2026 HIPAA Security Rule Update (medcurity.com)
69 points by mooreds 4 hours ago
btown 3 hours ago
It's worth noting that cybersecurity requirements can be a mechanism of control.
As a government regime, do you want to build an effective surveillance system where health data on large numbers of suspects can be pulled into a data fusion system at the push of a button, once a judicial framework for rubber-stamping is in place? And do you want to be able to pressure vendors into not supporting certain types of research/analysis and even direct patient care that could be construed/presented as counter to the regime's goals?
Both of these are easier when smaller vendors are forced out and larger vendors are the only ones left standing. As such, regulatory capture becomes a mutually beneficial tool to dominant vendors and regulators alike.
There are few coincidences when lobbying is involved. Which is not to say that cybersecurity improvements aren't a good thing! But speed and mechanisms of required rollout need to be balanced. And with the numerous signatories of [0] opposing the rule and describing "unreasonable implementation timelines," it's hard to say that this is entirely done in the interest of patients.
[0] https://assets.ctfassets.net/opszt4tga0mx/4QrJlGP2EkCiZjgvGx... (2025)
tptacek 4 hours ago
As is the case with SOC2, the "vulnerability scan" requirement here is likely to be meaningless; any automated process that can plausibly be described as instrumental in finding some kind of vulnerability is a "vulnerability scan", so all you have to do is run nmap.
john_strinlai 3 hours ago
they have comment/request for information sessions for HIPAA rule proposals, which your input would be valued.
tptacek an hour ago
I don't think the rule would be better with more detailed vulnerability scanning requirements! All these things inexorably become races to the bottom.
dgellow 4 hours ago
If it is like SOC2 I would expect respected auditors to reject that
morpheuskafka 3 hours ago
But there are no auditors required for HIPAA. Only the government (HHS OCR) itself can enforce the standards.
dgellow 3 hours ago
tptacek 3 hours ago
No? Like, wildly no? This is a big part of why you pay for the most respected auditors.
dgellow 3 hours ago
jasonlotito 2 hours ago
> so all you have to do is run nmap.
This is ignorance at best. No one who has ever actually had to do SOC2 compliance legitimately has just run nmap and been done with that.
tptacek an hour ago
john_strinlai 2 hours ago
>No one who has ever actually had to do SOC2 compliance
while i find tptacek's opinions very strong on the subject, you would be extremely mistaken to think those opinions were formed without experience
mooreds 3 hours ago
Here's the full proposed rule: https://www.federalregister.gov/documents/2025/01/06/2024-30...
Cider9986 43 minutes ago
As explained here[1], HIPPA makes our medical privacy worse, not better.
burnte 14 minutes ago
I've got this saved and I'll watch it and reply soon, but my kneejerk reaction is "this is someone who probably doesn't actually understand what they're talking about" simply because as someone who is in healthcare IT, I can assure you privacy is taken extremely seriously and I can guarantee medical privacy today is far better than it ever was before.
hoppyhoppy2 2 minutes ago
This is might be discriminatory, but I have trouble giving any credence to opinions about HIPAA from people who don't spell it correctly.
mapt 3 hours ago
I don't understand why there shouldn't be a strict-liability play here on top of penalties for knowing violations.
You lose all your customer's data to a darknet leak? We should be taking a huge chunk out of your balance sheet.
My insurer has disclosed names, social security numbers, and ENTIRE MEDICAL CASEFILES for their entire client base more than once at this point in overlapping data breaches. Why exactly don't they owe me $10k for my trouble, or N% shares of the company? If that's too much, why do these penalties exist for knowing disclosure, if incompetence is so tolerated that knowing disclosure does no damage?
erikerikson 2 hours ago
Penalties are $100-$50,000 per violation (i.e. per leak for each person), up to $1.5 million per year[0]. If in the US (I'm assuming given you mention your health insurance) you can report it to your state insurance commissioner which may have already occurred for your incidents.
[0] https://www.ama-assn.org/practice-management/hipaa/hipaa-vio...
panny 2 hours ago
There's also possible prison sentences. I just love it when someone wants to "get tough on X" when all the laws are already tough on X and just unenforced. That's how you end up with every American committing three felonies a day without knowing it.
erikerikson 2 hours ago
thewebguyd 2 hours ago
At some point we really should consider a similar system to points on a drivers license for repeat offenders like that. Once, maybe twice come with some serious fines and compensation to victims. 3 times or more? Why are they allowed to continue to be in that business? We can't let repeat offenders be allowed to continue to handle sensitive data.
bob1029 3 hours ago
The institutional moats grow ever wider.
PCI-DSS still takes the cake for most oppressive rules out of all the compliance frameworks. The notion that your system might become "in-scope" is one of the scariest things you have to deal with. Avoiding this designation is almost always easier than satisfying all the controls they prescribe. Stripe & friends have it really good. I don't know who their equivalents are in the health care industry but I am certain they exist.
burnte 9 minutes ago
> PCI-DSS still takes the cake for most oppressive rules out of all the compliance frameworks.
