Key Differences Between PCI DSS and HIPAA Compliance

Compliance standards are critical for protecting sensitive data and maintaining the integrity of systems across industries. Organizations in healthcare, finance, and other sectors must comply with various regulations, but two of the most well-known standards are the Payment Card Industry Data Security Standard (PCI DSS) and the Health Insurance Portability and Accountability Act (HIPAA). 

Both regulations aim to safeguard sensitive data, but they do so in different contexts and have distinct requirements. Understanding the role of PCI DSS and HIPAA in compliance is essential for organizations that handle payment card information and healthcare data.

This article provides a detailed comparison between PCI DSS and HIPAA, highlighting their key differences, similarities, penalties for non-compliance, and common misunderstandings. 

What is PCI DSS?

The Payment Card Industry Data Security Standard (PCI DSS) is a set of security standards designed to make sure that all organizations that handle credit card information maintain a secure environment. It provides guidelines for securing cardholder data, ensuring secure transactions, and preventing fraud. The PCI DSS is applicable to any entity that processes, stores, or transmits payment card data.

PCI DSS applies to any organization, regardless of size or type, that handles payment card information. This includes merchants, service providers, financial institutions, and any third party that interacts with payment card data. Essentially, any entity that stores, processes, or transmits credit card information must adhere to PCI DSS requirements.

Objectives of PCI DSS

The main objectives of PCI DSS are to:

• Protect Cardholder Data: The primary goal of PCI DSS is to protect sensitive payment card data from unauthorized access, ensuring that all information is securely stored and transmitted.
• Secure Systems and Networks: It focuses on securing the infrastructure that handles payment card data, reducing vulnerabilities within the network that hackers could exploit.
• Prevent Fraud and Breaches: By implementing stringent security measures, PCI DSS helps organizations reduce the likelihood of data breaches and prevent fraud, protecting both consumers and businesses.
• Maintain Secure Payment Networks: Organizations must verify that their payment systems and networks are continuously secure, minimizing the risks of cyberattacks and unauthorized access.

As a key component of the financial sector, insurance companies handle and store customer credit card information. Therefore, insurance providers must comply with PCI DSS standards to protect sensitive customer data and payment card information. 

Key Requirements of PCI DSS

Requirements of PCI DSS focus on securing networks, implementing strong access control measures, maintaining vulnerability management programs, and monitoring and testing networks. The key requirements include:

1. Firewall configuration: Install firewalls to protect cardholder data and prevent unauthorized access.
2. Change default passwords: Change vendor-supplied default passwords and security settings to enhance security.
3. Protect stored data: Encrypt or tokenize cardholder data to be certain it remains unreadable if accessed without authorization.
4. Encrypt data transmission: Check if cardholder data is encrypted during transmission over public networks to prevent interception.
5. Malware protection: Use up-to-date anti-malware software and conduct regular scans to protect against evolving threats.
6. Secure system development: Implement secure coding practices and regularly patch systems to address vulnerabilities.
7. Access control: Limit access to cardholder data on a need-to-know basis to minimize risks.
8. Authentication: Make sure users are uniquely identified and authenticated before accessing cardholder data.
9. Physical security: Restrict physical access to systems storing cardholder data, allowing only authorized personnel.
10. Access monitoring: Track and monitor all access to systems that handle cardholder data to detect suspicious activity.
11. Regular security testing: Conduct regular vulnerability scans and penetration tests to demonstrate that security measures are effective.
12. Security policy: Develop and maintain a comprehensive security policy to guide employees in protecting cardholder data.

With its stringent requirements, PCI DSS assures the protection of cardholder data and strengthens network security. This leads us to explore the specifics of HIPAA, another essential regulation that focuses on safeguarding sensitive data, but in the healthcare sector.

What is HIPAA Compliance? 

The Health Insurance Portability and Accountability Act (HIPAA) is a U.S. law that provides standards for protecting sensitive patient health information. HIPAA assures the confidentiality, integrity, and availability of healthcare data, covering both electronic and paper records. It is applicable to healthcare providers, insurers, and business associates who handle protected health information. HIPAA applies to healthcare organizations, including hospitals, doctors’ offices, health insurance providers, and business associates such as IT vendors who handle healthcare data. It is designed to protect the privacy of individual health information and sets guidelines for how healthcare organizations must secure and manage this data.

