Employees who violate HIPAA may face severe consequences, including disciplinary actions, termination of employment, legal penalties, fines, and even imprisonment, as their actions can compromise the privacy and security of patient information and breach the trust between healthcare providers and patients. Any entity found to have violated the HIPAA Rules can face massive financial penalties and administrative sanctions.
For this reason it is crucial for employees to have an in-depth knowledge of the legislation with respect to their work duties and to be made aware of the consequences they face if they are discovered to have violated HIPAA. Providing staff members with appropriate training is essential and also a requirement of the HIPAA Privacy and Security Rules.
All HIPAA-covered entities – health insurers, healthcare providers, healthcare clearinghouses – and their business associates, should ensure they have an effective training program in place that is tailored for each employee role. Regular refresher training sessions also need to be provided to reinforce the requirements of HIPAA and the need for compliance.
There will always be isolated incidents where employees deliberately violate the HIPAA Rules and breach patient privacy, but by providing regular training and monitoring employee activity (as required by HIPAA), an organization will be compliant and insulated from penalties and sanctions.
HIPAA Violation Consequences
HIPAA violation consequences range from initial responses for minor or unintentional violations, such as verbal warnings that emphasize compliance importance and written warnings that formally address the breach, documenting its consequences and expectations moving forward. For minor breaches, corrective action plans can be established, outlining steps for employees to rectify their behavior and undergo additional training to prevent recurrence. Deliberate or repeated breaches may warrant more severe consequences. Suspension could be considered, temporarily removing the employee from their position to underline the gravity of the violation and allow for reflection. In cases where breaches significantly compromise patient data security or erode trust, termination might be necessary. Such severe actions safeguard patient information and demonstrate a strong commitment to data security and compliance. Legal and financial penalties imposed by regulatory authorities are potential outcomes of violations. These penalties vary based on breach severity and can have substantial financial implications. Additionally, reputation damage is a significant consequence, impacting both the employee and the organization. Negative publicity and patient mistrust can lead to decreased patient retention and a tarnished organizational image. In extreme instances, intentional breaches might even result in criminal charges, leading to fines, probation, or imprisonment. Civil lawsuits initiated by affected patients against the organization or responsible individuals are another consequence. These lawsuits can lead to monetary damages and legal costs. Professionals in regulated industries, like healthcare, risk losing their professional licenses due to serious violations, which can drastically impact their career prospects. Moreover, employees found guilty of breaches may face disqualification from future roles requiring access to sensitive data, limiting their career opportunities.
What Happens When an Employee is Responsible for a HIPAA Violation?
There are four possible ramifications for employees responsible for a HIPAA violation occurring:
- An internal investigation into the HIPAA breach will be conducted to ascertain how the breach was allowed to happen.
- Depending on the circumstances of the breach, your employer may consider firing the employee responsible.
- There is a chance that the employee responsible could be disqualified from practicing by professional boards.
- A criminal conviction is possible in cases where an employee violated HIPAA for personal gain or to cause malicious harm.
The outcome for an employee will depends on the nature and severity of the HIPAA breach. This is determined by taking the following factors in to account:
- The extent of the breach.
- If the individual was conscious that they were violating the HIPAA Rules.
- Measures that were implemented to mitigate any negative consequences.
- Whether the employee displayed malicious intent or violated HIPAA for personal gain.
- Damage or harm caused as a result of the breach.
- The number of individuals affected.
- Whether the breach constituted a criminal act.
Minor violations may result in internal sanctions for the employee such as a verbal or written warning, or may simply be dealt with by providing further training. More serious violations could result in suspension or termination, with the most serious cases referred to law enforcement for criminal proceedings.
Civil HIPAA Violation Penalties for Employees
The HHS’ Office for Civil Rights and state Attorneys General have the authority to impose civil penalties for HIPAA violations. The penalties are tiered based on the extent to which the covered entity was aware that HIPAA Rules had been violated. The penalties are:
- Tier 1 – Unknowing violation – $100 to $50,000 per violation (maximum $25,000)
- Tier 2 – Reasonable cause – $1,000 to $50,000 per violation (maximum $100,000)
- Tier 3 – Willful neglect (corrected) – $10,000 to $50,000 per violation (maximum $250,000)
- Tier 4 – Willful neglect (not corrected) – $50,000 per violation (maximum $1.5 million)
HIPAA Breaches & Criminal Penalties
There are stringent criminal penalties for HIPAA violations and the penalties are tiered. At the lowest level, where HIPAA Rules have been knowingly violated and PHI has been obtained or disclosed, a financial penalty of up to $50,000 is possible. When PHI has been obtained under false pretenses, the maximum fine increases to $100,000. When an individual obtains PHI with the intent to sell, use, or otherwise disclose the information for personal gain, to achieve a commercial advantage, or to cause malicious harm, the maximum financial penalty increases to $250,000.
