PCI DSS Compliance in Healthcare

Published on : 05 Jul 2023

PCI DSS Compliance In Healthcare

Data security has become an essential aspect of our lives and is more crucial than ever before. In the healthcare industry, organizations are entrusted with a plethora of sensitive information, including PHI, PII, and financial data. This renders them accountable for complying with both HIPAA and PCI regulations. 

Adherence to these regulations is paramount for safeguarding sensitive patient information from data breaches and cyber attacks. With the proliferation of people paying hospital bills and health insurance using credit and debit cards, the risk of identity theft has also augmented exponentially! 

From March 2021 to March 2022, the average cost of a data breach in healthcare was over $10 million, up from $9.23 million between May 2020 and March 2021.

In this blog post, we’ll delve into the significance of PCI DSS compliance in healthcare and explore how it helps protect patient data and privacy.

What is data security in healthcare?

Understanding the significance of healthcare data begins with knowing what it entails. Personal health data, a compilation of information related to a patient such as their Names, Birthdates, Social Security Numbers, and other medical record data, is used to identify their medical history and records stored in a database. This information is crucial in providing accurate and personalized medical care to individuals.

To ensure the safety of this sensitive information, data security plays a pivotal role in safeguarding patient data from unauthorized access, illegal data breaches, or accidental deletion. The Health Insurance Portability and Accountability Act (HIPAA) has established stringent guidelines to ensure that patients’ data remains secure and protected. By adhering to these regulations, healthcare organizations can provide their patients with the assurance that their personal information is in safe hands.

The Importance of Data Security in Healthcare

As the healthcare industry rapidly embraces new technologies to enhance the delivery of healthcare services, the significance of data security continues to escalate. Electronic Health Records (EHRs), where confidential patient information is stored, have become an indispensable component of hospital information systems. 

Thus, protecting EHRs is crucial to avoid data breaches from hackers. These attacks can significantly impact not only the system but also the health of patients. Healthcare data security includes protecting medical, financial, and personal data.

1.Medical Data:

  • Medical information is stored securely in digital files, databases, fingerprint records, and DNA samples.
  • Patients can access online consultations with doctors.
  • Medical data may be transferred to healthcare authorities and government bodies when necessary.

2.Financial Data:

  • The healthcare sector securely records valuable financial data of patients, doctors, or medical institutions.
  • In case of a successful hacking attack, criminals can gain access to this data and steal finances.

3.Personal Data:

  • Personal information such as addresses, phone numbers, e-mails, passport data, social status, and unique identification numbers are available in a secure healthcare database.
  • Patients’ personal data is protected from potential misuse by blackmailers and stalkers.

However, with the proliferation of technology comes the mounting risk of information security breaches. 

On June 7, 2022, Texas Tech University Health Sciences Center reported a data breach due to a hacking incident that affected over 1.29 million people.

Well, there is some relief too. According to HIPAA, healthcare data breaches in the U.S. have decreased by 48% in 2023. 

You may be wondering, what is the role of PCI DSS in healthcare if an organization is already HIPAA compliant?

We have already created a webinar on “PCI DSS in the Healthcare Industry” to provide you with more information on this topic. However, we will also share our knowledge about it in this blog post. If you need more information, be sure to check out our fantastic webinar on the same topic.

Before we dive into the details, let’s have a brief overview of PCI DSS v4.0 and how it is positively shaping healthcare organizations. 

What is PCI DSS in the Healthcare Industry?

The Payment Card Industry Data Security Standard (PCI DSS) is a vital compliance scheme that aims to protect credit and debit card transactions against fraud and data theft. It was originally formed in 2004 by major card brands such as MasterCard, Visa, Discover Financial Services, American Express, and JCB International. 

These guidelines are now diligently maintained by the Payment Card Industry Security Standards Council (PCI SSC), which is responsible for ensuring that organizations comply with the guidelines to ensure secure card transactions and protect against data theft and fraud.

Keeping Sensitive Information Safe of the Healthcare Entities:

In the healthcare industry, it is crucial to keep sensitive information safe and secure, especially credit card data, which can be used to commit fraud and identity theft. As more transactions are being done electronically, it is becoming increasingly important to protect the data of patients and other healthcare entities. 

The healthcare entity includes any individual or organization involved in providing healthcare services, such as:

  • Physicians
  • Hospitals
  • Health maintenance organizations
  • Health insurance plans
  • Other types of healthcare facilities or plans.

That’s where PCI DSS comes in. PCI DSS is a robust cybersecurity standard that is endorsed by all the major credit card and payment processing companies. 

What is the Role of PCI DSS in Healthcare?

The PCI DSS v4.0 is the most up-to-date set of guidelines for protecting credit card data. 

By following the PCI DSS v4.0 guidelines on the official PCI DSS website. The healthcare organizations can help to ensure the security of their patients’ financial information and prevent data breaches. This is important for protecting patients’ privacy and preventing financial losses.

This widely accepted set of policies and procedures is designed to enhance the security of credit, debit, and cash card transactions, while also protecting cardholders from the misuse of their personal information.

