This report examines the critical intersection of tracking cookie control technologies and the heightened privacy requirements of healthcare and financial services sectors. The analysis reveals that while cookie consent management platforms have become ubiquitous, fundamental gaps persist between what these tools promise and what they actually deliver, particularly in industries handling the most sensitive personal data. Third-party tracking remains present on 98.6% of hospital websites despite mounting regulatory pressure, and healthcare organizations have paid over $100 million in penalties since 2023 for privacy violations involving tracking pixels and cookies. Financial institutions face similar risks as they navigate complex regulatory frameworks including GLBA, PCI DSS, and state-level privacy laws. The report synthesizes current best practices, regulatory expectations, technical implementation challenges, and emerging solutions to provide comprehensive guidance for organizations seeking genuine data protection rather than mere compliance theater.
Understanding Tracking Cookies, Cookie Blockers, and Cookie Control Technologies
Tracking cookies are fundamentally different from other cookie types, and understanding this distinction is essential for comprehending why cookie control has become increasingly critical in sensitive sectors. Tracking cookies are small text files stored on a user’s browser that collect and transmit data about the user’s online behavior across multiple websites. Unlike session cookies that disappear when a user closes their browser or necessary cookies that enable basic website functionality, tracking cookies persist across sessions and often across multiple websites, enabling behavioral profiling that extends far beyond the original website the user visited. These cookies can track clicks, shopping preferences, browsing patterns, form submissions, and other sensitive user activities, collecting information such as a user’s IP address, web browser type and version, pages visited, time spent on pages, links clicked, and conversion information.
The technical mechanisms underlying tracking cookies make them particularly insidious in environments handling sensitive data. When a website loads, tracking code typically fires immediately, often before a user sees any consent notification, allowing data collection to occur regardless of user preferences. The chain of tracking can be extraordinarily complex—a single website may embed cookies from not only the primary domain but also from numerous third parties including advertising networks, social media platforms, analytics providers, and data brokers. Meta Pixel and Google Analytics have emerged as particularly problematic vectors, with research finding that 33% of healthcare websites continue using Meta Pixel tracking code despite years of warnings and enforcement actions. Each of these third-party tracking tools may itself deploy additional tracking through nested cookies, creating what researchers describe as an “endless chain” of tracking that website owners frequently cannot fully control or even comprehend.
Cookie blockers and cookie control mechanisms represent technological and procedural responses to this tracking infrastructure, functioning at multiple levels of sophistication. At the most basic level, cookie blockers are browser-based tools that prevent third-party cookies from being stored on a user’s device. Modern browsers have increasingly incorporated built-in blocking capabilities—Safari’s Intelligent Tracking Prevention blocks all third-party cookies by default, Firefox includes Enhanced Tracking Protection and Total Cookie Protection that block most third-party cookies by default, and Microsoft Edge allows users to block third-party cookies through settings. These browser-level protections function largely independently of website cooperation, giving users some control over their own privacy without relying on website compliance.
However, for organizations operating healthcare and financial websites, the critical category of cookie control involves consent management platforms (CMPs) and related technologies that websites themselves deploy. A true consent management platform encompasses significantly more than a simple cookie banner notification. According to industry analysis, the distinction between a cookie banner, a preference center, and a full CMP matters enormously for actual compliance. A cookie banner is merely a pop-up notification that informs users the site uses cookies—it conveys information but implements no actual technical controls. A cookie preferences center or preference interface allows users to choose which cookie categories to enable or disable, providing settings without enforcement. A genuine consent management platform combines banner display, preference collection, and critical enforcement mechanisms—it must actually block or allow scripts and cookies based on user choices. The distinction is not semantic; organizations deploying only banners while continuing to load tracking code until consent is confirmed are not implementing genuine cookie control despite appearing to offer choice.
The technical implementation of genuine cookie control involves multiple layered approaches working in concert. First, blocking-by-default architecture ensures that tracking cookies and scripts do not load until explicit user consent is obtained. This requires sophisticated tag management capabilities that can delay or prevent the execution of third-party scripts until appropriate consent status is confirmed. Second, proper cookie control systems must support granular consent categories, allowing users to accept analytics cookies while rejecting advertising cookies, or to maintain functionality cookies while opting out of tracking. Third, cookie control must honor various opt-out mechanisms including explicit user rejection, Global Privacy Control signals, and Do Not Track headers. Fourth, the system must maintain auditable consent records documenting what choices each user made and when, creating a compliance trail for regulatory review. Fifth, integration with tag management systems like Google Tag Manager becomes essential to ensure that consent status is continuously respected as users navigate the website and as new scripts load.
Regulatory Landscape: Why Health and Finance Sectors Demand Extraordinary Care
The regulatory frameworks governing healthcare and financial services have become increasingly stringent regarding online tracking and cookie usage, establishing requirements that fundamentally exceed those in most other industries. The distinction between healthcare and finance sectors’ regulatory environments compared to general commerce creates the context for why these sectors require what might be termed “extra care” beyond standard cookie control implementation.