Read: What is Protected Health Information (PHI)?

Objectives of HIPAA

The main objectives of HIPAA are to:

• Protect PHI: HIPAA makes certain that patients’ protected health information (PHI) remains confidential and secure. It establishes strict safeguards to prevent unauthorized access to sensitive health data.
• Facilitate Data Exchange: HIPAA encourages the secure exchange of health information between providers and insurers, improving healthcare delivery. The confidentiality of this data is preserved through encryption and strict access controls.
• Combat Fraud: HIPAA aims to combat healthcare fraud by implementing stricter regulations and penalties for fraudulent activities, ensuring that healthcare resources are used properly and ethically.
• Improve Efficiency: HIPAA standardizes processes for handling health data, reducing administrative burdens. This leads to more effective healthcare delivery and cost savings for organizations.

Read: Free HIPAA Compliance Checklist 2025

HIPAA aims to verify that sensitive patient information is protected from unauthorized access and breaches, while also improving the healthcare industry’s agility through standardized data exchange.

Key Requirements of HIPAA

HIPAA compliance requires organizations to implement various safeguards to protect patient health information. The key requirements include:

1. Privacy Rule: The Privacy Rule establishes national standards for the safeguards of PHI (Protected Health Information). It sets limits on how and when PHI can be used or disclosed, ensuring that patient privacy is maintained.
2. Security Rule: The Security Rule mandates that healthcare organizations implement administrative, physical, and technical safeguards to protect electronic PHI (ePHI). This includes encryption, access controls, and secure storage practices to prevent unauthorized access or breaches.
3. Breach Notification Rule: This rule requires covered entities and their business associates to notify individuals and the Department of Health and Human Services (HHS) within 60 days of discovering a breach of unsecured PHI. Timely notification is critical to minimize damage and protect individuals’ privacy.
4. Business Associate Agreements (BAAs): HIPAA mandates that covered entities enter into agreements with third-party vendors (business associates) who handle PHI. These agreements assure that business associates follow the same privacy and security requirements as the covered entity.
5. Access Control and Authentication: Organizations must implement strong access control measures to verify that only authorized personnel can access PHI. Authentication methods, such as unique user IDs and passwords, are required to verify the identity of users accessing sensitive information.
6. Audit Controls: HIPAA requires healthcare organizations to implement mechanisms to record and examine access to PHI. This makes sure that any unauthorized access is detected, and any breaches can be traced and addressed promptly.
7. Transmission Security: This requirement affirms that ePHI transmitted over electronic networks is protected from unauthorized access. Security measures such as encryption must be employed to safeguard data during transmission, particularly over the internet.
8. Workforce Training: Covered entities must train their workforce members on HIPAA requirements and the proper handling of PHI. Regular training helps employees understand their roles in safeguarding sensitive health information and comply with HIPAA regulations.
9. Contingency Planning: Healthcare organizations must establish and implement contingency plans to check the availability and integrity of PHI during emergencies or disasters. This includes disaster recovery, data backup, and system restoration procedures to prevent data loss.
10. Data Minimization: HIPAA encourages the practice of data minimization, meaning that only the minimum necessary amount of PHI should be collected, accessed, or disclosed for any given purpose. This helps limit exposure to sensitive health information.
11. De-identification of Data: Under HIPAA, organizations may de-identify PHI for certain uses, such as research, where identifiable information is not required. De-identification removes any identifiable information that could link data back to an individual, ensuring privacy.
12. Patient Rights: HIPAA grants patients the right to access their health information, request corrections, and receive an accounting of disclosures. Healthcare organizations must comply with patient requests in a timely manner, allowing individuals to control their health data.

Read: Understanding HIPAA Compliance and Security Rules

Now that we’ve discussed HIPAA’s scope and objectives, it’s important to compare how PCI DSS and HIPAA differ, especially in terms of their focus areas and industries served.

