The roles of PCI DSS and HIPAA compliance: similarities, differences, and when you need both

It’s smart for any business to audit its security program and identify gaps—especially as you take in more sensitive data and expand your vendor footprint. A big part of that audit is scoping which standards and regulations you’re accountable to.

At a glance, a lot of frameworks can feel interchangeable (SOC 2, ISO 27001, PCI DSS, HIPAA). They all talk about access controls, monitoring, and policies. But you typically can’t substitute one for another—because scope, enforcement, and evidence requirements differ.

This guide focuses on two standards that often get confused (and sometimes both apply): PCI DSS and HIPAA.

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Key takeaways

PCI DSS protects payment card data; HIPAA protects health information. The overlap is real, but the scope isn’t the same.
PCI DSS is an industry standard enforced via card brands/acquirers. HIPAA is US law enforced by the government (HHS OCR).
You may need both if you handle payments and PHI. Many healthcare apps process card payments, store PHI, or support covered-entity workflows.
Treat “compliance” as owned workflows + evidence. Reuse shared controls (access, logging, encryption), but maintain distinct scope and attestation expectations.

Why this matters (and why you can’t “swap” frameworks)

Frameworks can look similar because good security hygiene is good security hygiene. But “we’re compliant with X” only helps if X matches:

the data types you process,
the role your organization plays (e.g., merchant, service provider, covered entity, business associate),
and the verification method your partners and regulators require.

That’s why it’s useful to compare PCI DSS and HIPAA directly.

Similarities between PCI DSS and HIPAA

PCI DSS (Payment Card Industry Data Security Standard) and HIPAA (Health Insurance Portability and Accountability Act) share core security themes—which is exactly why teams sometimes mis-scope them.

Their general purpose

Both PCI DSS and HIPAA are designed to improve security by requiring a set of controls and practices (technical + administrative). While neither is “just a checklist,” both ultimately translate into:

defined policies and procedures,
access control and authentication requirements,
monitoring and audit logging,
risk management,
and documented proof that controls exist and operate.

The parties they protect

Many frameworks primarily protect the organization (reduce breach likelihood and business impact). PCI DSS and HIPAA do that too—but they are explicitly designed to protect individuals:

PCI DSS: reduces exposure and misuse of cardholder data.
HIPAA: reduces exposure and misuse of protected health information (PHI).

If you handle either data type, buyers and partners will care not only that you’re secure, but that you can demonstrate security in a way that matches the relevant standard/law.

Differences between PCI DSS and HIPAA

Complying with just PCI DSS or just HIPAA typically does not eliminate the other obligation (if both scopes apply). Here’s what differentiates them.

The information they protect

PCI DSS focuses on protecting payment data—especially cardholder data and sensitive authentication data involved in payment transactions.
HIPAA focuses on protecting health information—especially PHI created, received, maintained, or transmitted in covered workflows.

If your product touches both payments and healthcare workflows, you can’t assume one “covers” the other.

Organizations that should comply

PCI DSS applies to organizations that store, process, or transmit cardholder data—or can impact the security of those environments. That can include:

ecommerce and subscription businesses,
healthcare providers that take card payments,
payment processors and gateways,
and vendors/service providers that touch payment flows or store payment data.

HIPAA applies to certain defined categories (and their service providers), including:

Covered entities (e.g., healthcare providers, health plans, healthcare clearinghouses),
Business associates (companies that perform services/functions involving PHI on behalf of covered entities),
and subcontractors that handle PHI downstream.

How they’re enforced

PCI DSS is enforced through the payment ecosystem (card brands, acquiring banks, and contractual requirements). Noncompliance often results in fees, increased SecureSlateiny, or inability to process payments.
HIPAA is US federal law enforced by the Department of Health and Human Services (HHS) Office for Civil Rights (OCR). Violations can trigger investigations, corrective action plans, and financial penalties.

How you verify compliance

Verification differs because the systems behind enforcement differ.

