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OCR Imposes 2nd Largest Ever HIPAA Penalty of $6.85 Million on Premera Blue Cross

The Department of Health and Human Services’ Office for Civil Rights (OCR) has imposed a $6.85 million HIPAA penalty on Premera Blue Cross to resolve HIPAA violations discovered during the investigation of a 2014 data breach involving the electronic protected health information of 10.4 million individuals.

Mountlake Terrace, WA-based Premera Blue Cross is the largest health plan in the Pacific Northwest and serves more than 2 million individuals in Washington and Alaska. In May 2014, an advanced persistent threat group gained access to Premera’s computer system where they remained undetected for almost 9 months. The hackers targeted the health plan with a spear phishing email that installed malware. The malware gave the APT group access to ePHI such as names, addresses, dates of birth, email addresses, Social Security numbers, bank account information, and health plan clinical information.

The breach was discovered by Premera Blue Cross in January 2015 and OCR was notified about the breach in March 2015. OCR launched an investigation into the breach and discovered “systemic noncompliance” with the HIPAA Rules.

OCR determined that Premera Blue Cross had failed to:

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  • Conduct a comprehensive and accurate risk analysis to identify all risks to the confidentiality, integrity, and availability of ePHI.
  • Reduce risks and vulnerabilities to ePHI to a reasonable and appropriate level.
  • Implement sufficient hardware, software, and procedural mechanisms to record and analyze activity related to information systems containing ePHI, prior to March 8, 2015.
  • Prevent unauthorized access to the ePHI of 10,466,692 individuals.

Due to the nature of the HIPAA violations and scale of the breach, OCR determined a financial penalty was appropriate. Premera Blue Cross agreed to settle the HIPAA violation case with no admission of liability. In addition to the financial penalty, Premera Blue Cross has agreed to adopt a robust corrective action plan to address all areas of noncompliance discovered during the OCR investigation. Premera Blue Cross will also be closely monitored by OCR for two years to ensure compliance with the CAP.

“If large health insurance entities don’t invest the time and effort to identify their security vulnerabilities, be they technical or human, hackers surely will. This case vividly demonstrates the damage that results when hackers are allowed to roam undetected in a computer system for nearly nine months,” said Roger Severino, OCR Director.

“We are pleased to have reached an agreement with the federal Office for Civil Rights to resolve legal inquiries into the 2014 cyberattack on our data network,” said Premera Blue Cross in a statement. “The commitments we have agreed to are consistent with our ongoing focus on protecting personal customer information.”

Last year, Premera Blue Cross agreed to settle a $10 million HIPAA violation lawsuit over the breach. The health plan had been investigated by 30 state attorneys general who determined Premera Blue Cross had not met its obligations under HIPAA and Washington’s Consumer Protection Act. In 2019, Premera Blue Cross also agreed to settle a $74 million lawsuit filed on behalf of individuals whose ePHI was exposed in the breach.

The latest penalty is the second largest HIPAA penalty imposed on a covered entity or business associate by OCR to resolve HIPAA violations, behind the $16 million financial penalty imposed on Anthem Inc. over its 2015 data breach involving the ePHI of 79 million individuals.

The fine is the 11th HIPAA violation penalty to be announced by OCR in 2020 and the 8th to be announced this month. So far in 2020, OCR has been paid $10,786,500 to resolve HIPAA violations discovered during investigations of data breaches and HIPAA complaints.

Author: Steve Alder is the editor-in-chief of HIPAA Journal. Steve is responsible for editorial policy regarding the topics covered on HIPAA Journal. He is a specialist on healthcare industry legal and regulatory affairs, and has several years of experience writing about HIPAA and other related legal topics. Steve has developed a deep understanding of regulatory issues surrounding the use of information technology in the healthcare industry and has written hundreds of articles on HIPAA-related topics.