What Are Covered Entities Under HIPAA

October 4, 2024

Trying to wrap your head around healthcare privacy laws? You’re not alone. HIPAA—the Health Insurance Portability and Accountability Act—was created to protect sensitive patient information. But terms like “covered entity” can still sound a little abstract.

A covered entity is anyone directly responsible for safeguarding patient health data. It’s not limited to just major hospitals or national insurance providers, but also includes your local clinic, dentist and health insurance company

Did you know that more than 200 million Americans rely on covered entities every day to keep their health information secure. That’s why it’s so important to know exactly who falls under this label—and what responsibilities they carry under HIPAA.

What Are Covered Entities as per HIPAA?

If you’ve been wondering, “What is a covered entity under HIPAA?”—you’re not alone. Let’s clear it up.

Covered entities are defined under HIPAA as the key players who are required to protect patient health information.

• Healthcare Providers
  Anyone who provides medical care and sends health information electronically—like doctors, hospitals, or clinics—falls under this category

• Health Plans
  Organizations that cover medical costs like health insurance companies, Medicare, Medicaid and Health Maintenance Organizations (HMOs) fall under this category.

• Healthcare Clearinghouses
  These entities act as middlemen, converting health data from one format to another. They process medical records between providers and health plans.

• Business Associates
  While not technically classified as covered entities, but they handle protected health information (PHI) for them—like billing or IT services—and must follow HIPAA rules under signed agreements.

What Are HIPAA Violations?

HIPAA, or the Health Insurance Portability and Accountability Act, was created to keep patient health information private and secure. But when an organization fails to follow those rules, it’s called a HIPAA violation—and the consequences can be serious.

Here are some examples of what that can look like in real situations:

• Unauthorized Access
  If someone accesses protected health information (PHI) without permission or a valid work-related reason, that’s a violation—even if no harm was done.

• Weak Data Security
  HIPAA expects covered entities to have adequate physical, technical, or administrative safeguards in place. If those protections are missing, weak, or outdated, it puts sensitive information at risk.

• Improper Disposal
  Discarding sensitive medical records without securely deleting them puts patient information at risk and breaks HIPAA rules.

• Sharing Without Consent
  Giving out patient information without the required consent is not just careless—it’s a direct violation of the law.

• Data Breaches
  Whether it’s caused by a hacker or an accidental leak, any unauthorized access to protected health information is a major issue under HIPAA.

• Failure to Report
  If a breach happens and no one notifies the affected individuals or the Department of Health and Human Services (HHS), that’s another layer of non-compliance.

• Lack of Training
  If employees aren’t trained properly on how to handle protected health data, it increases the chances of mistakes—and those mistakes can be costly.

🔗 Read More: What is Considered Protected Health Information Under HIPAA?

What Happens When a Covered Entity Violates HIPAA?

When a covered entity like a clinic, insurance provider, or clearinghouse violates HIPAA rules, the consequences can be significant. Depending on how serious the violation is, the fallout might include fines, investigations, and damage to patient trust.

Here’s what that can look like in practice:

• Financial Penalties
  The Office for Civil Rights (OCR) has the authority to issue fines. These can range from from $100 to $50,000 for each violation.

• Mandatory Changes
  If an organization is found to be non-compliant, they may be required to take corrective action. This could include updating policies, boosting security, or retraining staff.

• Government Oversight
  In many cases, the OCR will conduct a full investigation. They’ll review the organization’s processes and may keep them under closer watch going forward.

• Loss of Trust
  A privacy violation doesn’t just affect patients—it can harm an organization’s reputation. Once that trust is broken, it’s hard to earn back.

• Lawsuits from Patients
  Patients affected by the violation might choose to file lawsuits. In some cases, that can mean long legal battles and costly settlements.

• Criminal Charges
  In more serious cases—like those involving intentional misuse of health data—individuals can face criminal penalties, including jail time.

Why Is It Important for Covered Entities to Follow HIPAA?

For covered entities—like healthcare providers, insurers, and clearinghouses—HIPAA isn’t just a box to check. It’s a critical part of keeping patient data secure and maintaining trust.

Here’s why compliance really matters:

• Patients Trust You with Their Information
  When patients know their medical details are handled with care, they’re more likely to share honestly and get the care they need. That trust is the foundation of every good provider-patient relationship.