In healthcare, the Health Insurance Portability and Accountability Act (HIPAA) establishes the foundational privacy framework for protected health information, but its application to tracking technologies remained ambiguous until the Office for Civil Rights issued pivotal guidance in December 2022. The December 2022 OCR bulletin on tracking technologies represents a watershed moment in regulatory interpretation, clarifying that tracking technologies can easily capture protected health information even on websites that appear to contain only general information. The OCR’s interpretation casts an exceptionally wide net regarding what constitutes PHI in the context of website tracking. According to the guidance, information is PHI if it “is indicative that the individual has received or will receive health care services or benefits from the covered entity,” meaning that an IP address combined with a visit to a page about a specific health condition can constitute PHI even without explicit health information. The OCR specifically identified categories of unauthenticated webpages where tracking may capture PHI, including login pages, registration pages, appointment scheduling pages, doctor search pages, and informational pages about symptoms or health conditions such as pregnancy, miscarriage, Alzheimer’s disease, breast cancer, depression, and HIV.
This interpretation proved revolutionary in its practical implications. The OCR asserted that if a website’s tracking technology captures any identifying information about an individual in combination with any indication of their use of healthcare services, that captured information constitutes PHI, triggering full HIPAA obligations. This means that third-party tracking vendors who receive such information must either have executed a Business Associate Agreement (BAA) with the healthcare provider or the disclosure of the information violates HIPAA. The guidance further clarified that general consent notices or privacy policies describing the use of tracking technologies do not constitute valid HIPAA authorization—valid authorization requires specific, informed consent about data sharing with particular third parties. The practical result: healthcare providers cannot simply display a cookie banner and assume compliance; they must actively prevent tracking code from accessing and transmitting PHI, or they must obtain explicit authorization from each patient to share their information with specific third-party tracking vendors.
The application of this guidance to actual healthcare practice has proven contentious. In June 2024, a federal court sided with the American Hospital Association’s legal challenge, ruling that the OCR had overstepped its authority in interpreting the “proscribed combination” of IP address and website visit data as automatically constituting PHI. This court decision appeared to restrict the OCR’s interpretation and allowed healthcare providers continued latitude to use tracking technologies. However, this legal victory for hospitals has created confusion rather than clarity—the HHS subsequently dropped its appeal, leaving healthcare providers in a state of uncertainty about whether the OCR’s December 2022 guidance remains effectively binding despite the court challenge. Given this ambiguity and the ongoing enforcement actions by state attorneys general and the Federal Trade Commission, most compliance professionals advise healthcare organizations to assume the OCR’s broader interpretation remains the operative framework for compliance.
Financial services face similarly complex but distinct regulatory burdens regarding tracking and cookie usage. The Gramm-Leach-Bliley Act (GLBA), enacted in 1999, established privacy protections for consumer financial information that, while predating the cookie era, apply to all data collection and sharing practices of financial institutions. GLBA requires financial institutions to provide privacy notices explaining their information collection and sharing practices, to obtain opt-out consent from consumers before sharing nonpublic personal information with nonaffiliated third parties, and to safeguard collected information through reasonable security measures. When financial websites deploy tracking technologies that share customer data with advertising platforms or analytics vendors, they implicate GLBA’s requirements. Financial institutions must maintain clear policies about what information is shared with third parties and ensure that tracking arrangements comply with GLBA’s prohibitions on unauthorized disclosure.
The Payment Card Industry Data Security Standard (PCI DSS) adds another layer of requirements specific to payment card information, but extends beyond card data to general data security principles applicable to financial websites. PCI DSS Requirement 3 mandates protection of stored sensitive data, including limiting storage time, rendering authentication data unreadable through encryption, and protecting cryptographic keys. Requirement 8 requires unique user identification and strong authentication for all access to cardholder data environments. Requirement 10 mandates comprehensive tracking and monitoring of all access to network resources and cardholder data, with audit logs retained for at least one year and immediately accessible for three months. These requirements translate into significant constraints on cookie usage in financial services—any persistent cookies storing financial information must be encrypted, access must be logged and auditable, and the principle of data minimization requires limiting what information is stored in cookies to the absolute minimum necessary.
California’s CCPA and the recently implemented CPRA establish the most stringent state-level privacy frameworks in the United States, requiring detailed privacy disclosures and explicit opt-out mechanisms for data sales. The CPRA particularly enhanced requirements around sensitive personal information, which includes health information, financial account information, and biometric data, requiring explicit opt-in consent for sensitive data collection. Unlike the GDPR, CCPA/CPRA does not necessarily require pre-consent for all cookie types, but it does require clear opt-out mechanisms for data sales and sharing, with the ability to opt out specific categories of data use.
The European Union’s GDPR and ePrivacy Directive establish the most stringent cookie requirements globally, requiring explicit affirmative consent before placing non-essential cookies, rejecting any pre-ticked checkboxes, pre-loaded consent, or implied consent through inactivity. Organizations must provide granular controls allowing users to consent to specific cookie categories rather than accepting all cookies as a single package. Any website processing data of EU residents must comply with these requirements, creating practical implications for healthcare and financial organizations with international reach. The convergence of GDPR requirements with CCPA/CPRA requirements in California means that organizations serving both audiences must implement the more stringent standard—explicit opt-in consent with granular controls.
