Chances are, paying thousands of dollars as a result of a HIPAA violation isn’t in your healthcare organization’s 2026 budget. Although HIPAA violations aren’t always intentional, they still can be costly for healthcare organizations.
Along with financial penalties, covered entities that commit HIPAA violations often encounter remediation costs, notification and credit monitoring expenses and legal ramifications, including class action lawsuits from affected patients. They also must develop and implement a corrective action plan to bring policies and procedures into compliance with the law’s standards.
As we mentioned in a previous blog, HIPAA requires that healthcare organizations and their business associates safely manage who has the privilege and/or right to access, change or distribute sensitive health data. Unauthorized access or improper handling of patient data can result in civil and criminal fines and penalties. Although rare, criminal HIPAA penalties include fines of up to $250,000 and imprisonment for up to ten years.
Civil HIPAA Penalty Tiers
| Tier | Culpability Level | Per Violation (2025) | |
| Minimum | Maximum | ||
| 1 | Lack of Knowledge | $145 | $73,011 |
| 2 | Reasonable Cause | $1,461 | $73,011 |
| 3 | Willful Neglect (Corrected) | $14,602 | $73,011 |
| 4 | Willful Neglect (Not Corrected) | $73,011 | $2,190,294 |
2025 HIPAA Violation Fines and Settlements
The 2025 HIPAA violations certainly don’t match those in previous years, but they represent a cross-set of the types that continue to plague healthcare organizations of all sizes. The largest HIPAA violation to date belongs to Anthem, Inc., which paid a penalty of $16 million to the OCR in 2018 for a massive 2015 cyberattack and $115 million in a class-action lawsuit settlement.
1. Provider: Warby Parker, Inc.
Penalty amount: $1,500,000 Civil Monetary Penalty
Reason(s) for violation: Violation of the HIPAA Security Rule: Risk analysis, risk management and monitoring activity in information systems containing electronic protected health information (PHI)
2. Provider: BayCare Health System
Penalty amount: $800,000 settlement
Reason(s) for violation: Information access management (minimum necessary standard), risk management, information system activity review
3. Provider: PIH Health
Penalty amount: $600,000 settlement
Reason(s) for violation: HIPAA Risk Analysis violation, impermissible disclosure of the ePHI of 189,763 individuals, failure to issue a media breach notice and a lack of issuance of timely breach notifications to HHS and the affected patients
4. Provider: Northeast Radiology
Penalty amount: $350,000 settlement
Reason(s) for violation: HIPAA Risk Analysis violation
5. Provider: Syracuse ASC
Penalty amount: $250,000 settlement
Reason(s) for violation: Risk analysis failure; untimely data breach notifications to the HHS Secretary and individuals
6. Provider: Health Fitness Corporation
Penalty amount: $227,816 settlement
Reason(s) for violation: HIPAA Risk Analysis violation
7. Provider: Deer Oaks (The Behavioral Health Solution)
Penalty amount: $225,000 settlement
Reason(s) for violation: Risk analysis failure, impermissible disclosure of ePHI
8. Provider: Oregon Health & Science University
Penalty amount: $200,000 Civil Monetary Penalty
Reason(s) for violation: Violation of the HIPAA Right of Access
9. Provider: Cadia Healthcare Facilities
Penalty amount: $182,000 settlement
Reason(s) for violation: Social media disclosure without authorization and Breach Notification Rule failure
10. Provider: Concentra, Inc.
Penalty amount: $112,500 settlement
Reason(s) for violation: HIPAA Right of Access violation
Common Types of HIPAA Violations
While the 2025 enforcement cases represent high-profile examples, they almost all fall into a few recurring violation categories that have persisted throughout HIPAA’s enforcement history. Understanding these patterns helps organizations prioritize their compliance investments. The most common HIPAA violations include:
Unauthorized Access: Healthcare workers accessing patient records without a legitimate business need remains one of the most frequent violation types. This includes viewing celebrity records, checking on family members or satisfying personal curiosity about coworkers’ health conditions.
Missing or Incomplete Risk Analysis: The failure to conduct thorough, enterprise-wide security risk assessments underlies the majority of enforcement actions. Organizations often conduct incomplete risk analysis that examines only portions of their environment or fail to update assessments after significant changes.
Weak Access Controls: Insufficient access control measures, including shared passwords, missing Multi-Factor Authentication (MFA) and overly broad privileges, enable both external attacks and insider threats.
Lack of Encryption: Despite years of enforcement emphasis, organizations continue to store and transmit patient information without encryption, leaving data exposed when devices are lost or stolen.
Impermissible Disclosures: Sharing patient information without proper authorization, whether to researchers, employers, family members or the media, violates the HIPAA Privacy Rule’s requirements for patient consent.
Late or Missing Breach Notifications: The Breach Notification Rules require notification to affected individuals within 60 days of discovery, with larger breaches also necessitating media and HHS notification. Organizations that delay or provide incomplete notifications face additional penalties.
Missing Business Associate Agreements: Covered entities must execute business associate agreements (BAAs) with all vendors handling PHI on their behalf. Missing or inadequate BAAs create liability for both parties.
Improper PHI Disposal: Failing to properly destroy physical and electronic media containing patient records, such as placing unshredded documents in regular trash, constitutes a violation of HIPAA standards.
Applying AI to Procure HIPAA Compliance
With the utilization of agentic artificial intelligence (AI) in healthcare settings, HIPAA compliance ensures that AI systems protect patient data as effectively as healthcare providers. The intersection of AI and HIPAA creates new compliance considerations that organizations must address proactively.
AI Compliance Requirements
Implementing AI systems that handle patient information requires:
- Robust security measures: Encryption, secure storage and stringent access controls to prevent unauthorized access to data processed by AI systems
- Explicit patient authorization: Clear consent mechanisms for AI-driven data usage beyond treatment, payment and operations
- Routine risk assessments: Regular evaluation of AI systems as part of organizational security risk analysis processes
- Audit trails: Comprehensive logging of AI system access to and processing of PHI
Training Data and AI Performance
The effectiveness of AI models in healthcare is enhanced by the quality of training data. By identifying patterns and predicting user responses, this data plays a crucial role in improving the performance of agentic AI in clinical settings. Healthcare organizations must ensure that training data usage complies with HIPAA authorization requirements and minimum necessary standards.
AI: A Protective Tool for PHI
Agentic AI can help protect patient health data by:
- Using secure and HIPAA-compliant platforms to store and transmit PHI
- Detecting anomalous access patterns that may indicate unauthorized viewing or data exfiltration
- Automating compliance monitoring and alerting on potential violations
- Enhancing incident response through rapid threat identification
Organizations deploying AI must treat these systems as they would any other technology handling PHI: with comprehensive security measures, documented risk analysis and ongoing monitoring. At Providertech, our agentic AI platform enables you to easily communicate with your patients while safeguarding their information and increasing interdepartmental efficiencies. Built with TCPA safeguards, it boasts a secure and HITRUST-certified infrastructure and encryption for all data, including PHI.
Schedule a demo today to learn how you can experience happy patients every single call, every single time!
