What is a covered entity in the context of HIPAA?

In the context of HIPAA (Health Insurance Portability and Accountability Act), a covered entity refers specifically to certain organizations and individuals that handle protected health information (PHI). This includes healthcare providers who conduct certain transactions electronically, health plans that provide or pay for health care, and healthcare clearinghouses that process health information.

The importance of identifying covered entities lies in the fact that these groups are subject to HIPAA regulations, which are designed to protect patient information and ensure privacy. Covered entities have specific responsibilities for safeguarding PHI, including ensuring data security, obtaining patient consent for information sharing, and providing patients access to their health records.

In contrast, individuals working in healthcare without directly handling PHI, only large health systems that meet specific criteria, and patients themselves are not categorized as covered entities under HIPAA. This distinction is critical for understanding who must comply with the regulations and the implications for privacy and information security in healthcare.