Restitution may also need to be paid to the individuals whose PHI has been misused. In addition to fines for criminal violations of the HIPAA Rules, jail terms are possible. The maximum jail term is also dictated by the nature of the HIPAA violation.
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A maximum one-year jail term for criminal HIPAA violations involving knowingly obtaining or using PHI.
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A maximum five-year jail term for collecting protected health information under false pretenses.
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A maximum ten-year jail term for knowingly breaching HIPAA Rules to cause malicious harm, to gain a commercial advantage, or for personal gain.
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A mandatory two-year jail term for aggravated identity theft.
All criminal violations of the HIPAA Rules are handled by the U.S. Department of Justice.
Identifying HIPAA Breaches
There are many ways that violations of the HIPAA Rules are discovered. Commonly, covered entities and business associates discover internal breaches when colleagues report violations by co-workers to their HIPAA officer and when the IT department reviews access logs to see who has accessed medical records without authorization.
The HHS’ Office for Civil Rights (OCR) may discover HIPAA violations during investigations of complaints or data breaches, or during a HIPAA audit or compliance review. An individual whose privacy has been violated may discover their PHI has been impermissibly accessed or disclosed and may report it to the appropriate covered entity, law enforcement, or the HHS. It is also common for third parties such as security researchers to discover applications and cloud storage services containing PHI that have not been secured. OCR and state Attorneys General can conduct investigations into any potential breach of the HIPAA Rules and can impose financial penalties if violations are discovered.
In the event that HIPAA Rules are discovered to have been breached as a result of a lack of training, the covered entity will be deemed to be at fault rather than employees. HIPAA covered entities have a legal requirement to conduct training “as necessary and appropriate for employees in order for them to carry out their function in a HIPAA-compliant manner” (HIPAA Privacy Rule).
To prevent any disputes about whether appropriate training was provided to employees, employers must keep a record of all training provided together with the date of the training and the content of the training course. Ideally, employees should sign a document to confirm they have completed a training course.
If you are conscious that a HIPAA breach has occurred as an employee of a HIPAA covered entity or business associate, you should follow your organization’s process for reporting potential HIPAA violations. This is typically alerting your supervisor and the HIPAA officer. Action will need to be taken to assess whether HIPAA Rules have been violated and if so, steps must be taken to correct the violation and minimize any harm.
The easiest way to prevent HIPAA breaches is by ensuring all staff members receive comprehensive HIPAA and security awareness training and make sure that the training is regularly re-enforced.
HIPAA Training to Avoid Employees Violating HIPAA
HIPAA training plays a crucial role in preventing employees from violating HIPAA regulations by providing them with the necessary knowledge and awareness to understand their responsibilities and the potential consequences of non-compliance. Through comprehensive HIPAA training, employees learn about the privacy and security requirements, patient rights, and the appropriate handling of protected health information (PHI). They gain insights into the potential risks and vulnerabilities related to PHI, as well as the safeguards and best practices to protect it. By enhancing their understanding of HIPAA regulations, employees are more likely to recognize and avoid situations that could lead to violations. They learn about the importance of confidentiality, the proper use of electronic systems, the importance of secure communication channels, and the need for authorization when accessing PHI. Training also emphasizes the significance of ongoing compliance and the need to stay updated with evolving HIPAA regulations and industry best practices. By providing employees with the necessary education and guidance, HIPAA training empowers them to make informed decisions, adhere to compliance standards, and uphold the privacy and security of patient information. Regular and updated training reinforces these principles and ensures that employees maintain a high level of awareness and accountability, reducing the likelihood of HIPAA violations and contributing to a culture of compliance within healthcare organizations.
