L.A. Care Health Plan

About this report

Today, the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR) announced a settlement of potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Rules with LA Care, the nation's largest publicly operated health plan that provides health care benefits and coverage through state, federal, and commercial programs. OCR enforces the HIPAA Privacy, Security, and Breach Notification Rules that set the requirements that HIPAA-regulated entities must follow to protect the privacy and security of protected health information (PHI). The settlement concludes two OCR investigations initiated from a large breach report and a media article regarding a separate security incident. Under the agreement, LA Care agreed to pay $1,300,000 and to implement a corrective action plan, discussed in further detail below, which identifies steps LA Care will take to resolve these potential violations of the HIPAA Security Rule and protect the security of electronic protected health information (ePHI). “Breaches of protected health information by a HIPAA-regulated entity often reveal systemic, noncompliance with the HIPAA Rules,” said OCR Director Melanie Fontes Rainer. “HIPAA-regulated entities need to be proactive in ensuring their compliance with the HIPAA Rules, and not wait for OCR to reveal long-standing HIPAA deficiencies. Entities must protect the health information of its insureds while providing health care for the most vulnerable residents of Los Angeles County through its coverage, which includes Medicaid, Medicare, and Affordable Care Act health plans.” The potential violations in this case included: • failure to conduct an accurate and thorough risk analysis to determine risks and vulnerabilities to ePHI across the organization, • failure to implement security measures sufficient to reduce risks and vulnerabilities to ePHI to a reasonable and appropriate level, • failure to implement sufficient procedures to regularly review records of information system activity, • failure to perform a periodic technical and nontechnical evaluation in response to environmental or operational changes affecting the security of ePHI, and • failure to implement hardware, software, and/or procedural mechanisms that record and examine activity in information systems that contain or use ePHI. OCR’s investigation found evidence of potential noncompliance with the HIPAA Privacy and Security Rules across LA Care’s organization. In addition to the monetary settlement, LA Care has agreed to take the following steps under a comprehensive corrective action plan that will be monitored for three years by OCR to ensure compliance with HIPAA: • Conduct an accurate and thorough risk analysis to determine risks and vulnerabilities to electronic patient/system data across the organization. • Implement a risk management plan to address identified risks and vulnerabilities to the confidentiality, integrity, and availability of ePHI. • Implement and distribute policies and procedures for a risk analysis and risk management plan. • Report to HHS when it conducts an evaluation due to an environmental and operational change that affects the security of ePHI in LA Care’s possession or control. • Report to HHS within thirty (30) days when workforce members fail to comply with the HIPAA Rules. The resolution agreement and corrective action plan may be found at: https://www.hhs.gov/hipaa/for-professionals/compliance-enforcement/agreements/la-care-health-plan/index.html OCR is committed to enforcing the HIPAA Rules that protect the privacy and security of peoples’ health information. Guidance about the Privacy Rule, Security Rule, and Breach Notification Rules can also be found on OCR’s website. If you believe that your or another person’s health information privacy or civil rights have been violated, you can file a complaint with OCR at https://www.hhs.gov/ocr/complaints/index.html.

Summary as published by the HHS Office for Civil Rights.