> HIPAA doesn't say ROT13 or anything else in particular counts as "anonymized".

ROT13 was only an example of a step that makes data look "protected" in some way when it really isn't, just like the ineffective means used to anonymize data makes it look safe to sell that data when it really isn't.

There is a lot of research showing how easy it can be to identify an individual using data that has been anonymized. (https://www.technologyreview.com/2019/07/23/134090/youre-ver...)

HIPAA does provide a standard and guidelines for what they call the "de-identification of protected health information" (https://www.hhs.gov/hipaa/for-professionals/special-topics/d...) and it includes, for example, a list of specific identifying information that must be removed from the records before they can be sold or otherwise passed around in order to get safe harbor protections. It also includes an option where an "expert" ("There is no specific professional degree or certification program for designating who is an expert") can just say "Trust me bro, it's anonymized".

If somebody was able to buy their re-identified data from a broker and they could prove that was sold by a health provider bound by HIPAA, they would still have to prove that the provider who sold the data had "actual knowledge" that the broker would be able to re-identify the individual, where:

> actual knowledge means clear and direct knowledge that the remaining information could be used, either alone or in combination with other information, to identify an individual who is a subject of the information.

Which all seems like it would be almost impossible to prove unless the provider left obvious identifying information in the data, or if a whistleblower came forward with records of direct communication between the seller and buyer where the buyer was reassured that the data being sold to them would later be able to be re-identified.

Awareness of the fact that we have mountains of research showing that individuals are easy to re-identify from anonymized data doesn't count as "actual knowledge":

> Much has been written about the capabilities of researchers with certain analytic and quantitative capacities to combine information in particular ways to identify health information.32,33,34,35 A covered entity may be aware of studies about methods to identify remaining information or using de-identified information alone or in combination with other information to identify an individual. However, a covered entity’s mere knowledge of these studies and methods, by itself, does not mean it has “actual knowledge”

Which leaves us with healthcare providers who can use methods to "anonymize" data that have been proven to be vulnerable to re-identification, then freely sell that "anonymized" data to third parties with a nudge and a wink.

I'll admit to being pessimistic. We know that the strength of the regulations we have in the US has done little to slow down the buying and selling of our healthcare data.

We've also already seen a lot of very shady behavior by health care providers and companies such as tricking or coercing people into giving up their rights so that they don't even have to pretend to protect their data with anonymization before selling it. (see https://www.washingtonpost.com/technology/2022/06/13/health-... and https://www.washingtonpost.com/technology/2023/05/01/amazon-... and https://news.ycombinator.com/item?id=22177812 and https://www.12onyourside.com/story/23852025/on-your-side-ale...)