Steps for Addressing HIPAA Violations through Employee Discipline
| Steps for Addressing HIPAA Violations through Employee Discipline | Description |
|---|---|
| 1. Policy Awareness | Begin the process by ensuring that all employees have a clear understanding of the dental office’s HIPAA policies. Communication of these policies during onboarding and regular training sessions is essential. This step lays the foundation for promoting compliance and holding employees accountable for their actions. Through policy awareness, staff members comprehend the importance of safeguarding patient data and the potential consequences of violating HIPAA regulations. The aim is to create a culture where every employee recognizes the significance of data security and respects patient privacy. |
| 2. Clear Guidelines | Provide employees with explicit and comprehensible guidelines detailing what constitutes a HIPAA violation. Clear guidelines help employees distinguish between acceptable practices and potential breaches. By defining the boundaries, dental offices enable staff to make informed decisions that prioritize patient privacy. These guidelines encompass various scenarios, from handling electronic records to discussing patient information, both within the practice and with external parties. Clarity in these guidelines reduces ambiguity and minimizes the risk of accidental violations. |
| 3. Investigation | When a suspected HIPAA violation arises, initiate a thorough internal investigation to gather all pertinent details. The investigation involves identifying the individuals involved, the extent of the breach, and any contributing factors. This step helps in assessing the scope and severity of the violation, whether it’s an inadvertent mistake or a deliberate act. A meticulous investigation process ensures that the subsequent disciplinary actions are well-founded and based on accurate information. The collected evidence serves as a basis for determining the appropriate response. |
| 4. Documentation | Document the entire investigation process, including the collected evidence, interviews, findings, and actions taken. Comprehensive documentation provides a clear record of the investigation’s progression, which can be crucial for demonstrating due diligence and accountability. In case the disciplinary actions are challenged or if legal implications arise, having well-documented information ensures transparency and supports the organization’s decision-making process. Proper documentation helps create a trail of actions taken to address the violation. |
| 5. Severity Assessment | Assess the severity of the HIPAA violation to determine the proportional disciplinary measures. By evaluating the nature of the breach, its potential impact on patient data, and the employee’s intent, the organization can categorize violations based on their gravity. Determining the severity helps in applying consistent disciplinary actions that match the seriousness of the infraction. This assessment aids in striking a balance between accountability and fairness, ensuring that the consequences are appropriate and proportionate to the violation. |
| 6. Consult Legal Counsel | Seek legal counsel to ensure that the proposed disciplinary actions align with federal and state laws, regulations, and industry best practices. Legal experts provide guidance on the permissible consequences for HIPAA violations, ensuring that the organization avoids potential legal pitfalls. Their input helps in making informed decisions while adhering to legal boundaries, reducing the risk of legal challenges or further complications arising from the disciplinary process. |
| 7. Progressive Discipline | Implement a progressive discipline approach that considers the violation’s severity and the employee’s history. This approach involves a series of escalating consequences, starting with milder actions for minor infractions and advancing to more severe measures for repeated or significant breaches. The progressive model encourages corrective behavior while reserving more stringent measures for cases that merit them. It fosters a balanced approach to discipline, emphasizing improvement and compliance. |
| 8. Corrective Action Plans | Develop corrective action plans for employees involved in minor violations. These plans outline specific steps the employee must take to rectify their behavior and prevent future occurrences. The focus is on education and retraining, empowering the employee with the knowledge and tools to avoid similar mistakes. Corrective action plans are proactive measures that help employees learn from their errors and contribute to a culture of continuous improvement and compliance. |
| 9. Verbal Warning | Employ verbal warnings as initial consequences for minor violations or mistakes that require immediate attention. A verbal warning serves as an informal reminder of the importance of compliance and the potential ramifications of further violations. This step opens a channel for communication and discussion while conveying the message that the organization takes HIPAA seriously and expects adherence to its policies. |
| 10. Written Warning | Issue written warnings for repeated or more significant violations. A written warning documents the violation, explains its consequences, and underscores the organization’s expectations for future conduct. It serves as a formal notice that reinforces the seriousness of the breach and sets the stage for potential escalation if the behavior continues. Written warnings help in establishing a paper trail that demonstrates the organization’s efforts to address non-compliance. |