For PCI DSS, validation commonly involves a defined set of deliverables based on transaction volume and role, such as:

a Self-Assessment Questionnaire (SAQ) (for many organizations),
vulnerability scans from an approved scanning vendor (ASV) (where applicable),
an Attestation of Compliance (AOC),
and for larger or higher-risk entities, a third-party assessment by a Qualified Security Assessor (QSA).

For HIPAA, there isn’t a single “HIPAA certification” equivalent that guarantees compliance. HIPAA is an ongoing obligation, and your organization is expected to implement reasonable and appropriate safeguards and maintain documentation. Enforcement is typically reactive (complaints, breach investigations, audits), so your best defense is being able to show that your controls are designed, implemented, and operated consistently.

Why you may need PCI DSS and HIPAA together

You may need both if:

you accept or process card payments (or store card data), and
you create, receive, maintain, or transmit PHI as a covered entity or business associate (or subcontractor).

This is common in healthcare software because “payment” and “care” are operationally intertwined: patient billing, subscriptions, copays, telehealth visits, lab billing, and portal access can all touch both payment data and health data.

The good news: many foundational controls overlap. The key is to manage overlap without collapsing scope.

Overlap you can reuse (and what stays separate)

Here’s a practical way to think about reuse when both scopes apply.

Area	Often reusable across both	Often needs separation/extra attention
Identity & access	MFA, least privilege, RBAC, access reviews	Different role definitions and access justification (PHI vs payments teams)
Logging & monitoring	Centralized logging, alerting, incident tickets	“Who accessed what” evidence expectations for PHI and payment environments
Encryption	TLS, encryption at rest, key management	Scoping which systems are in PCI cardholder data environment (CDE) vs PHI systems
Vendor management	Vendor inventory, security review workflow	BAAs for PHI vendors; PCI service provider responsibilities/attestations
Incident response	IR plan, on-call, tabletop exercises	Breach notification obligations for PHI; card brand/acquirer reporting requirements
Risk management	Risk register, control owners, remediation tracking	Distinct scoping rules and validation artifacts (AOC/SAQ vs HIPAA documentation)

If you treat this as a single unified program, you risk “blurring” requirements and missing something in validation. If you treat it as two fully separate programs, you waste time duplicating work. The sweet spot is one set of core security workflows with clear scoping and evidence mapping for each obligation.

Your checklist to HIPAA compliance

If you need a practical starting point for HIPAA, use our software-team checklist (scoping PHI, access controls, audit logs, BAAs, incident response, and contingency planning):

HIPAA compliance for software development: A 7-step checklist

Streamline PCI DSS and HIPAA readiness with SecureSlate

PCI DSS and HIPAA get easier when you manage them as operational workflows: clear owners, mapped requirements, and evidence that stays current.

SecureSlate helps teams:

Map PCI DSS and HIPAA requirements to control owners and repeatable tasks
Centralize policies, audits, and evidence (so you’re not chasing screenshots every quarter)
Track vendors (including BAAs where applicable) and their compliance artifacts
Reuse overlapping controls while keeping PCI and HIPAA scope boundaries clear

Get started for free to see what “continuous compliance” looks like across multiple frameworks.

FAQ

Is PCI DSS the same thing as HIPAA?

No. They both improve security, but they protect different data, apply to different organizations/roles, and have different enforcement and validation expectations.

Do healthcare companies need PCI DSS?

If you store, process, or transmit cardholder data (or can impact those systems), PCI DSS is usually in scope—whether you’re a provider, a SaaS vendor, or a service provider in the payment flow.

Can I be HIPAA compliant without being PCI DSS compliant (or vice versa)?

If only one scope applies, yes. But if your organization handles both PHI and payment card data, you’ll typically need to address both—with appropriate scope boundaries and validation artifacts.

Disclaimer (legal note)

This article is for general informational purposes and is not legal, security, or audit advice. Compliance obligations vary based on your role, systems, contracts, and jurisdiction. Consult qualified counsel and relevant experts for guidance.