It is essential for all businesses that accept credit and debit card payments to comply with the PCI DSS. As a result, patients can have peace of mind knowing that their data remains secure when they make transactions using their debit or credit cards.

NOTE: Hospitals and other healthcare organizations must comply with PCI DSS if they store, process or transmit cardholder data. This is because PCI DSS is a set of security standards designed to ensure that all organizations that handle cardholder data maintain a secure environment. 

Now, you may be wondering, “What happens if a healthcare organization does not use a PCI DSS compliant transaction portal?” If a healthcare organization does not use a PCI DSS compliant transaction portal, it can result in severe consequences. 

According to PCI SSC, non-compliance with PCI DSS can result in penalties ranging from $5,000 to $100,000 per month by the Credit Card Companies (Visa, MasterCard, Discover, AMEX). That’s a lot of money!

These penalties may vary from each payment brand and also significantly vary based on the severity of the breach, non-compliance history, and payment volumes of the merchant . 

Even if a hospital uses a payment gateway that is PCI DSS compliant, the hospital itself must still comply with PCI DSS standards to ensure the protection of sensitive patient information. Non-compliance can result in financial losses and damage to the organization’s reputation.

Healthcare organizations must take PCI DSS compliance seriously and meet all requirements.

Here are some key requirements for PCI DSS compliance in healthcare organizations in pointer format:

  • Establish and maintain secure network systems, including firewalls, to protect patient data from external threats.
  • Regularly test and assess network vulnerabilities to identify and address any weaknesses.
  • Protect cardholder data by implementing strong access control measures.
  • Monitor and track all access to network resources and cardholder data.
  • Maintain an information security policy and regularly train staff on security awareness.


By adhering to PCI DSS standards, healthcare organizations can secure their patients’ financial information and prevent data breaches. The PCI SSC plays a vital role in safeguarding sensitive financial information in the healthcare industry.

Visit our blog and website at VISTA InfoSec to learn more about PCI DSS requirements and the consequences of non-compliance. We have published a comprehensive article on the topic.

In addition to PCI DSS, understanding HIPAA compliance is also important. Let’s examine the key differences and similarities between these two sets of security standards.



What is HIPAA?

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a comprehensive data protection regulation that safeguards personal health information (PHI), including medical records, and personally identifiable information (PII), such as names and addresses.

HIPAA plays a crucial role in modernizing the flow of healthcare information by specifying stringent requirements to protect the privacy of patients, referred to by the law as covered entities. It encompasses a wide range of data types, including:

  • Social security numbers
  • Driver’s licenses
  • Names
  • Fingerprints
  • Photographs

HIPAA’s scope extends beyond healthcare institutions to include business associates, which are defined as any entity, such as software vendors, that handles PHI belonging to covered entities.

Differences between HIPAA and PCI DSS:

  • HIPAA covers a wider range of issues related to patient safety, privacy rights, quality assurance, fraud, waste, and abuse compared to PCI DSS, which has limited security requirements. 
  • In terms of structure, HIPAA is broader and less detailed than PCI DSS, leaving most implementation details up to the provider’s discretion. 
  • All entities subject to HIPAA regulations, including business partners, must comply with the law. 
  • Companies processing payment card transactions are required to comply with PCI DSS. 
  • HIPAA’s omnibus rule, under the HITECH Act, includes the concept of meaningful use, which helps address the worst threats to ePHI such as loss, theft, and unauthorized access. PCI DSS does not mention meaningful usage. 
  • Health records are highly valued on the black market, with their value being 10 to 20 times greater than that of US credit card numbers, including the three-digit CVV code.

Similarities between HIPAA and PCI DSS:

  • Risk analysis, remediation processes, and regular vulnerability scans are common requirements for both PCI DSS and HIPAA security compliance.
  • Non-compliance with either regulation can lead to substantial fines, penalties, and a higher risk of experiencing a data breach.
  • Some system components handle both account and protected health information (PHI) data.
  • Antivirus software, active directories, and log monitors are infrastructure components mandated by both HIPAA and PCI DSS.
  • While HIPAA and PCI DSS are essential in their respective sectors, they are not interchangeable regulations.
  • Both HIPAA and PCI DSS have the common goal of safeguarding sensitive data.

Now, let’s move forward and examine how PCI DSS compliance can protect patient data.

How does PCI DSS compliance protect patient data in the healthcare industry?

You know, the question you asked is pretty complex and important. So, to give you a really thorough and detailed answer, we’ve broken it down into a few subcategories and related questions. By looking at these subtopics, we can get a better understanding of how PCI DSS compliance can help protect sensitive patient information.

1.Understanding PCI DSS Compliance Levels:

Did you know that there are actually different levels of PCI DSS compliance, depending on how many credit card transactions you process? Most merchants are in Levels 1-3 and can show they’re compliant just by filling out a Self-Assessment Questionnaire (SAQ). If you process at least 1 million, 2.5 million, or 6 million transactions per year (depending on which credit card brands you accept), you’ll be in Level 1.

