA and state laws |
| 2020 | California | Anthem Inc | $8.7 million | 78.8 million | Phishing attack and major data breach | Multiple violations of HIPAA and state laws |
HIPAA Enforcement by State Attorneys General during 2019
| Year | State | Entity | Amount | Individuals affected | Reason for Investigation | Findings |
| 2019 | Multistate (30 states) | Premera Blue Cross | $10,000,000 | 10.4 million | Hacking incident and major data breach | Multiple violations of HIPAA and state laws |
| 2019 | Multistate (16 states) | Medical Informatics Engineering | $900,000 | 3.5 million | Breach of NoMoreClipboard data | Multiple violations of HIPAA and state laws |
| 2019 | California | Aetna | $935,000 | 1,991 | 2 mailings exposed PHI (Afib, HIV) | Impermissible Disclosure of sensitive health information |
HIPAA Enforcement by State Attorneys General during 2018
| Year | State | Entity | Amount | Individuals affected | Reason for Investigation | Findings |
| 2018 | Massachusetts | McLean Hospital | $75,000 | 1,500 | Loss of backup tapes | Insufficient risk assessment, failure to encrypt data, delayed breach notifications |
| 2018 | New Jersey | EmblemHealth | $100,000 | 6,443 (81,000) | Mailing error exposed SSNs | Impermissible disclosure of PHI/ lack of staff training |
| 2018 | New Jersey | Best Transcription Medical | $200,000 | 1,650 | Exposure of ePHI in Internet | Risk assessment and risk management failure, breach notification failure |
| 2018 | Multistate (CT, NJ, DC) | Aetna | 640170.59 | 13,160 | 2 mailings exposed PHI (Afib, HIV) | Impermissible Disclosure of sensitive health information |
| 2018 | Massachusetts | UMass Memorial Medical Group / UMass Memorial Medical Center | $230,000 | 15,000 | Multiple data breaches | Failure to secure ePHI |
| 2018 | New York | Arc of Erie County | $200,000 | 3,751 | Exposure of ePHI on Internet | Failure to secure ePHI |
| 2018 | New Jersey | Virtua Medical Group | $417,816 | 1,654 | Exposure of ePHI on Internet | Multiple violations of the HIPAA Rules |
| 2018 | New York | EmblemHealth | $575,000 | 81,122 | Mailing error exposed SSNs | Impermissible disclosure of PHI / lack of staff training |
| 2018 | New York | Aetna | $1,150,000 | 12,000 | 2 mailings exposed PHI (Afib, HIV) | Impermissible Disclosure of sensitive health information |
HIPAA Enforcement by State Attorneys General during 2017
| Year | State | Entity | Amount | Individuals affected | Reason for Investigation | Findings |
| 2017 | California | Cottage Health System | $2,000,000 | More than 54,000 | Exposure of PHI on Internet | Failure to safeguard personal information |
| 2017 | Massachusetts | Multi-State Billing Services | $100,000 | 2,600 | Theft of unencrypted laptop computer | Failure to safeguard personal information |
| 2017 | New Jersey | Horizon Healthcare Services Inc | $1,100,000 | 3.7 million | Theft of 2 unencrypted laptop computers | Failure to safeguard personal information |
| 2017 | Vermont | SAManage USA, Inc. | $264,000 | 660 | Exposure of PHI on Internet | Failure to secure ePHI / breach notification failure |
| 2017 | New York | CoPilot Provider Support Services, Inc | $130,000 | 221,178 | Delayed breach notification | Violation of breach notification requirements |
HIPAA Enforcement by State Attorneys General (2010-2016)
| Year | State | Entity | Amount | Individuals affected | Reason for Investigation | Findings |
| 2015 | New York | University of Rochester Medical Center | $15,000 | 3,403 | List of patients provided to nurse who took it to a new employer | Impermissible disclosure of ePHI |
| 2015 | Connecticut | Hartford Hospital/ EMC Corporation | $90,000 | 8,883 | Theft of unencrypted laptop containing PHI | Lack of Business Associate Agreement / failure to encrypt ePHI |
| 2014 | Massachusetts | Women & Infants Hospital of Rhode Island | $150,000 | 12,000 | Loss of backup tapes containing PHI | Failure to safeguard ePHI / Lack of staff training |
| 2014 | Massachusetts | Boston Children’s Hospital | $40,000 | 2,159 | Loss of laptop containing PHI | Failure to encrypt ePHI |
| 2014 | Massachusetts | Beth Israel Deaconess Medical Center | $100,000 | 3,796 | Loss of laptop containing PHI | Failure to encrypt ePHI |
| 2013 | Massachusetts | Goldthwait Associates | $140,000 | 67,000 | Mishandling of PHI | Improper disposal of PHI |
| 2012 | Minnesota | Accretive Health | $2,500,000 | 24,000 | Mishandling of PHI | Failure to safeguard PHI |
| 2012 | Massachusetts | South Shore Hospital | $750,000 | 800,000 | Loss of backup tapes containing PHI | Failure to safeguard PHI |
| 2011 | Vermont | Health Net Inc. | $55,000 | 1,500,000 | Loss of unencrypted hard drive/delayed breach notifications | Failure to safeguard PHI / Violation of breach notification requirements |
| 2011 | Indiana | WellPoint Inc. | $100,000 | 32,000 | Failure to report breach in a reasonable timeframe | Violation of breach notification requirements |
| 2010 | Connecticut | Health Net Inc. | $250,000 | 1,500,000 | Loss of unencrypted hard drive | Failure to safeguard PHI / Violation of breach notification requirements |