Blog Post

The HIPAA Breach Notification Rule: What Dental Practices Must Do When Patient Information Is Compromised

Jordan Uditsky • August 7, 2024

Every dental practice is sitting on a fortune. The patient information they electronically collect, maintain, store, and use is a potential gold mine for hackers, cybercriminals, and other technological bad actors who can sell and leverage that data for their own gain or nefarious ends. For these reasons, dentists and all other healthcare providers, facilities, and the vendors they work with are ripe and continuous targets for cyberattacks and data breaches.

 

Such occurrences can quickly metastasize into a legal, financial, and reputational nightmare for dental practice owners. And dental practices and dental service organizations are waking up to these nightmares with increasing frequency. According to the Ponemon Institute, dental practices experienced a 45% increase in data breaches in the last two years, with the average cost of a healthcare data breach reaching $9.23 million.

 

As we discussed in this earlier post, the HIPAA Security Rule imposes detailed and technical compliance obligations on dental practices regarding the protection of patients’ electronic personal health information (ePHI). But when a breach does occur, practice owners must take quick, decisive actions on several fronts to triage the situation and remediate the damage. This includes making required disclosures and providing notice of the breach as set forth in the HIPAA Breach Notification Rule.

 

The Breach Notification Rule mandates that covered entities, including dental practices, notify affected individuals, the Secretary of the Department of Health and Human Services (HHS), and, in certain cases, the media of a breach of unsecured PHI.

 

What Constitutes a Breach?

 

For purposes of the Breach Notification Rule, a breach is defined as the acquisition, access, use, or disclosure of PHI in a manner not permitted under HIPAA, which compromises the security or privacy of the PHI. This does not include unintentional access by a workforce member, inadvertent disclosure by a person authorized to access PHI, or when the unauthorized person to whom the disclosure is made would not reasonably have been able to retain the information.

 

PHI is considered unsecured if it is not rendered unusable, unreadable, or indecipherable to unauthorized individuals through the use of encryption or destruction. Breaches of secured PHI (i.e., encrypted data) do not require notification as set forth below.

 

Risk Assessment and Notification Requirements After Breach Discovered

 

Once a practice becomes aware of a potential data breach, it must conduct a risk assessment to determine if there is a low probability that the PHI has been compromised. Factors to consider in such an assessment include the nature and extent of the PHI involved, the unauthorized person who used or received the PHI, whether the PHI was actually acquired or viewed, and the extent to which the risk has been mitigated.

 

Within 60 days after the discovery of a breach, a dental practice must provide notice to any affected patients that includes:


  • A description of the breach
  • The types of information involved
  • The steps individuals should take to protect themselves
  • What the practice is doing to investigate and mitigate the breach, and
  • Contact information for further inquiries.

 

Notice to HHS

 

For breaches affecting more than 500 residents of a state or jurisdiction, practices must notify HHS as well as local media outlets of the breach. Specifically, the practice must notify HHS at the same time it provides notice to affected individuals. That notice must be given “without unreasonable delay” and in no case later than 60 calendar days after the discovery of a breach of security. For breaches involving fewer than 500 people, covered entities must notify HHS annually and no later than 60 calendar days following the end of the year.

 

What Dentists Need To Do To Comply With The Breach Notification Rule

 

While the Notification Rule’s obligations don’t kick in until after a breach, dental practices should take several steps before a breach happens to ensure compliance and minimize the damage and fallout:


  • Develop and Implement Policies and Procedures: Dentists should establish written policies and procedures for managing PHI and addressing potential breaches. These should include processes for identifying, investigating, and responding to breaches, conducting risk assessments, and notifying affected individuals and the appropriate authorities.
  • Regular Staff Training: All staff members should be trained on HIPAA regulations, including the Breach Notification Rule, and the office's specific policies and procedures for handling PHI. Regular training ensures that staff members are aware of their responsibilities and can recognize and report potential breaches.
  • Implement Security Measures: As noted, dentists should implement administrative, physical, and technical safeguards to protect PHI as set forth in the HIPAA Security Rule. This includes using encryption for electronic PHI, securing physical records, controlling access to information, and using secure communication channels.
  • Establish a Breach Response Team: Having a designated team responsible for managing breaches ensures a coordinated and effective response. This team should include individuals from different areas of the practice, such as IT, legal, and compliance.
  • Maintain an Incident Response Plan: An incident response plan outlines the steps to take when a breach is suspected or detected. It should include procedures for containment, investigation, risk assessment, notification, and mitigation.

 

Compliance with the Breach Notification Rule is just one of many actions dental practices must take in the unfortunate event of a data breach. In our next post, we will discuss several other aspects of data breach response and mediation, all of which are crucial to protecting practices and patients alike.

