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HIPAA → vs PCI
HIPAA vs. PCI compliance: differences, similarities, and which you need
In today’s digital landscape, safeguarding sensitive information is paramount. Two critical compliance frameworks—HIPAA and PCI DSS—serve as benchmarks for protecting health and payment data, respectively. While both aim to secure sensitive information, they cater to different industries and have distinct requirements.
Let’s get into the nuances of each, to help you determine which standards apply to your organization.
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What is HIPAA?
The Health Insurance Portability and Accountability Act (HIPAA) is a U.S. federal law that sets standards for handling protected health information. It applies to covered entities such as hospitals, health plans, and healthcare clearinghouses, as well as their business associates.
HIPAA is implemented through five rules:
- Privacy Rule – Use/disclosure of PHI and patient rights
- Security Rule – Administrative, physical, and technical safeguards for ePHI
- Breach Notification Rule – Whom you must notify and by when after a breach
- Transactions Rule – Standardizes the electronic exchange of data
- Identifiers Rule – Protects unique identifiers
Noncompliance can result in significant civil and criminal penalties, as well as reputational damage.
What is PCI DSS?
The Payment Card Industry Data Security Standard (PCI DSS) is a global set of security requirements created by major credit card brands to protect payment cardholder data. It applies to any organization that stores, processes, or transmits payment card information, regardless of size or transaction volume.
PCI DSS compliance involves implementing strong access control measures, maintaining secure networks, encrypting sensitive data in storage and transmission, and undergoing regular security testing. Although it’s not a federal law, noncompliance can result in fines from card networks, increased transaction fees, and loss of merchant privileges.
HIPAA vs PCI: key differences
While both frameworks are designed to protect sensitive information, they differ in scope, focus, and regulatory authority.
Key differences include:
- Scope – HIPAA applies to healthcare PHI; PCI DSS applies to payment card data.
- Focus – HIPAA emphasizes privacy and patient rights; PCI DSS focuses on payment data security and fraud prevention.
- Specificity – HIPAA offers broad safeguard categories; PCI DSS prescribes highly detailed technical controls.
- Enforcement – HIPAA is enforced by the U.S. Department of Health and Human Services’ Office for Civil Rights (OCR); PCI DSS is enforced by the Payment Card Industry Security Standards Council (PCI SSC) through participating card brands.
- Penalties – HIPAA penalties are legally mandated and can be both civil and criminal; PCI DSS penalties are contractual, determined by card networks.
HIPAA and PCI similarities
Both HIPAA and PCI DSS share core security principles aimed at reducing the risk of breaches. They require organizations to protect sensitive data using encryption, access controls, and secure transmission methods.
Both frameworks also mandate ongoing risk assessments, employee training, and incident response plans to ensure continued compliance.
HIPAA and PCI DSS compliance together
Achieving both HIPAA and PCI DSS compliance creates a stronger, more unified security posture for healthcare organizations that handle both PHI and payment card data. It reduces the risk of overlapping audits, ensures consistent technical safeguards, and improves trust with patients and partners.
Use cases where both matter include:
- Hospitals with in-house billing
- Clinics offering online payment portals
- Telehealth providers that process copays via credit card while storing patient medical records.
For organizations operating in this dual space, integrating controls for both frameworks can streamline operations and reduce long-term compliance costs.
Real-world implications of non-compliance
Understanding the consequences of non-compliance underscores the importance of adhering to these standards.
HIPAA violation example
In 2015, Anthem Inc., a major health insurance provider, experienced a data breach affecting nearly 80 million individuals. The breach exposed names, birthdates, Social Security numbers, and other sensitive information. The company faced a $16 million settlement—the largest HIPAA penalty at that time.
PCI DSS violation example
In 2009, Heartland Payment Systems suffered a breach compromising over 100 million credit card records. The incident resulted in more than $140 million in fines and settlements, highlighting the severe financial repercussions of PCI DSS non-compliance.
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Next steps for compliance
Understanding the differences between HIPAA and PCI DSS is essential for any organization handling sensitive healthcare or payment data. While both frameworks aim to protect information, they apply to distinct industries and impose unique requirements.
Start by evaluating your current data handling practices to determine whether HIPAA, PCI DSS, or both apply to your operations—then take steps to close any compliance gaps.
Liquid Web can assist your business in achieving its HIPAA compliance. We maintain internal policy enforcement and documentation of our administration of your HIPAA audited servers with us.
You can choose from pre-configured solutions or a custom solution to suit your needs. We also offer PCI compliance scanning, and everything is backed by expert support.
Click through below to learn more or start a chat with one of our HIPAA-compliant hosting experts right now.
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Additional resources
What is HIPAA-compliant hosting? →
A complete beginner’s guide
Scaling a compliant cloud →
How to scale up without compromising security
HIPAA guide for small business →
A complete resources for medical SMBs
Beau Fandrick is an Internal Base Solutions Consultant with Liquid Web where he’s been helping clients find the right solution that will enable them to focus on what they’re good at since 2017. He obtained his Bachelors of Arts from Michigan State University in Psychology, and likes dad jokes.