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A hospital’s security questionnaire for a healthcare fintech vendor should establish what the service does, what hospital data it handles, which systems and subcontractors it can reach, and whether its safeguards and contracts fit those risks. Ask for evidence and unresolved exceptions—not just yes/no answers or certification names. Use the responses as input to the hospital’s own risk analysis; if the arrangement makes the vendor a HIPAA business associate, address the relationship in a written business associate agreement (BAA).
This guidance is U.S.-focused. A fintech company is not automatically a HIPAA business associate: its role depends on the parties, the service, and whether it creates, receives, maintains, or transmits protected health information (PHI) for a covered entity. A questionnaire helps procurement, privacy, security, compliance, and legal teams understand the arrangement; it does not determine the vendor’s legal status or complete the hospital’s risk analysis.
Start by mapping the service, data, and access
Before evaluating control claims, establish the exact service under review. The vendor’s answers should describe the deployed service and its actual data flows, not a generic corporate security program.
Vendor and service inventory
- What is the vendor’s legal entity name, service name, business purpose, and hospital business owner?
- Who are the vendor’s security, privacy, support, and incident-escalation contacts?
- Which hospital workflows depend on the service, and what operational impact would an outage or interruption have?
- Which systems, APIs, networks, identities, administrative interfaces, or support channels does the service connect to or access? Identify whether access is read-only, write-capable, privileged, or otherwise limited.
Data inventory and flow
- What data does the service create, receive, maintain, or transmit for the hospital? Identify PHI/ePHI and other sensitive data separately, and describe the data elements involved.
- For each data category, where does it enter, move through, and leave the service? Identify storage and processing locations, retention periods, and deletion practices.
- What uses and disclosures does the vendor make of the data to deliver the service? Identify any secondary uses and the contractual basis for them.
- Which vendor and subcontractor personnel or systems can access the data, and for what operational purpose?
HHS OCR’s sample business associate listing uses the associate’s name, services, and contact information as basic inventory fields. The hospital can use that as a minimum starting point, then add the service, data, access, and dependency details needed for its own review.
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Clarify the HIPAA role and align the agreement
Ask the vendor whether it believes it is acting as a business associate or a business associate’s subcontractor for this particular service. Request the reasoning and identify any disputed boundary. Route the determination to the hospital’s privacy and legal teams; a vendor’s checkbox is not the legal conclusion.
If the relationship is a business associate relationship, use a written BAA that addresses the applicable HHS provisions and is tailored to the service and current law. Confirm that the agreement covers, as applicable:
- Permitted uses and disclosures of PHI and appropriate safeguards.
- Reporting of impermissible uses or disclosures, security incidents, and breaches as required by the agreement and applicable rules.
- Cooperation with applicable individual-rights functions and other covered-entity obligations.
- Restrictions and conditions that must flow down to subcontractors that handle PHI.
- Termination rights and what happens to PHI at termination, including return or destruction where feasible and treatment of retained copies.
The questionnaire tests whether operational practices can support the agreement’s promises; it does not replace the agreement. The hospital should also confirm which requirements belong in the contract, which are diligence questions, and who approves exceptions.
Ask for risk and control evidence tied to this service
HHS OCR describes risk analysis as foundational to identifying and implementing safeguards for ePHI. The hospital must assess its own environment and vendor relationship; the vendor’s completed questionnaire is evidence for that work, not a substitute for it. HHS healthcare Cybersecurity Performance Goals also identify third-party product and service risk as an area to identify, assess, and mitigate. Those goals are voluntary guidance, not a replacement for applicable legal requirements.
For each relevant control, ask the vendor to describe its practice, identify the systems and data in scope, and provide appropriately scoped evidence. Ask how it handles:
- Risk analysis: How does the vendor identify threats and vulnerabilities affecting this service and the ePHI it handles? How are decisions approved, reviewed, recorded, and turned into mitigation plans?
- Identity and access: How are employee, support, administrator, and subcontractor accounts authorized, limited, reviewed, and removed? How is privileged access controlled?
- Authentication, logging, and monitoring: What activity is recorded and monitored for the service, and how are suspicious events escalated?
- Vulnerability and change management: How are vulnerabilities prioritized and remediated, and how are changes to the service evaluated for security impact?
- Secure development: Which development and testing practices apply to the service and its interfaces?
- Data protection: How is data protected in transit and at rest? Who is responsible for encryption keys and key-management operations?
- Resilience controls: What backup and recovery safeguards apply to the service architecture?