Critical Privacy Vulnerabilities: The Gap Between Consent Tools and Actual Data Protection
Despite widespread deployment of cookie consent tools and banners, a substantial gap persists between what organizations claim to do regarding cookie consent and what actually happens with user data. This gap represents perhaps the most significant risk factor for healthcare and financial organizations, as regulators increasingly focus on the disconnect between stated compliance mechanisms and actual data flows.
The empirical evidence of this gap is striking. Research examining hospital websites found that while 59% of healthcare organizations deployed consent banners, suggesting a commitment to privacy compliance, 98.5% of websites loaded cookies on page load, meaning that trackers executed before any consent banner appeared or before users could make preferences known. On average, 33 cookies loaded before consent banners even displayed to users, and these consent tools often misclassified or failed to identify cookies and trackers altogether. This represents not a technical quirk but a fundamental compliance failure—websites displaying consent banners while simultaneously loading tracking code before consent violation the principle of informed choice that undergirds all privacy regulations.
The mechanisms through which CMPs fail to deliver actual protection take several forms. First, many CMPs cannot guarantee that third-party scripts stop firing once users opt out, creating situations where delays in script blocking, misconfigured implementations, or noncompatible scripts allow data leakage despite user refusal. The architecture of modern web tracking means that third-party tools often deploy their own nested cookies and scripts—a website’s CMP cannot always prevent these subsidiary tracking mechanisms from functioning, since they exist beyond the website owner’s direct control. This technical limitation transforms consent management from a mechanism of genuine user control into a compliance theater that appears to offer choice while allowing tracking to continue.
Second, many CMPs lack visibility into what data third-party tools actually collect and transmit. Website owners frequently cannot articulate what data flows from their websites to third-party analytics, advertising, and data brokerage firms. Research on tracking pixels specifically found that healthcare websites often failed to understand that pixels transmit specific user data beyond simple visit information—appointment details, medical record numbers, search terms, and other identifying information can flow through pixels to Meta, Google, and other platforms without website operators realizing the specific data being transmitted. This opacity means that even when website operators deploy cookie control tools, they may not have actual visibility into whether the CMP effectively blocks the data flows that triggered the tracking in the first place.
Third, the consent banners themselves frequently employ dark patterns that nudge users toward accepting all cookies rather than providing genuine choice. The term “dark patterns” refers to design choices that manipulate or deceive users into decisions they might not otherwise make. Common dark patterns in cookie consent include making the “accept all” button larger or more prominent than the “reject” button, requiring multiple clicks to reject while accepting requires a single click, using ambiguous language that obscures what users are consenting to, or requiring users to navigate through complex preference menus to opt out while simple clicks enable opt-in. Regulators increasingly target these dark patterns; the California Privacy Protection Agency in 2025 explicitly emphasized enforcement against cookie consent interfaces employing dark patterns to obtain misleading consent. The practical result is that many cookie consent mechanisms do not represent genuine user choice but rather engineered defaults that nudge toward acceptance regardless of what users actually prefer.
Fourth, cookie consent tools frequently fail to maintain compliance with what the regulations actually require. Healthcare organizations particularly struggle with this disconnect. The OCR guidance makes explicit that a cookie banner alone does not constitute valid HIPAA authorization. Simply displaying a notice that the website uses cookies and third-party tracking does not, in the OCR’s interpretation, provide patients with the specific, informed consent required before transmitting their health information to third parties. Yet the vast majority of healthcare websites have not moved beyond this bare minimum, instead relying on generic cookie banners that fail to meet the OCR’s articulated standard for valid consent.
Financial organizations face parallel challenges with cookie control. Banks and financial services firms deploying cookies in their websites must ensure that GLBA requirements are met—data cannot be shared with nonaffiliated third parties without explicit notice and opt-out rights. Yet many financial websites use Google Analytics and similar tools that result in data sharing with advertising platforms, potentially violating GLBA if the financial institution has not obtained specific opt-out authorization for such sharing. The Blue Shield of California breach exemplifies this failure—the organization deployed Google Analytics configured to share member data with Google Ads for nearly three years without explicit member consent, resulting in exposure of approximately 4.7 million individuals’ protected health information. This was not a case of a malicious actor or sophisticated hack; it was a misconfiguration of a commonly deployed analytics tool, yet it represents exactly the kind of privacy violation that cookie control is supposed to prevent.
The proliferation of tracking technologies beyond traditional cookies compounds these vulnerabilities. While CMPs focus primarily on cookie blocking, modern tracking operates through multiple mechanisms including web beacons or tracking pixels, fingerprinting scripts that create device identifiers, session replay scripts that record user interactions, and embedded tracking codes in mobile applications. Many CMPs do not address these non-cookie tracking mechanisms. Fingerprinting technologies, in particular, create persistent identifiers without relying on cookies, meaning that blocking cookies provides incomplete protection against cross-site tracking. Healthcare and financial organizations deploying traditional CMPs focused solely on cookies may incorrectly assume they have addressed tracking risks while fingerprinting and other mechanisms continue operating unblocked.