• Avoiding Legal Trouble
  Following HIPAA helps organizations steer clear of fines, investigations, and legal action. It’s a proactive way to protect both your patients and your business.

• Better Quality of Care
  Respecting privacy rules ensures that patient data is used the right way—only for treatment, billing, or operations. This supports better, more coordinated care.

• Fewer Security Risks
  HIPAA compliance encourages a security-first mindset. When systems and teams are trained properly, the risk of data breaches or mishandling drops significantly.

• Protecting Your Reputation
  Patients and partners want to work with organizations that take privacy seriously. Being known for strong compliance helps reinforce your credibility in the community.

• Opportunities for Growth
  Some funding programs or partnerships require HIPAA compliance. Following the rules opens doors to new opportunities—without the risk of getting penalized later.

One of the simplest ways to ensure your team is prepared? Regular HIPAA training paired with recognized HIPAA certification can keep your workforce informed and audit-ready.

🔗 Read More: Is Zoom HIPAA Compliant?

How to Understand HIPAA Compliance With Online HIPAA Courses

Learning how to stay HIPAA compliant doesn’t have to be complicated—or time-consuming. Online HIPAA training courses offer a convenient way to understand what’s required and how to apply it in your day-to-day work.

Here’s how these courses can help:

• Learn at Your Own Pace
  Online HIPAA courses let you study when it works best for you, while still covering all the essentials of HIPAA certification and HIPAA training.

• Covers Everything You Need to Know
  Most online courses walk you through key HIPAA rules, like the Privacy Rule, Security Rule, and Breach Notification Rule. It’s a full-picture view of compliance.

• Easy-to-Follow Format
  With videos, interactive lessons, and real-world examples, even complex topics feel easier to grasp.

• Focus on Real-Life Scenarios
  Many programs use case studies so you can see how HIPAA applies in everyday healthcare settings.

• Access to Experts
  Some courses offer direct access to instructors or support teams if you have questions along the way.

• Always Up to Date
  Since HIPAA regulations can change, online courses are regularly updated with the latest guidance.

• Get Certified
  Once you finish the course, you’ll receive a HIPAA certification—a valuable credential that proves your understanding and commitment to compliance.

Steps to Enroll in an Online HIPAA Course

Getting started with HIPAA training is simpler than you might think. Here’s a step-by-step guide to help you sign up for the right course:

1. Start with Research
   Look for trusted providers that offer HIPAA training online. Check reviews, credibility, and whether the course provides recognized certification.

1. Review the Course Content
   Make sure the syllabus includes key areas like the Privacy Rule, Security Rule, and Breach Notification Rule. Some courses are better suited for beginners, while others go deeper for advanced learners.

1. Check Accreditation

Pick a course that’s recognized by relevant healthcare or professional organizations. This adds weight to your certification.

1. Choose a Format That Works for You

Decide if you prefer a self-paced course or one led by an instructor. Also, check how long the course takes and make sure it fits your schedule.

1. Sign Up and Create an Account

Once you’ve chosen your course, go to the provider’s website, register with your details, and set up a password. You’ll usually get a confirmation email right after.

1. Enroll and Make the Payment

Select the course and complete the payment process. Take note of any deadlines or login instructions.

1. Access Course Materials

After enrolling, log in and start exploring the lessons, videos, or study tools provided.

1. Complete the Course

Work through all the modules, complete any quizzes or assignments, and stay engaged—take notes, and ask questions if support is available.

1. Download Your Certification

Once you finish, download or request your certificate. It’s proof of your HIPAA training and can be used for job applications, audits, or internal compliance tracking.

Conclusion

Understanding who qualifies as a covered entity under HIPAA is more than just knowing the terminology—it’s about recognizing who’s responsible for protecting patient privacy across the healthcare system.

Whether you’re a provider, a health plan, or work with health data in any capacity, staying HIPAA compliant is essential. The responsibility to safeguard sensitive health information doesn’t just sit with IT teams or administrators—it belongs to everyone who handles patient data.

With growing digital threats and more electronic health records in play, HIPAA compliance isn’t just smart—it’s necessary. And the good news? With the right training and tools, it’s also achievable.