| 11. Suspension | Consider suspension for deliberate or repeated breaches that warrant a stronger disciplinary response. Suspension involves temporarily removing the employee from their role, signaling the gravity of the situation. It serves as a means of emphasizing the importance of compliance and protecting patient data. Suspension provides an opportunity for the employee to reflect on their actions while highlighting the potential consequences of their behavior. |
| 12. Termination | In cases of severe or repeated HIPAA violations that compromise patient data security, termination might be necessary. Termination demonstrates a zero-tolerance approach to intentional breaches or actions that jeopardize patient trust and organizational integrity. While a difficult decision, it is imperative to safeguard patient information and the reputation of the dental office, sending a clear message about the organization’s commitment to compliance and data security. |
| 13. Recovery and Prevention | In parallel with disciplinary actions, focus on recovery and prevention. Take steps to recover from the breach, including communicating with affected patients and addressing any concerns. Implement preventive measures to reduce the risk of future violations, such as enhancing training, refining policies, and reinforcing a culture of compliance. This dual approach ensures that the organization learns from mistakes and fortifies its defenses against future breaches. |
| 14. Retraining | Mandate additional HIPAA training for employees involved in violations. Retraining emphasizes the importance of regulatory compliance and provides an opportunity for employees to refresh their understanding of HIPAA rules and best practices. By reeducating staff members, dental offices encourage a renewed commitment to compliance and equip employees with the knowledge to avoid future breaches. |
| 15. Reassess Policies | After addressing a violation, conduct a thorough review of HIPAA policies and procedures. Identify any weaknesses or gaps that contributed to the breach and make necessary revisions. Reassessing policies ensures that the organization evolves in response to challenges and continually strengthens its data security measures. Updating policies demonstrates a commitment to learning from incidents and enhancing future compliance efforts. |
| 16. Rebuilding Trust | If a violation led to patient concerns or complaints, take proactive steps to rebuild patient trust. Transparently communicate the breach, the actions taken to address it, and the measures implemented to prevent future occurrences. By openly addressing patient concerns, dental offices can demonstrate their dedication to patient privacy and data security, restoring confidence in the practice. |
| 17. Consistency | Maintain consistency in applying disciplinary actions across the organization. Ensuring fairness and uniformity helps avoid accusations of favoritism or discrimination. Consistency in the disciplinary process reinforces the organization’s commitment to upholding standards and treating all employees equitably, regardless of their role or position. |
| 18. Continued Monitoring | Keep a watchful eye on employees who have violated HIPAA policies, especially in the aftermath of disciplinary actions. Continued monitoring helps ensure that these employees adhere to compliance moving forward. It also provides an opportunity to offer support, guidance, and additional training to help them stay on the right track and avoid future breaches. |
| 19. Reporting to Authorities | In cases of serious violations that breach legal thresholds, report the incident to appropriate authorities, such as the Office for Civil Rights (OCR) or state regulatory agencies. Reporting ensures that legal obligations are met and that external oversight can be provided if necessary. This step also demonstrates the dental office’s commitment to transparency and accountability. |
| 20. Documentation of Actions | Document all disciplinary actions taken, including verbal and written warnings, suspension details, and termination decisions. Thorough documentation provides a clear record of the disciplinary process, including the rationale behind each decision. Such documentation is essential for demonstrating compliance with regulations and justifying actions taken. |
Frequently Asked Questions
Can I get fired for an accidental HIPAA violation?
Yes, you can be fired for an accidental HIPAA violation depending on the seriousness of the violation and the policies of your employer. While unintentional mistakes do happen, it’s crucial to understand that HIPAA laws are put in place to protect patients’ sensitive health information. Therefore, even accidental violations can have serious consequences, including termination. Most healthcare organizations have policies in place that outline potential disciplinary action for HIPAA violations, which can range from mandatory retraining and written warnings to suspension or termination. Even an accidental violation could be viewed as negligence, particularly if the organization provided adequate training and resources to prevent such a violation.
What is the most serious consequence for intentionally breaching PHI security?
Intentional breaches of Protected Health Information (PHI) security are treated very seriously under HIPAA and the most serious consequence for such a violation can be criminal charges, which are divided into tiers based on the intent of the individual:
- If a person knowingly obtained or disclosed PHI, they could face a fine up to $50,000 and up to one year in prison.