Implementation Strategies: Moving Beyond Consent to Genuine Data Governance
Organizations in healthcare and financial services must recognize that genuine cookie control extends far beyond banner implementation to encompass comprehensive data governance throughout the website ecosystem. The distinction between compliance theater and substantive data protection lies in the depth and authenticity of implementation.
The foundational step requires comprehensive auditing of all tracking technologies currently deployed on organizational websites and applications. This audit must identify not only first-party cookies and scripts but also all third-party tracking tools, including analytics platforms, advertising pixels, social media widgets, live chat systems, and any other code that collects or transmits user data. For healthcare organizations, this audit must specifically map which tracking tools have access to pages where users might enter or access health information—patient portals, appointment scheduling pages, health condition information pages, and any other URLs that might transmit identifying information in combination with health-related data. Many organizations conducting such audits for the first time discover that they have far more tracking than they realized; healthcare websites average 16 trackers with some containing as many as 93 different tracking mechanisms.
Once tracking technologies are identified, healthcare and financial organizations must make deliberate decisions about which tracking serves legitimate organizational purposes and which represents unjustified risk. In many cases, analytics platforms that generate insights about website performance can be justified—organizations have legitimate interests in understanding how users interact with their websites and how to improve user experience and access to services. However, tracking specifically for behavioral advertising targeting, cross-site profiling, and data brokerage serves no organizational purpose and exposes patient and customer data to unjustified risk. Healthcare organizations, in particular, should minimize or eliminate tracking pixels from social media platforms like Meta, which have been the subject of repeated enforcement actions for receiving and using health data without authorization.
The actual implementation of cookie control requires deploying CMPs that genuinely enforce consent rather than merely documenting it. Healthcare organizations should prioritize CMPs with demonstrated HIPAA-compliant capabilities—platforms that can automatically block tracking by default until explicit consent is obtained, that maintain audit logs documenting consent decisions, and that integrate with organizational privacy infrastructure to enforce data minimization. Financial institutions should ensure CMPs integrate with data governance frameworks that ensure GLBA compliance and PCI DSS compliance—automated data governance that prevents transmission of sensitive cardholder or financial information to third-party advertising platforms regardless of cookie consent.
For healthcare specifically, the implementation must address the fundamental requirement of obtaining specific patient authorization before any data sharing with third-party trackers. Generic cookie banners fail this requirement; patients need to understand specifically which third parties will receive what information about them and have the ability to consent or refuse. This might mean that healthcare organizations cannot use Meta Pixel or other social media trackers without implementing explicit patient consent mechanisms that require affirmative action from patients specifically authorizing such sharing.
Financial institutions must implement similar specificity regarding what data flows to what parties and ensure that GLBA opt-out requirements are met. If financial organizations continue to deploy Google Analytics configured to share data with advertising platforms, they must ensure that customers have been provided explicit notice and opportunity to opt out of such sharing. The alternative, and the approach increasingly taken by compliance-conscious financial institutions, is to avoid third-party analytics platforms altogether in favor of first-party analytics that never leaves the organization’s infrastructure and therefore never triggers third-party data sharing obligations.
Technical implementation must include proper configuration of tracking technologies that remain necessary for legitimate purposes. This includes implementing secure cookie attributes—setting cookies with the Secure flag so they transmit only over encrypted HTTPS connections, setting the HttpOnly flag to prevent JavaScript access that could enable cross-site scripting attacks, implementing appropriate expiration dates so cookies do not persist longer than necessary, and using the SameSite attribute to restrict cross-site request forgery risks. For healthcare organizations handling health information, additional encryption of any health-related data in cookies becomes necessary, though best practice suggests avoiding storage of sensitive health information in cookies altogether.
Organizations must also integrate cookie consent with broader privacy and data protection frameworks rather than treating cookies as an isolated compliance domain. Patient portals and financial account portals should implement comprehensive access controls ensuring that only authorized individuals access sensitive information, not just rely on session cookies to maintain authentication. Audit trails should document all access to sensitive data, including access through web interfaces, enabling organizations to detect unauthorized access and maintain compliance with HIPAA and PCI DSS audit requirements. This holistic approach recognizes that cookie control is one component of data protection rather than the totality of privacy compliance.
Recent Enforcement Actions and Industry Impact: The Rising Cost of Non-Compliance
The period from 2023 through 2025 has witnessed unprecedented enforcement activity regarding tracking technologies in healthcare and financial services, creating urgency around cookie control that extends far beyond theoretical compliance concerns to concrete financial penalties and reputational consequences.