- Independent assessment: What assessment or audit report is available, who performed it, when was it completed, and which service components and locations were in scope?
For reports, attestations, or certifications, ask what was assessed, the assessment period, the service scope, any exceptions, and their remediation status. Ask the vendor to explain shared-responsibility boundaries and any material control that is excluded from the evidence. A framework or certification name by itself does not establish that the hospital’s service and data flows were covered.
Make incident response and notification operational
Ask how the vendor identifies, triages, investigates, contains, and documents suspected incidents affecting the service or hospital data. HHS guidance says covered entities should respond to suspected or known incidents, mitigate harmful effects where practicable, and document incidents and outcomes. The vendor’s process should let the hospital act on its own responsibilities.
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- Who is available to the hospital during an incident, including outside normal business hours, and how can they be reached?
- What initial facts will the vendor provide, how will it deliver updates, and how will it share investigation findings as they become available?
- How does the vendor preserve relevant evidence, support the hospital’s legal and regulatory assessment, mitigate impact, and document the outcome?
- What notification trigger, timeframe, method, and escalation contacts will the parties put in the contract?
HHS sample BAA provisions address business associate reporting of security incidents and impermissible uses or disclosures. The reviewed HHS materials do not establish one universal vendor-to-hospital notification deadline. Set a workable contractual trigger and timeframe with counsel, taking the service, applicable requirements, and the hospital’s response needs into account.
Identify subcontractors and dependencies
Request a list of subcontractors and other material service providers that can access hospital data or systems. For each, ask:
- What function does it perform, where does it sit in the data flow, and what data or system access does it receive?
- What diligence and ongoing oversight does the vendor perform?
- How are incident escalation and contractual privacy and security restrictions passed through the chain?
- How will the vendor disclose or obtain approval for material changes to the subcontractor chain, so the hospital can assess their impact?
Under HHS sample BAA provisions, a business associate must ensure that a subcontractor with access to PHI agrees to the same restrictions and conditions that apply to the business associate. The hospital should verify the contract and the operating process that support this flow-down.
Check availability, recovery, and exit arrangements
Assess resilience in proportion to the hospital’s dependence on the service. Ask for service availability commitments, incident communications, backup design, recovery objectives, and relevant recovery-test evidence. Ask how the vendor maintains the confidentiality, integrity, and availability of ePHI it creates, receives, maintains, or transmits for the covered entity.
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Evaluate answers against the hospital’s risk
Compare the vendor’s answers by service and data exposure, access to hospital systems, PHI/ePHI sensitivity, subcontractor chain, control evidence and remediation, incident commitments, resilience, and contract protections. These are practical review dimensions drawn from HHS risk-analysis and third-party-risk guidance, not a government-mandated scoring rubric.
A simple response scale can help reviewers distinguish evidence from unsupported assurances. This is a suggested internal tool; the hospital must define its own acceptance criteria, pass/fail thresholds, and escalation path.
| Response category | What it means | Reviewer action |
|---|---|---|
| Documented and evidenced | The vendor describes the control and supplies evidence relevant to the service in scope. | Check scope, date, exceptions, and fit with the hospital’s risk criteria. |
| Documented with exceptions or remediation | A process exists, but a gap, exception, or unfinished corrective action remains. | Record the gap, owner, remediation plan, due point, and any needed interim safeguard or approval. |
| Not documented or unsupported | The vendor cannot substantiate the answer or show a documented practice. | Determine whether the gap is acceptable, requires further evidence, or should block or escalate the procurement. |
| Not applicable, with explanation | The vendor says the control does not apply and explains why. | Validate the reasoning against the service architecture and data flow rather than accepting a bare “N/A.” |
Record who reviewed each material gap and how it was resolved. The hospital’s risk analysis and procurement policy—not a universal questionnaire score—should determine whether residual risk is acceptable.
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Keep the questionnaire specific and maintainable
Use one questionnaire for the defined service, then tailor follow-up questions to the vendor’s answers and the hospital’s exposure. Preserve the service scope, evidence reviewed, exceptions, contract decisions, and approvals so that later changes can be compared with the original assessment. Revisit the assessment when material changes to the service, data flows, access, or subcontractor chain could alter risk.
HIPAA applicability and contract duties depend on the arrangement, and this U.S.-focused outline does not resolve state privacy or security laws, payment-network requirements, or the hospital’s risk tolerance. Have the hospital’s counsel and security team confirm current requirements and contract terms before operational use.
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