HIPAA Compliance [2025]: Components, Privacy Rules, and PHI

HIPAA establishes nationwide standards for protecting patient data and standardizing healthcare processes. OCR enforcement activity and fines continue to rise, especially for missing risk assessments, poor encryption, excessive access, and delayed breach reporting. This guide explains what counts as PHI, who must comply, core Privacy and Security Rules, breach timelines, real-world penalties, and a practical, program-based approach to compliance.

1. HIPAA Compliance [2025] Page number: 01 www.cybersecurity24x7.com CyberSecurity24x7 HIPAA Compliance [2025]:
Components, Privacy Rules, and PHI
A concise guide to what HIPAA covers, who
must comply, and how to build a robust
program

2. HIPAA sets national standards to protect
patient data and standardize healthcare
processes.
HHS oversees, OCR enforces; penalties are
increasing.
Common failures: missing risk
assessments, no encryption, excess
access, poor training, delayed reporting.
PHI consists of 18 identifiers; mishandling
triggers heavy liability.
Compliance requires administrative,
physical, and technical safeguards.
Treat HIPAA as a continuous program, not
a one-time project.HIPAA Compliance [2025] Page number: 02 www.cybersecurity24x7.com CyberSecurity24x7
Executive Summary

3. HIPAA Compliance [2025] Page number: 03 www.cybersecurity24x7.com CyberSecurity24x7 What is HIPAA?
HIPAA stands for
“Health Insurance
Portability and
Accountability Act. Its
purpose is to let
people change jobs
without losing health
coverage, standardize
how medical bills get
processed, and
protect sensitive
patient data from
misuse.
Core Aims
Maintain insurance
portability
Standardize billing
Protect patient
data
Who’s in charge
HHS (oversight)
OCR (enforcement)

4. Missing risk assessments
No encryption
Excessive user access
Insufficient staff training
Delayed breach reportingHIPAA Compliance [2025] Page number: 04 www.cybersecurity24x7.com CyberSecurity24x7
Top 5 Common HIPAA Violations

5. HIPAA Compliance [2025] Page number: 05 www.cybersecurity24x7.com CyberSecurity24x7 18 Identifiers of PHI
Name
Geographic
data
Dates
Phones
SSN
Account
no.
Device IDs
Biometrics
Fax Email
Medical
record no.
Health
plan no.
Certificate
/License
Vehicle
IDs
URLs IP address
Full face
image
Other
unique IDs

6. Providers,
Hospitals/Clinics,
Pharmacies,
Health Plans
IT Vendors,
Billing, Cloud
Cloud Providers,
Legal/AccountingHIPAA Compliance [2025] Page number: 06 www.cybersecurity24x7.com CyberSecurity24x7
Who Must Follow HIPAA Rules
Covered Entities Business Associates

7. HIPAA Compliance [2025] Page number: 07 www.cybersecurity24x7.com CyberSecurity24x7 HIPAA Privacy Rule
Limit uses/disclosures of PHI
Minimum necessary standard
Patient rights: access,
corrections, accounting of
disclosures, restrictions
Applies to paper, electronic, and
oral PHI

8. HIPAA Compliance [2025] Page number: 08 www.cybersecurity24x7.com CyberSecurity24x7 HIPAA Security Rule
Administrative
Administrative
Administrative
Security officer,
training,
access control,
incident response,
risk assessments
Facility controls,
secure workstations/devices,
media disposal
Encryption,
access logs,
MFA,
firewalls/AV,
auto logoff

9. HIPAA Compliance [2025] Page number: 09 www.cybersecurity24x7.com CyberSecurity24x7 HIPAA Breach
Notification Timeline
Within 60 days: Notify patients
500+ affected: Notify HHS
immediately
500+: Notify media
Under 500: Report annually

10. HIPAA Compliance [2025] Page number: 10 www.cybersecurity24x7.com CyberSecurity24x7 7 Pillars of
HIPAA Compliance
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11. HIPAA Compliance [2025] Page number: 11 www.cybersecurity24x7.com CyberSecurity24x7 Costly HIPAA ViolationsAnthem $16M
Premera
Blue Cross
$6.85M
Memorial
Healthcare
$5.5M
NY
Presbyterian
$2.2M
fine amount in millions
Orgaanizations

12. HIPAA Compliance [2025] Page number: 12 www.cybersecurity24x7.com CyberSecurity24x7 HIPAA Implementation
Checklist
Map PHI flows
Encrypt all devices
Role-based access in EMR
Monitor access logs
Phishing awareness training
Quarterly IR testing
Annual BAA review
Learn more @
www.cybersecurity24x7.com