The enforcement landscape reveals patterns that illuminate regulatory priorities and compliance failures. Between 2023 and 2025, healthcare organizations and health-related companies paid over $100 million in penalties and settlements for pixel tracking and cookie-related privacy violations. The case record demonstrates consistent themes: organizations deployed tracking technologies without sufficient patient consent, data reached third-party platforms without appropriate authorization, and in many cases the organizations failed to implement effective cookie controls to prevent unauthorized data transmission. Notable cases include BetterHelp settling for $7.8 million for sharing mental health data with third parties, GoodRx settling class action lawsuits for $25 million for sharing health data with Meta and Google, Mass General Brigham settling for $18.4 million for cookies and pixels on websites, Novant Health paying $6.6 million for Meta Pixel on patient portals, and Johns Hopkins Health System paying $2.5 million for Meta Pixel on its patient portal. These are not isolated incidents but rather representative examples of widespread compliance failures.
The Blue Shield of California case merits particular examination as it illustrates how organizations deploying standard analytics tools can inadvertently violate privacy regulations. Blue Shield deployed Google Analytics, an extraordinarily common analytics tool used by healthcare and financial organizations worldwide, on its member websites. For nearly three years between April 2021 and January 2024, the Google Analytics implementation was configured to share data with Google Ads, Google’s advertising platform, without member knowledge or consent. This configuration enabled Google to receive protected health information about 4.7 million individuals including insurance plan information, medical claim service dates, provider information, and health-related search queries—data then used to target advertising back to the individuals. Blue Shield discovered the misconfiguration in February 2024 but did not publicly disclose it until April 2024, months later. The breach illustrates how easily healthcare organizations can fall into privacy violations using standard commercially available tools, and how readily cookies and trackers can leak sensitive information.
The regulatory response to these enforcement actions has intensified. The Federal Trade Commission explicitly identified tracking pixels and cookies as enforcement priorities, taking action against healthcare platforms for sharing sensitive health data without authorization and emphasizing that companies using tracking pixels that disclose personal information to third parties violate the FTC Act, the Health Breach Notification Rule, HIPAA, and state privacy laws. State attorneys general have begun independent actions; New York’s attorney general settled with New York Presbyterian Hospital for $300,000 for pixel-related HIPAA violations. The OCR has issued letters to nearly 130 healthcare organizations warning them about tracking technology compliance risks and indicating an intention to increase enforcement activity.
These enforcement actions carry consequences extending beyond financial penalties. Organizations that suffer privacy breaches or enforcement actions face reputational damage, loss of patient and customer trust, potential loss of business to competitors perceived as more privacy-protective, and internal costs associated with breach notification, forensic investigation, remediation, and compliance rebuilding. Moreover, healthcare and financial organizations face potential class action litigation from affected individuals who assert their privacy rights were violated; many of the cases resulting in multimillion-dollar settlements originated as class actions brought by affected patients or consumers rather than solely as regulatory enforcement actions.
The pattern of enforcement activity reveals that regulators prioritize visible, obvious cookie control failures more than sophisticated compliance mechanisms. Organizations that deploy tracking code without any cookie consent mechanisms face the most severe enforcement; organizations that deploy cookie banners but fail to actually block trackers face somewhat less severe but still significant enforcement; and organizations that deploy functioning CMPs that genuinely block tracking when users opt out generally avoid enforcement. This progression suggests that even imperfect cookie control efforts, if genuinely implemented rather than performative, reduce enforcement risk.
Specialized Considerations: Healthcare-Specific Cookie Control Requirements
Healthcare organizations face distinctive cookie control challenges that extend beyond those faced by financial institutions or general commerce websites. These challenges arise from the sensitive nature of health information, the regulatory framework specifically targeting healthcare privacy, and the unique characteristics of healthcare websites that frequently combine public information with patient-specific portals.
Healthcare websites inherently contain sensitive information that attracts tracking. Patient portal pages, appointment scheduling pages, health condition information pages, and provider search pages all naturally invite visitor activity that might indicate health conditions, treatments, or medical concerns. A visit to a page about HIV or depression, a search for an addiction treatment provider, a visit to a page about fertility services—each represents data that, while appearing to be merely website visit information, actually reveals sensitive health information when combined with visitor identification. The OCR’s guidance recognizes this reality and applies HIPAA’s protections to such seemingly innocuous website visits when they occur on healthcare provider websites.
This sensitivity creates a distinctive implementation challenge: healthcare organizations cannot adopt the cookie control strategies commonly deployed by financial institutions or e-commerce companies. A retail bank might argue that deploying Google Analytics or other third-party analytics tools is necessary to understand website performance and user behavior, generating sufficient utility to justify the privacy costs. Healthcare organizations face a stronger case that they cannot justify deploying third-party tracking tools that receive identifying information in combination with health-related URLs or searches—the privacy risks exceed the utility of understanding website analytics. Accordingly, healthcare organizations should consider HIPAA-compliant analytics alternatives that maintain first-party data within the organization’s control rather than transmitting identifying information to third-party platforms.
