HHS recently announced inflation-adjusted penalty amounts related to Summary of Benefits and Coverage (SBC), Medicare secondary payer (MSP) and HIPAA privacy and security rules violations. These new penalty amounts are calculated based on a cost-of-living increase of 1.01182%. The new amounts are applied to penalties assessed on or after November 15, 2021, for violations occurring on or after November 2, 2015.
Summary of Benefits and Coverage (SBC)
The ACA requires insurers and group health plan sponsors to provide SBCs to eligible employees and their beneficiaries before enrollment or re-enrollment in a group health plan. The maximum penalty for a health insurer or plan’s failure to provide an SBC increased from $1,176 to $1,190 per failure.
Medicare Secondary Payer (MSP) rules
HHS Administrative Simplification
The HIPAA administrative simplification regulations provide standards for privacy, security, breach notification and electronic health care transactions to protect the privacy of individuals’ health information.
The penalty amounts vary depending on the violators’ level of intentions and situations broken down by HIPAA’s four-tiered penalty structure. The below chart summarizes the new and prior penalty amounts.
With this latest increase in penalties, employers may want to review their compliance on SBC, MSP and HIPAA along with other employee benefits compliance requirements to help prevent agency audits and potential penalties.
HHS, Adjustment of Civil Monetary Penalties for Inflation and the Annual Civil Monetary Penalties Inflation Adjustment for 2021 »
PPI Benefit Solutions does not provide legal or tax advice. Compliance, regulatory and related content is for general informational purposes and is not guaranteed to be accurate or complete. You should consult an attorney or tax professional regarding the application or potential implications of laws, regulations or policies to your specific circumstances.
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