On March 7, 2014, the HHS Office for Civil Rights (“OCR”) announced its first settlement and corrective action plan with a county government. Skagit County in northwest Washington State has agreed to pay $215,000 to settle potential violations of the HIPAA Privacy, Security and Breach Notification Rules.

According to Susan McAndrew, deputy director of health information privacy at OCR, “this case marks the first settlement with a county government and sends a strong message about the importance of HIPAA compliance to local and county governments, regardless of size.” Generally, local and county governments are subject to HIPAA because certain departments within the government are involved in the provision of or payment for health care services. The Skagit County Public Health Department provides essential services to many individuals who would otherwise not be able to afford health care. Importantly, a single legal entity whose business activities include both HIPAA covered and non-covered services (like a county government) may designate itself as a “hybrid entity” by identifying its “health care components.” This designation, however, must be formally documented in the entity’s policies and procedures. Most of the requirements of the Privacy, Security and Breach Notification Rules apply only to the hybrid entity’s health care components.

OCR began investigating Skagit County following a breach self-report notifying OCR that the electronic protected health information (“ePHI”) of seven individuals receiving services from the Skagit County Public Health Department was posted on a publicly available server maintained by the county and accessed by unknown parties. The investigation revealed that the ePHI of not just seven – but 1,581 – individuals, was made available on the public server. The ePHI, which could be accessed through a simple Google search, included highly sensitive information, such as the testing and treatment of infectious diseases. OCR’s investigation further revealed Skagit County’s general and widespread non-compliance with the HIPAA Privacy, Security and Breach Notification Rules, including the implementation of sufficient policies and procedures.

In addition to the $215,000 settlement, the Resolution Agreement between Skagit County and OCR included a corrective action plan (“CAP”) that requires Skagit County to, among other things, (1) provide substitute breach notification to affected individuals not previously notified; (2) create and revise written policies and procedures to comply with HIPAA; and (3) submit for OCR’s review and approval hybrid entity documents designating the county’s covered health care components. The CAP also requires Skagit County to provide regular status updates to OCR, which will work closely with the county to correct deficiencies.

While OCR marks this settlement as the first with a county government, it is not the first for a public entity. In June 2012, the Alaska Department of Health and Social Services agreed to pay $1.7 million to settle possible violations of the Security Rule. Notably, both of these enforcement actions, and most actions since 2012, have resulted from a breach self-report used by OCR as an opportunity to conduct a de-facto audit of the entity’s general HIPAA compliance. Whether this enforcement trend will continue will likely depend upon the scope (and perhaps more importantly, the funding), of OCR’s second round of statutorily required audits of covered entities and business associates. Regardless, given the environment of increased OCR enforcement, regulated entities should ensure, at a minimum, that they have implemented the basic elements of HIPAA compliance—performance of a Security Rule risk analysis, implementation of sufficient policies and procedures (including documentation of any hybrid entity designation), and adequate training of workforce members.

Additional information about OCR’s enforcement activities can be found athttp://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/index.html.