Patient portals present specific technical challenges for cookie control. Patient portals require authentication and maintain session cookies that preserve user authentication as patients navigate between portal pages—these authentication cookies serve essential functions and cannot be blocked without breaking portal functionality. However, patient portals must not simultaneously allow third-party tracking to access patient information transmitted through the portal. The technical solution requires segmenting cookies based on their function—authentication cookies necessary for portal operation continue, while third-party tracking cookies block entirely. This segmentation requires more sophisticated cookie management than simple blanket blocking of all non-essential cookies.
Mobile applications developed or offered by healthcare organizations create additional complexity. The OCR guidance extended HIPAA tracking requirements to mobile applications, emphasizing that apps that track health-related information or collect health information trigger full HIPAA obligations. Healthcare organizations deploying mobile apps for patient engagement must ensure that embedded tracking code does not transmit PHI to third parties without appropriate authorization. This often means disabling standard SDKs and tracking libraries that come pre-integrated in mobile development platforms and analytics services.
Healthcare organizations must also address the practical reality that patients may use healthcare websites on shared devices, creating privacy concerns beyond traditional individual user tracking. A patient accessing their healthcare provider’s patient portal from a shared computer might inadvertently expose their information to other users of that device if cookies and tracking mechanisms create persistent identifiers associated with that user. While this falls somewhat outside the scope of traditional cookie control, healthcare organizations implementing comprehensive privacy protection should consider mechanisms like requiring re-authentication for sensitive patient portal functions and avoiding persistent cookies that maintain logged-in status across sessions.
Specialized Considerations: Financial Services Cookie Control Requirements
Financial services organizations face a parallel but distinct set of cookie control challenges grounded in different regulatory frameworks and the unique characteristics of financial data. While healthcare regulations like HIPAA specifically designate certain individuals as “covered entities” with special obligations, GLBA applies broadly to any financial institution handling consumer financial information, including banks, credit unions, credit card companies, mortgage brokers, and many other entities.
The financial services cookie control challenge arises partly from the different regulatory philosophy underlying GLBA compared to HIPAA. GLBA emphasizes transparency and consumer control over data sharing—financial institutions must disclose what information they collect and share, provide opportunities for consumers to opt out of sharing, and maintain security measures protecting the information. Cookies do not automatically violate GLBA; however, cookies that result in data sharing with third parties without proper notice and opt-out mechanisms violate GLBA. This creates a different compliance pathway than healthcare: financial organizations might technically be able to use Google Analytics or other third-party analytics platforms if they have properly informed customers about such sharing and provided clear opt-out mechanisms, whereas healthcare organizations more narrowly should avoid such sharing altogether due to the sensitive nature of health information.
PCI DSS requirements add significant constraints specific to payment card information. Any cookies storing payment card information must meet stringent encryption and access control requirements. The practical implication is that financial institutions should avoid storing cardholder data in cookies altogether, instead maintaining payment information in separate secure systems and using cookies only for non-sensitive session management. This architecture requires more sophisticated technical implementation than simple cookie-based tracking.
Financial services faces a particular risk from misconfigured analytics platforms, as the Blue Shield case demonstrated. Google Analytics, Mixpanel, and similar analytics platforms can be configured to share data with advertising platforms—a configuration that financial institutions must explicitly avoid or actively prevent. The risk is not that analytics tools inherently violate GLBA but that standard configurations of these tools may result in data sharing that was not explicitly authorized. Financial organizations deploying analytics must either use platforms that never share data with advertising partners, configure analytics platforms to explicitly prevent sharing with advertising systems, or obtain customer authorization for such sharing through prominent disclosures and opt-out mechanisms.
Financial services must also contend with the complexity of consumer financial information being defined broadly under GLBA and various other regulations. Information is considered nonpublic personal information under GLBA if it concerns a consumer and is not publicly available—this includes not only account information but also information about financial condition, transactions, and interactions with the financial institution. A financial website’s tracking of user behavior—pages visited, products viewed, searches conducted—constitutes consumer financial information subject to GLBA privacy protections, not just account-specific data. This broadens the scope of cookie control required; financial institutions cannot easily segment “sensitive” and “non-sensitive” information because information about visitor behavior to a financial website generally qualifies as consumer financial information requiring GLBA protection.
Implementation Challenges and Emerging Solutions
Despite increasing regulatory pressure and growing awareness of privacy risks, organizations continue to struggle with effectively implementing genuine cookie control. These challenges reflect technical complexity, organizational constraints, and the evolving nature of tracking technologies that often outpace regulatory and technical protective measures.
One fundamental challenge involves the complexity of understanding which tracking technologies are actually deployed on organizational websites and applications. Many organizations, particularly healthcare systems and mid-sized financial institutions, lack visibility into their complete technology ecosystem. When a hospital or bank deploys a website through third-party platforms, integrates marketing automation tools, implements customer relationship management systems, and incorporates various specialized business applications, tracking code often comes bundled with these systems without explicit awareness by the organization. A hospital might deploy a patient portal built on a third-party platform that includes embedded analytics and tracking without the hospital fully understanding what data flows to what parties. Marketing departments might deploy marketing automation platforms that automatically append tracking pixels to website pages without compliance or privacy teams being aware. This organizational fragmentation means that cookie control implementation often fails because different teams do not coordinate on tracking technology usage and cleanup.
