How HHS Publicizes HIPAA Penalties: A Guide to Protecting Your Practice’s Reputation (45 CFR § 160.426)

Executive Summary

Small healthcare practices are not immune to HIPAA enforcement actions and when violations occur, the consequences extend far beyond monetary penalties. The U.S. Department of Health and Human Services (HHS) publicly posts civil monetary penalties (CMPs) and resolution agreements under HIPAA, often accompanied by detailed press releases. Under 45 CFR § 160.426, HHS is authorized to use public announcements as a compliance tool. For small practices, this can mean significant reputational damage in addition to financial loss. This guide provides a detailed look at how HHS publicizes enforcement actions and outlines how small practice owners can proactively safeguard their reputations.

Introduction

Most small practices focus on HIPAA compliance to protect patient privacy and avoid fines. However, fewer recognize the reputational risks that arise when HHS makes those violations public. When a penalty is issued, it’s not just a matter of paying a fine. HHS may publish the practice's name, the nature of the violation, and the details of the enforcement action on its website and through press statements. Once online, these reports are indexed by search engines and often remain accessible indefinitely, potentially damaging a practice’s credibility with patients, partners, and payers.

This guide explores the framework of 45 CFR § 160.426, breaks down how and why HHS publicizes penalties, and offers clear, actionable steps for small practices to reduce their exposure to public shaming.

Understanding HHS Public Disclosure Authority (45 CFR § 160.426)

Under the HIPAA Enforcement Rule, specifically 45 CFR § 160.426, the Secretary of HHS is granted the authority to:

“Publicly disclose information about the imposition of a civil money penalty, resolution agreement, or other enforcement action... to promote compliance with the HIPAA rules.”

This provision reflects a broader policy objective: using public exposure as a deterrent. By publicizing penalties, HHS signals that non-compliance carries not only legal and financial consequences but also reputational harm.

What HHS Publicizes?

When HHS enforces a HIPAA penalty either through a settlement agreement or by imposing a civil monetary penalty it typically publishes the following information:

• The name of the covered entity or business associate
• The amount of the penalty or settlement
• A summary of the violation(s)
• Corrective actions required under the resolution agreement
• A formal press release
• Posting on the HHS Office for Civil Rights (OCR) “Enforcement Highlights” webpage

These public notices are intended to demonstrate transparency and promote accountability in the healthcare industry. However, for small practices, such publicity can have long-lasting consequences of the regulatory context. The notifications always include the specific reason the penalty was imposed, so agencies and the public understand what type of HIPAA violation occurred.

Who Gets Notified When a HIPAA Penalty Is Finalized?

When a HIPAA penalty becomes final, the Secretary of HHS is required not only to notify the public, but also to directly notify the following organizations or entities (along with the reason for the penalty):

• The appropriate State or local medical or professional organization
• The appropriate State agency or agencies administering or supervising State health care programs (as defined in 42 U.S.C. 1320a-7(h))
• The appropriate utilization and quality control peer review organization
• The appropriate State or local licensing agency or organization (including the agency specified in 42 U.S.C. 1395aa(a), 1396a(a)(33))

The method of notification, such as website postings, press releases, or direct communication, is left to the discretion of the Secretary, who chooses the most appropriate way to inform the public and relevant agencies.

How Public Enforcement Impacts Small Practices

• Loss of patient trust
• Damage to referral relationships
• Negative media coverage in local outlets
• Increased scrutiny from state medical boards or insurers
• Long-term harm to online reputation and search rankings

The OCR breach portal, also known as the “Wall of Shame,” receives regular traffic from journalists, competitors, and advocacy groups. Once your practice’s name appears there, controlling the narrative becomes significantly more difficult.

Why HHS Uses Public Disclosure

• Deterrence: Public penalties serve as cautionary tales to other covered entities.
• Accountability: Stakeholders (including patients) have a right to know when privacy rights are violated.
• Transparency: Demonstrating active enforcement builds confidence in federal privacy protections.
• Encouraging Voluntary Compliance: Entities are more likely to improve internal processes when they see others penalized.

Common Pitfalls That Lead to Publicized Penalties

• Failure to conduct a risk analysis: This is one of the most cited violations.
• Outdated or missing HIPAA policies: Especially regarding breach response or patient access.
• No business associate agreements (BAAs): Or using BAAs that lack required provisions.
• Ignoring patient access requests: Delays or denials can trigger complaints.
• Unreported breaches: Attempting to “fix quietly” without notifying HHS.
• Lack of workforce training: Staff mishandling PHI remains a frequent root cause.

A Case Study: When Ignoring an Access Request Led to Public Shame

In a real enforcement action from 2022, a small specialty practice failed to provide a patient with timely access to their complete medical record. Despite multiple patient requests and reminders, the clinic delayed fulfillment for over eight months. The patient eventually filed a complaint with OCR.

Following an investigation, OCR determined the practice had violated the HIPAA Right of Access provision. A $28,000 settlement was reached, accompanied by a resolution agreement requiring updated policies and staff training.

Most notably, HHS issued a national press release naming the practice and describing the violation in detail. Local news outlets picked up the story, and the practice saw a measurable dip in patient visits over the following quarter. While the monetary fine was modest, the reputational fallout was far more damaging, a cautionary example of how even a single misstep can become public knowledge.

Expert Tips for Avoiding Public Enforcement Exposure

• Conduct a Comprehensive Risk Analysis: Ensure it’s documented and updated annually.
• Keep Policies and Procedures Current: Review them at least once per year.
• Train All Staff on HIPAA Fundamentals: Include privacy, security, breach response, and patient rights.
• Respond Promptly to Access Requests: Always fulfill patient access within 30 days, or document valid delays.
• Vet and Maintain All BAAs: Confirm compliance and re-execute outdated agreements.
• Report Breaches Immediately: Don’t delay or underreport timely breach response mitigates risk.

Simplified Compliance Checklist

Regulatory References and Official Guidance

• HIPAA Enforcement Rule: 45 CFR Part 160, Subparts C–E
• Public Disclosure of Enforcement Actions: 45 CFR § 160.426
• HHS OCR Enforcement Highlights Portal
• HHS Resolution Agreements and Civil Monetary Penalties Archive

Concluding Recommendations and Next Steps

For small practices, HIPAA compliance is not just about avoiding fines, it’s about preserving trust. When penalties are publicized under 45 CFR § 160.426, the fallout can be more damaging than the financial cost. Fortunately, small entities can take control of their risk by proactively identifying gaps, training their teams, and ensuring their policies are both current and enforced.

Reputation is built on accountability and transparency. Rather than fearing public exposure, practices should aim to prevent it through a strong, ongoing commitment to compliance. And if a mistake does occur, the best strategy is immediate correction, full cooperation with HHS, and taking steps to rebuild patient trust.