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What are HIPAA-Covered Entities?‍

What are HIPAA-Covered Entities?‍

By 

Jennifer Mcgee

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Updated on  

January 3, 2023
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3 Mins

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The purpose of HIPAA is to improve efficiency in the healthcare industry and reduce the chances of any abuse or fraud.

The implementation of HIPAA has protected the privacy of an individual, ensured an increase in the number of health insurance, and also ensures that the individuals are notified if their privacy to health records is violated.

The HIPAA-covered entity is an organization or corporation that deals with and handles Protected Health Information (PHI) or Personal Health Records (PHR). 

These entities have an obligation not to disclose the PHI or PHR to any third person without the knowledge and consent of the patient. 

This restriction on the entities to safeguard the personal identifiers and health history and reports is imposed by HIPAA laws. The HIPAA-covered entities are required to comply with HIPAA and HITECH i.e. the Health Information Technology for Economics and Clinical Health Act.

What are the Healthcare plans/ entities defined by HIPAA?

The entities covered under HIPAA include Advance healthcare planning organizations, healthcare providers, and healthcare clearinghouses. HIPAA is applicable to the Business Associates (BA) and subcontractors of these covered entities. 

Health Plan

The health plan may include the health insurance companies, military and veteran’s health programs, government programs to pay for healthcare, etc.

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Healthcare providers

Healthcare providers may include hospitals, clinics, pharmacies, home health agencies, nursing homes, dentists, psychologists, or any other healthcare services provider.

Healthcare clearinghouses

Healthcare Clearinghouses may include entities that do not directly handle the personal health-related information but process that information from another entity. For instance, billing services at hospitals are provided by another entity.

Am I a covered entity under HIPAA?

You must be wondering if you are a covered entity under HIPAA or not then the easiest way to understand this is when a person, business entity, or any organization deals with processing nonstandard health-related information. But if such a person, business entity, or organization doesn’t get any covered transaction electronically, then they are not covered entities under HIPAA and vice-versa.

HIPAA-Covered Entities

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Frequently Asked Questions

When does a state law supersede HIPAA?

HIPAA is the prevailing law, it overrides the state laws but if any state’s law is stringent then the state laws will be implemented.

What are the 3 major things addressed in HIPAA law?

The 3 major things addressed in HIPAA are the Health Insurance Reforms, reduced fraud and abuse in the Healthcare Industry by restricting the disclosure of the patient’s health information and HIPAA lastly kickstarted the momentum of healthcare by introducing the administration’s healthcare reforms. 

What is a HIPAA violation?

HIPAA has provisions regarding the safety and security of the patient and his privacy. If any of the provisions are violated or the information covered under HIPAA is disclosed to a third party then it will amount to a violation of the HIPAA Privacy Rule and liable for penalty.

What is the main purpose of HIPAA?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a federal law that protects patients' sensitive health information from being disclosed without the patient's consent or knowledge.

What is HIPAA Compliance?

HIPAA Compliance means the process by which HIPAA-covered entities need to protect and secure a patient's healthcare data or protected health information.
Jennifer Mcgee
Parent to five young children. Expert in Estate Planning, Probate, and Family Law Matters. Volunteer with Victim’s Advocates in the local sheriff's department...
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