- If the offense was committed under false pretenses, the penalties increase to a $100,000 fine and up to five years in prison.
- In the most serious cases, where the offense was committed with the intent to sell, transfer, or use PHI for commercial advantage, personal gain, or with malicious intent, the penalties can be up to a $250,000 fine and up to ten years in prison.
Apart from these statutory penalties, individuals found guilty of intentional violations can also face civil lawsuits from affected patients. These lawsuits could result in additional financial penalties and can also damage the reputation and career of the guilty individual. The individual may also lose their professional license or certification, depending on their role and the regulations of their professional licensing board.
If any staff member is found to have violated HIPAA rules, what is a possible result?
When a staff member is found to have violated HIPAA rules, the implications can be serious, heavily dependent on the nature and severity of the violation. One possible outcome is disciplinary action from their employer. Depending on the gravity of the violation, this can take various forms from a verbal or written warning to more serious consequences. In some cases, this could involve mandatory retraining to ensure the employee understands and can properly adhere to HIPAA regulations in the future. In extreme cases, especially for repeated or egregious violations, suspension or even termination of employment could result. Financial penalties can also be enforced. The Office for Civil Rights (OCR) can impose fines that fluctuate from $100 to $50,000 per violation, contingent on the category and severity of the violation. The total sum can be substantial, as the maximum reaches up to $1.5 million per year for violations of an identical provision. In cases of severe or deliberate violations, criminal charges may be filed. These charges can lead to significant fines, reaching up to $250,000, and potentially imprisonment for up to ten years. Both the intent behind the violation and the harm caused are considered when determining the criminal penalty.
Affected patients also have the option to file civil lawsuits against the individual responsible for the breach. This could lead to further legal consequences and financial penalties. Besides these direct consequences, a HIPAA violation can also cause significant damage to a professional’s reputation, which could subsequently impact their future career opportunities within the healthcare industry. For healthcare professionals, a violation could potentially lead to the suspension or loss of their professional license or certification, as regulated by their professional licensing board. The risk of this underscores the importance of adhering to HIPAA regulations to safeguard not only patients’ sensitive information but also one’s own professional standing.
Is it legal to sanction an employee who has violated privacy policies?
Yes, it is legal to sanction an employee who has violated privacy policies, including HIPAA. Employers have a responsibility to enforce privacy rules and regulations, and this includes disciplining employees who fail to comply. This is essential to maintain the security and confidentiality of sensitive data, such as Protected Health Information (PHI), and to ensure an organization’s continued compliance with legal and regulatory requirements. Sanctions for violating privacy policies can range from verbal or written warnings to retraining, suspension, and even termination, depending on the severity of the violation and the employer’s policies. These disciplinary measures are intended to address and correct the violation, deter future non-compliance, and maintain the integrity of the organization’s privacy practices. Employers must apply sanctions consistently and in accordance with a clearly communicated privacy policy and disciplinary procedure. This is to ensure fairness and avoid potential issues of discrimination or wrongful termination.
What are the potential consequences for employees who violate HIPAA?
Employees who violate HIPAA can face serious consequences, which can be both civil and criminal. These range from disciplinary actions implemented by the employer, such as warnings, retraining, or even job termination, to substantial fines levied by regulatory authorities and, in severe cases, imprisonment. The severity of consequences typically depends on the nature and extent of the violation.
Can violating HIPAA result in employment termination?
Yes, violating HIPAA can lead to employment termination. While the exact policies can vary depending on the employer, many healthcare providers and organizations have strict guidelines about HIPAA compliance. A serious violation, particularly if it involves purposeful disregard for the rules or a pattern of non-compliance, can lead to an employee being fired.
How does a violation of HIPAA by an employee impact the organization they work for?
A HIPAA violation by an employee can have significant repercussions for the organization involved. These can include financial penalties, a loss of trust among patients or clients, damage to reputation, and in severe cases, loss of licenses or certification. Additionally, the organization may need to take steps to mitigate the violation, such as notifying affected individuals, which can be a costly and time-consuming process.
What are the criminal penalties for violating HIPAA?