My personally most hated compliance ruleset. I've been in Healthcare for over a decade, I'm a HIPAA/data security expert, and PCI compliance is genuinely harder and more nonsensical than HIPAA.
And to be honest, for every ONE healthcare place I've seen that would fail a HIPAA audit, I've seen 20 companies that would fail PCI compliance and by a wider margin. The number one PCI issue I've seen *literally* everywhere is recording/writing down card numbers with CVV. It's strictly forbidden by the rules, and every snall and medium business breaks that rule constantly.
kstrauser 3 hours ago
I despise PCI-DSS. A friend owns a small business and has a credit card reader. Due to that, we had to build out a separate LAN so that the reader is on its own precious network, and have to pay an external auditor for a quarterly scan of our external IP. Bullshit past findings were things like “your VPN server supports old encryption algorithms”. “But our clients don’t support them. They select the newer algorithms!” “But they could!” “What do you care? Those clients aren’t even on the same LAN as the scanner.” “PCI-DSS lol!” I have no way of knowing, but I bet the firewall might’ve accidentally blocked the scanning IP from reaching the VPN server port on the retest and called it a day, but surely not.
Basically, Visa and friends externalized their own shitty security and made every other company in the land responsible for wrapping their janky hardware in electronic bubble wrap. A real security framework would’ve said “don’t make a credit card scanner so weak that it can’t survive being on the same LAN as a printer”. Instead, the whole country has to waste billions of dollars mitigating that risk for them.
akerl_ 2 hours ago
> Bullshit past findings were things like “your VPN server supports old encryption algorithms”. “But our clients don’t support them. They select the newer algorithms!”
Given that downgrade attacks are a massive category of attacks for network protocols, and in fact modern protocols go to great lengths to make them impossible, that doesn’t sound very bullshit at all.
kstrauser 2 hours ago
saltcured an hour ago
Of course they have to double down on yet another compliance regime. Why not converge on an existng NIST 800-53 baseline, or some HHS "tailored" variant? Or CMMC, if they want to push for more strict certification processes instead?
It's getting absurd with how many different compliance regimes a modern research university will have to follow simultaneously, if they do a broad set of defense, energy, basic sciences, and health research as well as having an attached medical school and teaching hospital.
bonsai_spool 3 hours ago
It's so grating to read obviously LLM-generated text, even more so from a company that is asking us to hire them for a security audit.
AI writing makes somewhat more sense on tech blogs. Where a business' value proposition is "We are knowledgeable and reliable about computer security", it seems unwise.
usernamed7 3 hours ago
I was thinking the same - makes the article feel very amateur and unprofessional. And I know for a fact that AI can do a better job at writing than this, I doubt they read it and had any sense of how poor the writing actually is.
dwa3592 3 hours ago
It really depends on who is testing and enforcing these standards. I have worked in this area, built scalable systems for medicare. The annual pen testing used to be a joke. Any consultant who would come had no clue what was being built, how the process worked - and they wouldn't even care to understand. After a meeting, we'd get the notification that the pen testing was successful. So, on paper you can change any rule - if the consultants you are hiring don't give a shit (which they usually don't)- nothing gets enforced. We would go out of our 'job responsibilities' to do internal testing of all sorts (the external agency would not even do 2% of that).
marsbars241 3 hours ago
Wait a second. If encryption is required for all ephi, that means faxes will finally die, right? Right??? Please!
saltcured an hour ago
Nah, in legal compliance minds, faxes are magical, remote, wet ink.
theptip 2 hours ago
My thought too. This would be huge if true.
Jeremy1026 40 minutes ago
Mandatory annual security assessments are going to be brutal for small businesses.
mjevans 3 hours ago
How kind of them to require 2FA without requiring the governments to issue real 2FA tokens for use in signing / interacting. No doubt this will require some rootkit 'authenticator' app on the consumer's purchased mobile device that they are then not allowed to truly own.
pphysch 3 hours ago
TOTP should be totally fine and can be used with very dumb hardware/software.
time0ut 3 hours ago
Interesting. I haven’t fully read through the rule change, but seems like HHS is directly adopting the controls required by HITRUST? I have been out of the industry for a while. Always interesting how the industry shapes regulation and vice versa.
jpitz 2 hours ago
I'm not sure how meaningful it is to adopt some of the controls from HITRUST without any of the consequences.
201984 3 hours ago
Is this why every healthcare website has 2FA now? It's so annoying.
burnte 7 minutes ago
Medical records are the most valuable records to steal. They contain financial info like SSN for card fraud, but also demographic info that makes it crazy valuable.
ck2 an hour ago
you can be certain the DOGE kids downloaded as much as they could grab from federal systems about everyone's medical history including the federal e-prescription system
rules for thee but not for me
caycep 2 hours ago
eh how are they going to make the usual small practice do "penetration testing"?