Differences Between PCI DSS and HIPAA Compliance

While both PCI DSS and HIPAA aim to protect sensitive data, they focus on different types of information and industries. Understanding their distinct requirements is crucial for organizations to establish proper compliance. Here’s a table summarizing the key differences between PCI DSS and HIPAA compliance:

Aspect	PCI DSS	HIPAA
Focus	Payment card information protection	Healthcare data privacy and security
Scope	Applies to any organization that handles payment card data	Applies to healthcare organizations and their business associates
Applicable Data	Payment card data (credit/debit card information)	Protected Health Information (PHI)
Security Requirements	12 requirements focusing on payment card security	Administrative, physical, and technical safeguards for PHI
Compliance Audits	Regular external audits, often by QSA (Qualified Security Assessors)	Self-assessment and external audits by HHS (Health and Human Services)
Penalties	Fines and possible loss of ability to process card payments	Fines, civil and criminal penalties, and loss of business license
Regulatory Body	PCI Security Standards Council (PCI SSC)	U.S. Department of Health and Human Services (HHS)
Risk Management	Focuses on securing payment systems and transactions	Focuses on securing patient health records and ensuring privacy
Enforcement	Payment processors and banks enforce compliance	HHS enforces compliance via audits and investigations
Training	Focuses on cardholder data security for all employees	Training on the handling of patient data and confidentiality

Despite their differences, there are several key similarities between PCI DSS and HIPAA that organizations must be aware of in order to manage compliance effectively.

Similarities Between PCI DSS and HIPAA Compliance

While PCI DSS and HIPAA are designed to protect different types of sensitive data, they share several similarities:

1. Data Protection

Both standards aim to protect sensitive data—PCI DSS focuses on cardholder data, while HIPAA protects patient health information. The healthcare industry deals with sensitive healthcare data and financial transaction records; hence, it is prone to cyberattacks and data breaches. Compliance with PCI DSS in the healthcare industry demonstrates a commitment to safeguarding sensitive patient data, ensuring strong security throughout the entire system.

2. Access Control

Both PCI DSS and HIPAA require organizations to limit access to sensitive data based on the principle of least privilege. This guarantees that only authorized individuals can access the information necessary for their roles. By controlling access, organizations minimize the risk of unauthorized exposure and potential breaches of sensitive data.

3. Security Standards

Both PCI DSS and HIPAA mandate the use of encryption, strong passwords, and other security controls to protect data. Encryption makes sure that sensitive data, whether stored or transmitted, remains secure and unreadable to unauthorized users. Strong password policies and additional controls prevent unauthorized access, safeguarding both payment card information and healthcare data.

4. Risk Management

Both PCI DSS and HIPAA require regular risk assessments to identify and address vulnerabilities in the system. Organizations must continuously evaluate their systems to make sure they are secure and compliant with the respective standards. This proactive approach helps prevent data breaches and mitigates risks related to cybersecurity threats or human error.

5. Compliance Audits

Both standards require routine audits to assure compliance and identify areas for improvement. Regular audits help organizations assess their adherence to the standards and identify any gaps in their security posture. These audits are essential for maintaining continuous compliance and ensuring that any vulnerabilities are promptly addressed.

Read: Compliance Audits: A Guide to Ensuring Regulatory Adherence

While understanding these similarities, organizations should also be aware of the penalties for non-compliance, which can have severe financial and reputational consequences.

Penalties for Non-Compliance of PCI DSS and HIPAA

Non-compliance with PCI DSS and HIPAA can result in significant penalties:

PCI DSS

• Fines and Financial Penalties: Fines can range from $5,000 to $100,000 per month, depending on the severity of the breach, the size of the organization, and how quickly the breach is addressed. ​
• Loss of Payment Processing Privileges: In extreme cases, non-compliance may lead to the revocation of the ability to process payment card transactions, severely disrupting business operations. ​
• Reputational Damage: Beyond financial penalties, a PCI DSS breach can cause significant damage to an organization’s reputation, leading to loss of consumer trust and long-term financial harm. ​
• Remediation Costs: Organizations may incur additional costs to remediate security issues, conduct forensic investigations, and implement improved security measures.

HIPAA

• Civil Penalties: Violations can result in fines ranging from $100 to $50,000 per violation, with a maximum annual penalty of $1.5 million. ​
• Criminal Penalties: Intentional violations can lead to fines up to $250,000 and imprisonment for up to 10 years, depending on the nature and intent of the violation. ​Centraleyes
• Breach Notification Failures: Failure to report a breach within the required timeframe can result in additional penalties. ​
• Increased Scrutiny: Organizations may face heightened audits and investigations from the Department of Health and Human Services (HHS) following violations. ​

Organizations must take proactive steps to verify that they meet compliance standards to avoid these costly consequences. VComply’s ComplianceOps helps organizations manage regulatory compliance, audits, and reporting, reducing the risk of non-compliance.

