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HIPAA Violation Penalties: The Four Tiers and OCR Enforcement Context

Four civil penalty tiers under 45 CFR 160.404 with Jan 28, 2026 inflation-adjusted amounts — plus OCR 2019 enforcement discretion note.

Published: September 2026 Compliance · HIPAA 8–12 min read

HHS OCR enforces HIPAA civil monetary penalties under a four-tier culpability structure in 45 CFR 160.404. Amounts are periodically inflation-adjusted. This page uses the January 28, 2026 adjustment figures for assessments on/after that date (for violations after November 2, 2015).

Related: HIPAA hub · OCR prep · Breach notification.

Civil penalty tiers (Enforcement Rule / HITECH) — Four culpability tiers under 45 CFR 160.404. Figures below reflect the January 28, 2026 HHS inflation adjustment (assessments on/after that date for violations after November 2, 2015): Tier 1 (did not know) $145–$73,011; Tier 2 (reasonable cause) $1,461–$73,011; Tier 3 (willful neglect, corrected within 30 days) $14,602–$73,011; Tier 4 (willful neglect, not corrected within 30 days) $73,011–$2,190,294. The regulation’s calendar-year figure for identical violations is $2,190,294. OCR’s 2019 Notice of Enforcement Discretion may still apply lower annual caps by tier (inflation-adjusted from $25k / $100k / $250k / $1.5M) pending further rulemaking.

HITECH Act (2009) — Strengthened HIPAA with statutory breach-notification duties, higher civil monetary penalties, and direct business-associate liability (implemented via the 2013 Omnibus Rule), alongside EHR/incentive programme context.

Tier Summary (Jan 28, 2026 Adjustment)

Tier
Culpability
Per-violation range
Calendar-year figure (regulation)
1
Did not know
$145–$73,011
$2,190,294
2
Reasonable cause
$1,461–$73,011
$2,190,294
3
Willful neglect, corrected ≤30 days
$14,602–$73,011
$2,190,294
4
Willful neglect, not corrected ≤30 days
$73,011–$2,190,294
$2,190,294

OCR 2019 Notice of Enforcement Discretion

OCR’s 2019 Notice of Enforcement Discretion continues to apply lower annual caps by tier (inflation-adjusted from the $25k / $100k / $250k / $1.5M structure) pending further rulemaking. Buyers and counsel should read both the regulation’s calendar-year figures and OCR’s published discretion policy for any given enforcement year.

Public Settlements

OCR publishes resolution agreements and civil money penalties on hhs.gov. Cross-check amounts and facts against the agency notice for your case study — settlement headlines change as new matters close. See also cases summarised on the HIPAA hub.

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Frequently Asked Questions

What are the four HIPAA penalty tiers?

Did not know; reasonable cause; willful neglect corrected within 30 days; willful neglect not corrected within 30 days — see 45 CFR 160.404.

Which dollar amounts should we cite in 2026?

Use the January 28, 2026 HHS inflation adjustment for assessments on/after that date, and note OCR may still apply its 2019 annual-cap discretion policy.

Do business associates face the same CMPs?

Yes — after HITECH/Omnibus, BAs can be directly liable and subject to OCR enforcement.

HIPAA hub · Incident response · Certification · CSA

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