The statement seems to imply that it was one of these "external scripts...reluctantly approved...for...performance monitoring". Specifically google analytics. B

The statement seems to imply that it was one of these "external scripts...reluctantly approved...for...performance monitoring". Specifically google analytics. But google is an all consuming vacuum for information, and presumably defaults to sharing data between your analytics account and your ads account. And in today's modern software dev world where everything is dependent on everything, that's exactly the sort of setting that could get accidentally imported somewhere where it wasn't supposed to. In fact it's also possible this came about because a page changed over time and no one re-reviewed that original approval. Imagine for example that they had some un-authenticated pages set up so that people could see what sort of Medicare plans BS offers. Every year, thousands of people flock to the site, drop their zip code in and see what plans are available in their area. So far so good, no PHI (zip + medicare without anything else isn't generally PHI). Then a year later someone gets the bright idea to let you search for which doctors are in or out of network. Again, not PHI for most practical purposes. Yes, it could be enough data to uniquely identify someone and their health conditions, but in practice, it's hardly going to raise any red flags. Next year someone suggests adding the ability to list your medications so that you can see what you out of pocket costs for a plan will be. We're edging up on PHI here, but as long as they're not taking actual personally identifying info like dates of birth or addresses, this probably still isn't getting flagged as a PHI page. Finally the next year someone suggests "wouldn't it be handy if our existing customers could have their medications and providers from the prior year just imported into the search automatically. Well sure it would, so they go ahead and implement it but whoops, pulling that data out of the system also pulled along some internal tracker id that happens to be composed partially of their external "HIPAA safe" analytics ID that gets mapped to the internal tracking ID so they can got analytics attached to your session even before you authenticate. And now that ID is matched up to health information in a way that both creates a unique connection between the health information and an individual and now also links that individual to a specific cross-site google tracking ID. And now you've had a data breach, without ever (intentionally) approving the application of marketing libraries on a PHI containing site. I agree that there should be a lot more safeguards still, but the bug also being in place between 3-4 years suggests to me that it was a lot more subtle than just "don't include `ads.google.js` on the patient's medical history page". It's possible they really are just completely inept and haven't had any audits in 5 years but we won't really know that unless/until someone leaks more details.