Addressing this fragmentation requires organizational restructuring to ensure that privacy, compliance, marketing, technology, and business teams communicate about tracking technologies. Many organizations now require vendor assessments that specifically address tracking technology deployment and require vendors to certify that embedded tracking code does not transmit sensitive information without organization authorization. Some organizations have deployed compliance teams whose specific responsibility involves auditing technologies for unauthorized tracking and working with business teams to remediate identified risks. While this appears burdensome, the costs of such coordination pale compared to multimillion-dollar breach settlements and regulatory actions.
A second challenge involves the technical limitations of current CMP platforms. Even sophisticated CMPs cannot guarantee complete prevention of data leakage when third-party tracking systems embed complex chains of nested tracking and when newer tracking mechanisms like fingerprinting do not rely on cookies. A CMP that blocks cookies may leave fingerprinting-based tracking functional; a CMP that blocks scripts may fail to block pixels; a CMP that blocks client-side trackers may miss server-side tracking occurring at infrastructure levels the CMP does not control. Organizations seeking genuine data protection increasingly recognize that CMPs alone are insufficient and that they must implement additional protective layers including client-side script protection, server-side data governance, and continuous monitoring for unauthorized data flows.
Emerging solutions address these limitations through more comprehensive approaches to data governance. Some organizations are implementing client-side security solutions that provide real-time visibility into what scripts execute on their websites and what data those scripts access and transmit. These solutions create alerts when scripts attempt to exfiltrate data, enabling rapid identification and blocking of unauthorized tracking. This approach represents a shift from static configuration of CMPs toward dynamic monitoring and enforcement of data governance policies throughout the website ecosystem.
Organizations are also increasingly adopting privacy-by-design principles, embedding privacy considerations into website architecture decisions from inception rather than attempting to layer privacy protections onto existing systems. This might involve architectural decisions to minimize what identifying information appears in URLs or form submissions, reducing the data available for tracking systems to capture even if trackers fire. It might involve decisions to process sensitive financial or health-related functions through separate systems with distinct cookie and tracking architectures compared to public-facing informational websites, reducing the mixing of sensitive and non-sensitive data.
Browser vendors continue advancing privacy protections through technical mechanisms that reduce reliance on website-level cookie control. Safari’s default blocking of third-party cookies, Firefox’s Enhanced Tracking Protection, and emerging standards like the Privacy Sandbox initiative aim to reshape the browser environment toward privacy protection by default. However, healthcare and financial organizations cannot assume that user browsers will provide sufficient protection; they must implement organizational-level controls that function regardless of users’ browser privacy settings. A patient accessing a healthcare website through Internet Explorer or an outdated browser version without built-in privacy protections should still be protected by healthcare organization-level cookie control.
Regulatory Trajectory and Future Compliance Requirements
The regulatory environment surrounding cookies and tracking technologies continues evolving rapidly, with emerging requirements and enforcement patterns suggesting that organizations’ compliance obligations will intensify rather than ease. Understanding this trajectory enables organizations to make forward-looking decisions rather than continuously reacting to unexpected regulatory developments.
The convergence of multiple regulatory frameworks suggests that future requirements will exceed current standards. GDPR’s stringent requirements for explicit consent, transparency, and user rights continue setting the international benchmark; EU regulators actively pursue enforcement against organizations falling short of GDPR standards, with fines reaching hundreds of millions for significant violations. The California Privacy Rights Act, effective in 2023, introduced heightened requirements for sensitive personal information including health information and financial information, requiring explicit opt-in consent rather than merely providing opt-out options. If California’s approach spreads to other states—as it appears likely given momentum toward comprehensive state privacy laws—organizations will face a patchwork of jurisdiction-specific requirements that may exceed current federal standards. The FTC has signaled emphasis on enforcement against dark patterns and deceptive privacy practices, suggesting that even technically compliant cookie control mechanisms employing manipulative design will face scrutiny.
HIPAA enforcement specifically appears likely to increase. The OCR has relatively limited resources but has increasingly prioritized online privacy, suggesting that enforcement will intensify in the coming years. State attorneys general, emboldened by the success of enforcement actions against healthcare organizations, appear likely to continue independent actions. Federal legislators periodically consider proposals to strengthen HIPAA or create private rights of action enabling patients to sue for privacy violations, potentially creating additional enforcement pressure. While such legislative proposals have faced industry opposition and have not succeeded to date, the trajectory suggests ongoing pressure to strengthen HIPAA’s enforcement mechanisms.
Financial services regulations similarly appear positioned to strengthen. Congress is actively reviewing the Gramm-Leach-Bliley Act, examining whether it adequately addresses modern data practices and whether it should include a private right of action enabling consumers to sue for violations. Federal banking regulators have emphasized cybersecurity and data security as supervisory priorities, meaning that banking regulators will likely continue pressuring financial institutions to enhance data protection including cookie control. State attorneys general have demonstrated willingness to pursue independent financial privacy enforcement actions, creating pressure to meet or exceed federal standards.
