Who should HIPAA complaints be directed to within the covered entity?

by | May 4, 2023 | HIPAA News and Advice

HIPAA complaints within a covered entity should typically be directed to the entity’s designated Privacy Officer or Compliance Officer, as they are responsible for overseeing and addressing HIPAA-related concerns and ensuring compliance with HIPAA regulations. Compliance with HIPAA regulations is important for healthcare entities, as well as their business associates who handle patient data. When it comes to addressing complaints related to HIPAA violations within a covered entity, there must be a well-defined process and designated responsible individuals to handle such matters.

Dealing with HIPAA ComplaintsExplanation
Privacy OfficerOversees privacy practices within the organization.
Addresses complaints related to privacy violations.
Coordinates investigations and corrective actions.
Compliance OfficerManages overall HIPAA compliance, including HIPAA Privacy and Security Rules.
Conducts audits and assessments.
Responds to HIPAA-related complaints and incidents
Collaborates with the IT and security teams for ePHI security.
Channels for Complaint SubmissionCovered entities should establish clear submission channels, such as email or hotline.
Complaints can be submitted by employees, patients, or external parties.
Investigation and DocumentationPrivacy Officer and Compliance Officer work together to investigate complaints
Detailed documentation of the complaint process is required for compliance and future audits.
Escalation to HHS OCRIndividuals dissatisfied with the covered entity’s response can escalate to the U.S. Department of Health and Human Services (HHS) through the Office for Civil Rights (OCR).
Table: Who’s Responsible for HIPAA Complaints and What Should Be Done?

Covered entities, under HIPAA, include various healthcare entities, including healthcare providers (such as hospitals, clinics, and physicians’ offices), health plans (insurance companies), and healthcare clearinghouses. These entities are legally bound to protect the privacy and security of patients’ health information. HIPAA defines specific requirements regarding the handling of protected health information (PHI), including its storage, transmission, and disclosure. Violations of HIPAA regulations can lead to severe consequences, including financial penalties and damage to an organization’s reputation.

To effectively address and manage HIPAA complaints within a covered entity, the company must designate responsible individuals and establish clear processes. The individuals involved in handling HIPAA complaints within a covered entity typically include the Privacy Officer and the Compliance Officer. The Privacy Officer plays an important role in ensuring that an organization complies with HIPAA’s Privacy Rule. This rule governs the use and disclosure of PHI. The Privacy Officer is responsible for overseeing the entity’s privacy practices and addressing any complaints or concerns related to privacy violations.

The Privacy Officer develops and implements policies and procedures related to privacy practices in compliance with HIPAA. He conducts training and awareness programs for employees regarding HIPAA privacy rules. He receives and documents complaints related to privacy violations. He investigates reported privacy breaches and takes corrective actions. He is responsible for collaborating with other departments to ensure the secure handling of PHI. He maintains records of privacy-related activities and incidents. The Privacy Officer serves as the point of contact for individuals within the organization and external parties, such as patients or their representatives, who have concerns about the misuse or mishandling of their PHI. Individuals can submit their complaints directly to the Privacy Officer, who is responsible for initiating an investigation and coordinating with relevant departments to address the issue promptly.

The Compliance Officer oversees the overall compliance efforts of the covered entity with respect to all aspects of HIPAA, including both the HIPAA Privacy Rule and the Security Rule. The Compliance Officer ensures that the organization adheres to the administrative, technical, and physical safeguards required by HIPAA to protect PHI. The responsibilities of the Compliance Officer include developing and implementing a HIPAA compliance program; conducting regular assessments and audits to identify and correct potential compliance gaps; educating employees on the importance of HIPAA compliance and their role in it; managing and responding to HIPAA-related complaints and incidents; collaborating with IT and security teams to ensure the security of electronic PHI (ePHI); and preparing for and participating in external HIPAA audits conducted by the Office for Civil Rights (OCR).

The Compliance Officer works closely with the Privacy Officer to investigate and address HIPAA complaints. Their role includes assessing whether the complaint involves a breach of security that could compromise the confidentiality, integrity, or availability of PHI. If a breach is confirmed, the Compliance Officer is responsible for initiating the breach notification process, as required by the HIPAA Breach Notification Rule.

Covered entities need to have a well-documented and transparent process for handling HIPAA complaints. This process should include steps on the receipt of a complaint, initial assessment, investigation, corrective action, documentation, communication, and prevention. When a complaint is received, whether from an employee, patient, or external party, it should be documented promptly. Complaints can be submitted through various channels, such as a dedicated email address, a hotline, or in person. The Privacy Officer and/or Compliance Officer should conduct an initial assessment of the complaint to determine its validity and severity. Some complaints may be straightforward, while others may require a more in-depth investigation.

If the complaint appears credible and involves a potential HIPAA violation, an investigation should be initiated. This investigation may involve interviews with relevant individuals, reviewing policies and procedures, and examining relevant documentation. Based on the findings of the investigation, appropriate corrective actions should be taken. These actions may include retraining employees, revising policies and procedures, or implementing additional security measures to prevent future violations.

Throughout the process, detailed records should be maintained. This documentation is important for demonstrating compliance with HIPAA regulations and may be required in case of an external audit or investigation by the OCR. The Privacy Officer or Compliance Officer should communicate the outcomes of the investigation and any corrective actions taken to the individual who filed the complaint, as well as to relevant parties within the organization. Then, steps should be taken to prevent similar complaints and violations in the future. This may involve ongoing education and HIPAA training for employees, regular compliance assessments, and continuous improvement of privacy and security measures.

HIPAA regulations also provide a mechanism for individuals to file complaints directly with the U.S. Department of Health and Human Services (HHS) through the Office for Civil Rights (OCR). If a patient or individual is dissatisfied with the covered entity’s response to their complaint or believes their concerns have not been adequately addressed, they have the option to escalate the matter to the OCR for further investigation.


Addressing HIPAA complaints within a covered entity is a process that involves designated individuals, including the Privacy Officer and Compliance Officer. These individuals are responsible for overseeing privacy and security compliance, investigating complaints, and taking corrective actions when necessary. Having a well-defined process and clear communication channels is necessary for ensuring that HIPAA violations are promptly addressed, safeguarding the confidentiality and integrity of patients’ health information. Organizations must prioritize HIPAA compliance to avoid potential legal and reputational consequences.

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