Read: What is the Key to Successful HIPAA Compliance?

Given the seriousness of these penalties, it’s essential to also recognize the common misunderstandings that can arise when managing PCI DSS and HIPAA compliance together.

Common Misunderstandings of PCI DSS and HIPAA Compliance

A common misunderstanding is that PCI DSS and HIPAA are essentially the same, due to both focusing on protecting sensitive information. However, there are key misconceptions between these two standards:

1. Misunderstanding of Applicability

A common misunderstanding is that PCI DSS and HIPAA are essentially the same because both protect sensitive information. However, they apply to different industries: PCI DSS pertains to payment card data, while HIPAA focuses on healthcare data (PHI).

2. Assumption of Cross-Compliance

Some organizations mistakenly believe that compliance with one standard (PCI DSS or HIPAA) guarantees compliance with the other. Although both standards require encryption, the specifics of how encryption should be implemented differ between PCI DSS and HIPAA.

3. Confusion Over Data Types

Another misunderstanding is assuming that both standards protect the same kind of data. While PCI DSS focuses on cardholder data, HIPAA addresses protected health information (PHI), which is broader and includes both physical and electronic health records.

4. Overlooking Vendor Responsibility

Organizations may mistakenly believe that vendors who handle sensitive data are solely responsible for compliance. In reality, both PCI DSS and HIPAA require covered entities to certify that their third-party vendors meet the same compliance standards through Business Associate Agreements (BAAs) and service contracts.

To help organizations better navigate compliance, VComply offers solutions that simplify and accelerate the process, making it easier to manage both PCI DSS and HIPAA requirements.

How Can VComply Help with PCI DSS and HIPAA Compliance?

Ensuring compliance with both PCI DSS and HIPAA can be a complex and time-consuming process, especially for organizations handling both payment card and healthcare data. VComply offers powerful tools to simplify this compliance process:

1. Unified Compliance Management

Managing regulatory compliance across multiple standards can be complex and time-consuming. However, consolidating efforts into a single platform can simplify the process.

With VComply’s ComplianceOps, businesses can efficiently manage regulatory compliance, field audits, and reporting for both PCI DSS and HIPAA within one unified platform.

2. Automated Risk Assessment

Proactively identifying and addressing compliance risks is essential for safeguarding sensitive data. By utilizing VComply’s RiskOps, businesses can automate and assess risk programs, proactively addressing compliance issues and ensuring that security measures meet both PCI DSS and HIPAA standards.

3. Centralized Policy Management

Consistency in policy development and application across departments is crucial for maintaining compliance. A centralized system assures uniformity and easy tracking of policy effectiveness. Using VComply’s PolicyOps, organizations can centralize policy development, review, and attestation to confirm that policies are consistently applied across departments, meeting both PCI DSS and HIPAA requirements.

4. Effective Case Management

Efficient resolution of compliance-related issues requires systematic tracking and management. Having a streamlined approach helps ensure timely actions and resolutions. With the support of VComply’s CaseOps, organizations can report, triage, track, and resolve compliance-related issues, ensuring timely resolutions for both PCI DSS and HIPAA compliance concerns.

To automate your PCI DSS and HIPAA compliance efforts, Click here for a free demo of VComply today and explore how its integrated platform for managing policies, audits, risk assessments, and reporting can help.

Wrapping Up

In conclusion, understanding the role of PCI DSS and HIPAA in compliance is critical for organizations that handle sensitive data. While both standards share common goals of protecting data, they differ in scope, requirements, and enforcement. For businesses that need to comply with both PCI DSS and HIPAA, it’s essential to implement a comprehensive compliance management system.

By incorporating VComply’s tools, organizations can simplify compliance management, automate critical tasks, and improve overall productivity, ensuring they meet both PCI DSS and HIPAA requirements.

Start your free trial of VComply today to see how its features can support your compliance strategy and help your organization stay ahead of regulatory requirements.