The trajectory of technology may also drive regulatory evolution. As tracking technologies become more sophisticated and data aggregation enables increasingly precise profiling and prediction, regulators may determine that current consent-based frameworks inadequately protect consumers. Future regulations might impose restrictions on certain types of tracking or profiling regardless of consent, or might establish negative rights restricting what organizations can do with tracking data even if users consent to collection. The emerging discussion of AI and algorithmic decision-making in healthcare and finance may generate requirements specifically addressing how tracked data is used in automated decision-making, potentially restricting uses even when data collection is technically authorized.
Organizations planning cookie control strategies should assume that requirements will continue tightening rather than loosening, making forward-looking investments in robust privacy infrastructure more financially prudent than minimal compliance that barely meets current requirements but will require wholesale replacement as standards evolve. Organizations that implement GDPR-level privacy protections for all customers, not just EU residents, position themselves well for future regulatory convergence. Organizations that implement explicit, granular consent mechanisms rather than relying on implied or soft opt-in consent are better positioned for evolving privacy standards. Organizations that implement first-party data strategies rather than becoming dependent on third-party tracking platforms are less vulnerable to regulatory restrictions on third-party tracking.
Securing Your Digital Well-being
The landscape of cookie control and tracking technologies in healthcare and financial services requires recognition that genuine privacy protection extends far beyond deploying cookie banners or implementing basic consent management platforms. The evidence overwhelmingly demonstrates that cookie consent tools, while widely deployed, frequently fail to deliver actual data protection—many organizations display banners while simultaneously allowing trackers to fire, consent tools misidentify or fail to control trackers, dark patterns manipulate users toward acceptance, and third-party platforms continue receiving sensitive information despite apparent consent mechanisms. The cost of this gap between appearance and reality has become concrete: over $100 million in penalties in healthcare alone, regulatory investigations expanding into financial services, and class action litigation creating unpredictable litigation costs.
Healthcare organizations must recognize that HIPAA’s application to cookies and tracking technologies reflects legitimate regulatory judgment that tracking systems readily capture protected health information and create unjustified risks to patient privacy. Rather than attempting to minimize this regulatory burden through narrow technical interpretations, forward-looking healthcare organizations should embrace privacy-protective approaches that eliminate unnecessary tracking, implement rigorous controls over remaining tracking activities, and position themselves as privacy leaders rather than compliance minimalists. Such approaches generate business benefits through enhanced patient trust and differentiation from competitors viewed as less privacy-protective, offsetting the costs of enhanced cookie control implementation.
Financial services organizations should similarly recognize that GLBA and emerging state privacy laws reflect legitimate regulatory judgment that consumers deserve transparency about what personal information flows to third parties and deserve control over such sharing. Rather than minimizing privacy obligations, financially sophisticated organizations should recognize that privacy-protective practices create competitive advantage in financial services, where trust is essential and privacy breaches destroy customer relationships. Organizations perceived as privacy leaders can command pricing premiums and customer loyalty that offset the costs of enhanced cookie control.
The key to moving from compliance theater to genuine privacy protection involves three interconnected elements. First, comprehensive organizational commitment that treats privacy as a business priority rather than a regulatory burden—organizations must allocate adequate budget, technology, and personnel to genuine privacy protection. Second, technical implementation that enforces rather than merely documents consent—CMPs that actually block tracking, monitoring systems that detect unauthorized data flows, and architecture that prevents sensitive information from reaching tracking systems. Third, cultural transformation that ensures privacy considerations influence decision-making throughout organizations—business teams selecting technologies, marketing teams deploying tracking, technology teams implementing systems, and compliance teams overseeing the entire ecosystem all require privacy awareness and accountability.
The future will likely bring additional regulatory pressure, technological evolution that outpaces regulatory frameworks, and increasing sophistication of both tracking and privacy protection technologies. Organizations that treat cookie control as foundational to their privacy strategy rather than as a peripheral compliance obligation position themselves to succeed in this evolving environment. Those that continue treating privacy as a compliance box to check will continue facing the strategic vulnerability evidenced by the multimillion-dollar penalties and reputational damage that have become characteristic of privacy violations in healthcare and financial services.
—
References
The information in this report was informed by analysis of tracking cookie technology, privacy regulations including HIPAA, GDPR, CCPA, and GLBA, recent enforcement actions by regulators and courts, and best practices documentation from privacy technology providers and regulatory agencies. Specific sources examined include the Office for Civil Rights guidance on tracking technologies, court decisions addressing healthcare website tracking, settlement announcements from health plans and healthcare systems, Federal Trade Commission enforcement actions, California Privacy Protection Agency guidance, and technical documentation from consent management platform providers and privacy advocacy organizations.
Protect Your Digital Life with Activate Security
Get 14 powerful security tools in one comprehensive suite. VPN, antivirus, password manager, dark web monitoring, and more.
Get Protected Now