 

HIPAA Breach Notification Questions? Call Grogan, Hesse & Uditsky Today

 

At Grogan, Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and we welcome the opportunity to work with you.

 

If you have questions or concerns about your practice’s compliance with the HIPAA Breach Notification Rule, please call us at (630) 833-5533 or contact us online to arrange for your free initial consultation.

 

Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices, and this blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.

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Many dentists and dental practices offer financing arrangements as a way to help patients, especially the uninsured, pay for their care and treatment. For those who utilize third-party vendors for such financing, recently enacted amendments to the Illinois Dental Practice Act impose new disclosure and transparency obligations on dentists and practices and place limits on what staff can do and say in their interactions with patients regarding the subject. The amendments became effective January 1, 2025. With other states enacting or considering similar legislation regarding external patient financing for health care providers, these changes serve as a reminder to dentists in every jurisdiction about the importance of staying up to date on changes in their state’s laws and regulations. Here is what you need to know and do about these changes in order to ensure compliance once the calendar turns to the new year. No Establishing, Promoting, or Assisting With Third Party Financing A dentist, employee of a dentist, or agent of a dentist may not “arrange for, broker, or establish financing extended by a third party for a patient.” That term encompasses and prohibits submitting an application to a third-party creditor, lender, or creditor's intermediary for approval or rejection on behalf of a patient. It also prohibits dental practices from providing patients with software, links, or QR codes that have been customized with the practice’s branding. Practices can, however, provide patients with a third party’s marketing and advertising materials so long as they are not customized to the practice. Beyond providing or displaying generalized third-party advertising materials, dentists and staff cannot do much more in terms of helping a patient apply for or obtain financing. Anyone associated with a practice cannot do any of the following: Complete any portion of an application for financing extended by a third party for a patient or patient's guardian. Provide the patient or patient's guardian with an electronic device to apply for financing extended by a third party. Promote, advertise, or provide marketing or application materials for financing extended by a third party to a patient who has been administered or is under the influence of general anesthesia, conscious sedation, moderate sedation, or nitrous oxide; is being administered treatment; or is in a treatment area, including, but not limited to, an exam room, surgical room, or other area when medical treatment is administered, unless an area separated from the treatment area does not exist. Mandatory Disclosure When discussing or providing applications for financing extended by a third party, a dentist, employee of a dentist, or agent of a dentist must provide the following written notice in at least 14-point font: DENTAL SERVICES THIRD-PARTY FINANCING DISCLOSURE This is an application for a CREDIT CARD, LINE OF CREDIT, OR LOAN to help you finance or pay for your dental treatment. This credit card, line of credit, or loan IS NOT A PAYMENT PLAN WITH THE DENTIST'S OFFICE. It is a credit card, line of credit, or loan from a third-party financing company. Your dentist does not work for this company. Your dentist may not complete or submit an application for third-party financing on your behalf. You do not have to apply for a credit card, line of credit, or loan. You may pay your dentist for treatment in another manner. Your dentist's office may offer its own payment plan. You are encouraged to explore any public or private insurance options that may cover your dental treatment. The lender or creditor may offer a "promotional period" to pay back the credit or loan without interest. After any promotional period ends, you may be charged interest on portions of the balance that have already been paid. If you miss a payment or do not pay on time, you may have to pay a penalty and a higher interest rate. If you do not pay the money that you owe the creditor or lender, then your missed payments can appear on your credit report and could hurt your credit score. You could also be sued by the creditor or lender. If your dentist's office has completed or submitted an application for third-party financing on your behalf, you may file a complaint by contacting the Illinois Department of Financial and Professional Regulation at https://idfpr.illinois.gov/admin/dpr/dprcomplaint.html or by calling (312) 814-6910." 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Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices. This blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
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There are many reasons why a dentist may want to sell their practice - retirement, relocation, a desire to step back from the responsibilities of ownership, or an offer too good to refuse. Whatever the motivation, one goal is always the same: maximizing the financial benefits of the transaction. Those benefits – today and far into the future - depend on many factors, but few have as much impact as how the Internal Revenue Service treats the gains you realize from the sale of your practice. How you structure the sale, the nature of the entity you’re selling, the specific assets involved in the sale, and any special considerations like earnouts or deferred payments will determine how much winds up in your pocket vs. how much you’ll be sending to Uncle Sam. Here are some fundamental tax considerations to understand if you are looking to sell your dental practice in 2025: What Type of Entity Are You Selling? As noted in the title of this post, how you structure the sale of your practice is as important as the nature and value of the