Criminal penalties for violating HIPAA depend on the nature of the violation. If the violation occurred unknowingly, the individual may face a fine of up to $50,000 and up to one year in prison. If the violation occurred under false pretenses, penalties increase to a $100,000 fine and up to five years in prison. If the violation occurred with intent to sell, transfer, or use Protected Health Information (PHI) for commercial advantage, personal gain, or malicious harm, the penalties can be up to a $250,000 fine and up to ten years in prison.
What are the financial penalties for employees who violate HIPAA?
The financial penalties for violating HIPAA can be quite steep. The Office for Civil Rights (OCR), which enforces HIPAA, can impose a penalty of $100 to $50,000 per violation, with a maximum penalty of $1.5 million per year for each violation. The exact amount depends on the severity of the violation and the degree of negligence involved.
How does the severity of a HIPAA violation impact the consequences faced by an employee?
The severity of a HIPAA violation directly impacts the consequences an employee faces. Minor, unintentional violations may result in internal disciplinary actions such as retraining or a formal warning. More severe or repeated violations can lead to job termination, while intentional misconduct, especially if it results in harm, can lead to the most severe consequences, including large fines and criminal charges.
What is the process for reporting a HIPAA violation within an organization?
Each organization should have a clear, defined process for reporting suspected HIPAA violations. Typically, this involves reporting the incident to a privacy officer or supervisor, who then investigates the matter. If the violation is confirmed, they then determine the appropriate response, which can range from retraining or disciplinary action to reporting the violation to federal authorities.
How are suspected HIPAA violations investigated within an organization?
Suspected HIPAA violations are usually investigated internally within an organization by a designated privacy officer or compliance department. The investigation process often involves interviewing the parties involved, reviewing relevant documentation or records, and determining whether a violation of patient privacy rights or security regulations occurred. If a violation is found, appropriate action is then taken, which could include disciplinary measures and potentially reporting the incident to federal authorities.
Can an employee be held personally liable for a HIPAA violation?
Yes, employees can be held personally liable for HIPAA violations. Depending on the nature of the violation, employees can face both civil and criminal penalties, including fines and jail time. In some cases, they may also be held personally responsible in lawsuits brought by individuals whose information was improperly disclosed.
How is the determination made between an unintentional and an intentional HIPAA violation?
The determination between unintentional and intentional HIPAA violations is made based on the facts and circumstances surrounding the violation. Key factors include whether the violation was due to a genuine mistake or lack of knowledge, or whether there was deliberate intent to violate privacy rules. This evaluation is often done during the investigation process following a reported violation.
Does an employee’s history of compliance with HIPAA rules impact the consequences of a violation?
Yes, an employee’s history of compliance with HIPAA rules can impact the consequences of a violation. If an employee has a history of non-compliance, penalties for violations can be more severe. Conversely, if an employee has a strong history of compliance, a single, unintentional violation may be treated more leniently, with emphasis placed on retraining rather than punishment.
Can employees be held accountable for HIPAA violations committed unknowingly?
Yes, employees can be held accountable for HIPAA violations committed unknowingly. While intent is a factor that is taken into consideration when assessing penalties, even unintentional violations can lead to significant fines and other consequences. This underscores the importance of thorough training and adherence to HIPAA rules at all times.
Are there any protections for employees who inadvertently violate HIPAA due to misinformation or lack of training?
In many cases, an organization will retrain employees who inadvertently violate HIPAA due to misinformation or lack of training. However, this does not absolve the employee or the organization from penalties that might be assessed by regulatory bodies. It’s critical for employers to provide comprehensive HIPAA training to all employees to prevent such incidents.
Can an employee face criminal charges for a HIPAA violation?
Yes, in severe cases, an employee can face criminal charges for a HIPAA violation. This typically occurs when the violation involves knowingly and improperly disclosing Protected Health Information (PHI), especially if done for personal gain or with intent to harm. Criminal charges can lead to substantial fines and even imprisonment.
How does the Office for Civil Rights (OCR) handle reported violations of HIPAA by employees?
The Office for Civil Rights (OCR) is the body responsible for enforcing HIPAA regulations. When a violation is reported, the OCR will conduct an investigation. If the investigation confirms a violation, the OCR will typically attempt to resolve the issue by obtaining voluntary compliance, corrective action, or a resolution agreement from the covered entity. In cases where the violation is severe or the covered entity is uncooperative, the OCR can impose civil monetary penalties.
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