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OCR Video Emphasizes Ongoing Risk Management Under HIPAA Security Rule

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Summary

The Department of Health and Human Services' Office for Civil Rights released an educational video on risk management under the HIPAA Security Rule, emphasizing that risk management is mandatory, ongoing, and increasingly subject to enforcement scrutiny. OCR cited 2025 data showing approximately 76% of large reported HIPAA breaches resulted from hacking or IT incidents. The agency highlighted that entities identifying vulnerabilities but failing to implement corrective actions face exposure to findings of willful neglect and civil monetary penalties.

“OCR reiterated that risk analysis is only the starting point of the risk management process.”

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What changed

OCR released an educational video summarizing its enforcement approach to HIPAA Security Rule risk management requirements under 45 CFR § 164.306(a). The video emphasizes that regulated entities must implement, maintain, and document security measures that meaningfully reduce risks to electronic protected health information—not merely document identified risks and leave them unaddressed. OCR cited common deficiencies including entities that identified vulnerabilities but failed to act for years, and noted that such failures frequently support findings of willful neglect.

Healthcare covered entities and business associates should review their risk management programs against OCR's stated expectations: risk analysis must drive concrete security decisions, documented policies alone are insufficient evidence of compliance, and organizations that delay remediation of known risks face significant enforcement exposure including civil monetary penalties on a per-day, per-violation basis.

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Apr 21, 2026

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April 21, 2026

OCR Video Emphasizes Ongoing Risk Management Under the HIPAA Security Rule

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On April 8, 2026, the Department of Health and Human Services’ Office for Civil Rights (OCR) released an educational video, Risk Management Under the HIPAA Security Rule, detailing the risk management requirements under HIPAA as well as findings and conclusions from OCR’s investigations. While framed as an educational outreach video, it sends a clear enforcement message: risk management is mandatory, ongoing, and increasingly scrutinized by OCR. Drawing on recent investigations, OCR emphasized that risk management is not a one-time compliance exercise or paperwork obligation. Rather, regulated entities must implement, maintain, and document security measures that actually reduce risks to electronic protected health information (ePHI). When entities are aware of risks but do not act on them, they are left exposed, both to cyberattacks and enforcement actions. In this blog post, we provide an overview of the HIPAA Security Rule risk management requirements and highlight key takeaways from OCR’s video.

How Should Regulated Entities Address Security Risks?

Risk management is a required implementation specification under the HIPAA Security Rule. It requires covered entities and business associates to implement security measures sufficient to reduce risks and vulnerabilities to ePHI to a “reasonable and appropriate” level, as set forth under § 164.306(a). At a foundational level, risk management under the HIPAA Security Rule requires regulated entities to identify, prioritize, and address risks to the confidentiality, integrity, and availability of all ePHI the entities create, receive, maintain, or transmit, taking into account their size, complexity, technical infrastructure, and available resources. In practice, OCR described risk management as including:

  • Using the results of a risk analysis to inform decisions about administrative, physical, and technical safeguards;
  • Evaluating whether existing controls adequately address reasonably anticipated threats, including cyberattacks, system failures, and environmental hazards;
  • Selecting and implementing security measures, such as access controls, authentication mechanisms, audit logging, and encryption, that meaningfully reduce identified risks;
  • Ensuring the workforce complies with security policies and does not circumvent safeguards; and
  • Periodically reviewing and updating security measures as threats, technologies, and operations evolve. Importantly, OCR reiterated that risk analysis is only the starting point of the risk management process. The Security Rule requires follow-through: identified risks must drive real decisions, prioritization, and implementation of security controls—not merely be documented and left unaddressed. In a number of recent settlements, OCR has noted the failure of regulated entities to address identified risks.

Key Takeaways from OCR’s Risk Management Video

Risk Management Must Be Ongoing and Documented

OCR stressed that risk management is not a one-time exercise. Entities must periodically reassess risks, update controls, and modify security measures in response to evolving threats, new technologies, and organizational changes. OCR also emphasized that policies and procedures alone are insufficient evidence of compliance. In investigations, OCR looks for documentation demonstrating that security measures were actually implemented. Examples include:

  • Risk remediation plans and timeframes;
  • Meeting notes or internal communications showing progress;
  • Management approvals;
  • System screenshots and configuration settings; and
  • Audit logs and monitoring records. Risk Analysis Must Drive Security Decisions

OCR reiterated that risk analysis results must inform decisions and lead to concrete security controls. OCR cited frequent exploitation of remote access vulnerabilities, particularly where single factor authentication is used, as a recurring enforcement issue. OCR cited investigations in which compromised credentials enabled cyberattacks—risks that could have been substantially reduced through multifactor authentication. OCR also underscored that minimal controls are not enough. In one investigation, a four character password requirement was cited as an example of a control that failed to meet the Security Rule’s “reasonable and appropriate” standard and contributed to a breach.

“Reasonably Anticipated” Threats Are Well Established

OCR emphasized that risk management must address reasonably anticipated threats, chief among them being cyberattacks. In 2025, approximately 76% of large, reported HIPAA breaches resulted from hacking or information technology incidents, consistent with trends from prior years. OCR also noted that regulated entities should account for:

  • Natural disasters and facility specific risks based on geography and infrastructure;
  • Power outages, fires, floods, and other facility emergencies; and
  • Impermissible uses or disclosures stemming from weak access controls, misconfigured systems, or technologies such as online tracking tools. OCR Investigations Show Common Risk Management Deficiencies

OCR highlighted multiple investigations in which regulated entities:

  • Identified vulnerabilities but failed to implement corrective actions for years;
  • Experienced repeated exploitation of the same vulnerabilities; and/or
  • Took meaningful steps only after a breach occurred. OCR noted that such failures frequently support findings of willful neglect, particularly where entities knew of risks and failed to act within a reasonable timeframe. Willful neglect violations not corrected within 30 days can expose entities to significant civil monetary penalties, assessed on a per-day, per-violation basis.

Conclusion

OCR’s video reinforces a consistent and increasingly explicit enforcement theme: risk management requires action, not just awareness. Regulated entities that identify risks but delay, defer, or fail to act—especially over multiple years—face significant exposure as OCR’s enforcement focuses on risk management efforts. As OCR made clear, entities that fail to timely remediate known risks, or that rely solely on plans, policies, or minimal controls, risk being characterized not only as targets of breaches, but as organizations that left ePHI vulnerable in violation of the Security Rule.

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CFR references

45 CFR 164.306

Named provisions

Risk Management Security Management Process

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Classification

Agency
Mintz
Instrument
Notice
Branch
Executive
Legal weight
Non-binding
Stage
Final
Change scope
Minor

Who this affects

Applies to
Healthcare providers
Industry sector
6211 Healthcare Providers
Activity scope
HIPAA compliance Risk management Security documentation
Geographic scope
United States US

Taxonomy

Primary area
Healthcare
Operational domain
Compliance
Compliance frameworks
HIPAA
Topics
Data Privacy Cybersecurity

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