practice you’re selling. However, the entity structure you chose when you formed your practice still has a significant impact on how you’ll be taxed when you walk away. If you organized your practice as a C corporation, all proceeds from the sale of the corporation’s assets will be taxed on the corporate level. This means these proceeds may be taxed twice: once at the corporate level and again when you distribute those monies to yourself. If, however, your practice is a regular partnership (such as a limited liability company or a limited liability partnership) or an S Corporation, you may pay tax on both ordinary and/or capital gains income on your personal income tax return, depending on the structure of the sale. Capital Gains v. Ordinary Income If you make a profit when you sell an asset, you make a capital gain. But not all such gains are subject to capital gains tax. Sometimes, the IRS taxes profits as ordinary income at the taxpayer’s individual rate. Since the current individual rate is around 37 percent, sellers would rather pay the currently lower capital gains rate (the maximum of which is 20%) to the extent possible. Notably, the capital gains tax only applies to profits on assets held for more than 12 months. Unless a dental practice goes from zero to 60 or acquisition to sale in less than a year, which is rarely the case, the sale will implicate the capital gains tax. Accordingly, structuring your deal to maximize the amounts taxed as capital gains vs. ordinary income is one of the most significant considerations in minimizing your tax liabilities. This depends, to a large degree, on how you allocate and treat the assets you are selling. Asset Allocation Most sales of dental practices are structured as asset sales, meaning the purchaser is acquiring specific assets of the practice rather than its stock. Dental practices are comprised of several different kinds of assets—equipment, supplies, real property, goodwill—and separate accounting and tax rules apply to each type of asset. Tangible Assets : These include equipment, furniture, office and medical supplies, and other physical assets. Typically, tangible assets are treated as depreciated property, so gains on the sale of these assets are usually subject to recapture rules, where depreciation deductions taken in prior years may be "recaptured" and taxed as ordinary income. Accounts Receivable : Any outstanding accounts receivable can be part of the sale. For cash-basis taxpayers (the most common for dental practices), accounts receivable are taxed as ordinary income since they represent payments for services already rendered but not yet received. Goodwill and Intangible Assets : The goodwill of your dental practice, which includes the value of your brand, client base, and reputation, is generally taxed at the capital gains rate. This is advantageous because the long-term capital gains rate is often lower than the ordinary income rate. Other intangible assets may also qualify for capital gains treatment, depending on how they are classified. If you have taken depreciation deductions on your practice’s equipment or real property, the IRS requires that depreciation be "recaptured" and taxed as ordinary income up to the amount of prior depreciation. While this applies to equipment and other depreciable assets, goodwill, and certain intangibles do not face depreciation recapture. Earnouts: Deferred Purchase Price Payment or Compensation? From the IRS’ perspective, how and when you receive payment for the sale of your practice will determine its tax treatment. If those payments come in the form of earnouts, the key issue is whether the IRS views each payment as a deferred purchase price payment or the payment of compensation. Earnout provisions are often included in practice sale agreements and provide for contingent additional payments from the buyer to the seller upon the practice meeting specified financial targets or other milestones in the future. Earnout payments are generally treated as part of a deferred purchase price so long as the seller is not performing services for the buyer and the practice after the consummation of the sale. The earnout payments may be treated as compensation income if the seller provides services for the buyer or target company after the acquisition or, in some cases, if the purchase agreement includes a non-competition provision. If the IRS treats earnout payments as deferred purchase price payments (for a non-corporate seller), they will be capital gains, which, as noted, are taxed at a much lower rate than ordinary income. However, if the IRS determines that the earnout constitutes compensation to the seller, the IRS will consider it ordinary income that can be subject to tax rates as high as 37 percent, along with employment taxes (such as Social Security and Medicare taxes). Accordingly, the sale agreement should specifically refer to earnout payments as part of the purchase price to support the treatment of such payments as capital gains rather than ordinary income. However, what you call the payments in the documentation is far from determinative, as the IRS will look beyond the language of the agreement to consider several substantive factors when deciding how earnout payments should be classified. This is where careful structuring and documentation can play an outcome-determinative role in how these substantial sums will be treated for tax purposes. You put a lot into your dental practice over the years. How much you take out and whether your sale will reap the benefits you anticipate depends on how well your professional team of attorneys, accounting professionals, and financial advisors do their jobs when crafting your transaction. That is one of many reasons why you should consult with an experienced dental practice sale and acquisition attorney to discuss and understand your options. We Focus on You So You Can Focus on Your Patients At Grogan Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Please call us at (630) 833-5533 or contact us online to arrange for your free initial consultation. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices. This blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
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