And if you’re a service provider who stores, processes, or transmits more than 300,000 credit card transactions each year, you’re also in Level 1. This is a great chance to show how committed you are to protecting patient data by becoming PCI DSS compliant!

So, what do you need to do to become PCI DSS compliant in the healthcare industry? Let’s find out together!

2.Overcoming Challenges in Achieving PCI DSS Compliance in Healthcare:

  • Keep your payment card documentation updated: Make sure you keep your payment card documentation up to date. This means regularly updating your records of payment card processes and credit card environments. That way, you can keep track of everything and reduce the risk of security breaches. Plus, it helps make sure all the necessary controls are in place.


  • Implement network segmentation for PCI compliance: One important step for PCI compliance is to set up proper network segmentation. This helps keep sensitive data safe by separating it from other parts of your network. If you don’t have good segmentation, it can be hard to apply PCI controls effectively, which could leave you open to attacks.


  • Monitor access to payment card systems: Keep an eye on who’s accessing your payment card systems and data. By tracking and monitoring access, you can make sure everything stays secure and spot any unauthorized attempts to get at sensitive information. It’s like an early warning system that lets you take action fast to protect your organization.


  • Utilize effective security event monitoring in healthcare: With healthcare organizations often spread out across multiple locations and systems, it’s super important to have good security event monitoring in place. This helps you spot potential security threats or breaches as they happen, so you can respond quickly and limit any damage. Keeping patient data safe is a top priority, and continuous monitoring is a key part of that.


  • Update legacy systems for PCI compliance: Don’t forget to update any old systems or applications to meet new security standards. As technology keeps advancing, security standards do too. If you’re using legacy systems that don’t have the right security capabilities, they could be vulnerable to attacks. Keeping everything up to date helps make sure your payment card data stays safe.


  • Navigate multiple regulatory standards: Healthcare organizations have the added challenge of having to comply with multiple regulatory standards, like both PCI and HIPAA. It takes careful attention to make sure you’re meeting all the requirements. But by doing so, you can protect sensitive data, stay compliant, and keep the trust of your patients and customers.

3.Key Steps to Achieve PCI DSS Compliance in the Healthcare Industry:

  • Develop Policies and Procedures: Did you know that achieving PCI DSS compliance requires developing approximately 50 documents? It can be a time-consuming process, but don’t worry – experts like VISTA InfoSec offer industry-leading PCI policies and procedures to help you achieve compliance quickly. (Requirement 12)


  • Implement PCI Requirements: It’s important to ensure that security measures such as awareness training, annual risk assessments, user security, and incident response are in place and operating as intended. A PCI QSA audit can provide assurance that you’re on the right track.


  • Continuously Monitor: Don’t let your guard down – it’s essential to continuously assess and enhance internal controls related to policies, procedures, and processes to ensure the continued safety of organizational assets.


  • Conduct Scanning and Penetration Testing: Stay one step ahead of hackers by performing vulnerability scanning of internal and external networks and penetration testing by ethical hackers to identify and address security gaps. (Requirement 11)


  • Educate Employees on Security Best Practices: It’s essential to educate all employees who handle sensitive data on how to safeguard it. This includes training on subjects such as password management, phishing awareness, and incident reporting. By providing regular training, you can help ensure that your employees stay informed about the latest threats and know how to respond appropriately. Don’t leave the security of your data to chance – invest in employee education. (Requirement 12.6)


In conclusion, we hope that this blog has provided valuable insights into the importance of PCI DSS compliance in the healthcare industry. This was just an overview of how crucial PCI DSS is in the healthcare industry. 

We encourage you to visit our detailed webinar on “PCI DSS Compliance for Healthcare Organizations.” This webinar will give you in-depth knowledge about the importance of PCI DSS in the healthcare industry.

All the sources and resources mentioned in the blog can help you implement the necessary steps to become PCI DSS compliant and avoid hefty fines and penalties. 

If you need more information on HIPAA and PCI DSS in the healthcare industry, please let us know in the comments and share your feedback on this blog. 

Visit our website for additional resources and don’t hesitate to reach out to us for further assistance. Thank you for reading.

Narendra Sahoo
Narendra Sahoo

Narendra Sahoo (PCI QPA, PCI QSA, PCI SSF ASSESSOR, CISSP, CISA, CRISC, 27001 LA) is the Founder and Director of VISTA InfoSec, a global Information Security Consulting firm, based in the US, Singapore & India. Mr. Sahoo holds more than 25 years of experience in the IT Industry, with expertise in Information Risk Consulting, Assessment, & Compliance services. VISTA InfoSec specializes in Information Security audit, consulting and certification services which include GDPR, HIPAA, CCPA, NESA, MAS-TRM, PCI DSS Compliance & Audit, PCI PIN, SOC2 Compliance & Audit, PDPA, PDPB to name a few. The company has for years (since 2004) worked with organizations across the globe to address the Regulatory and Information Security challenges in their industry. VISTA InfoSec has been instrumental in helping top multinational companies achieve compliance and secure their IT infrastructure.