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The Department of Health and Human Services (HHS) announced its annual inflation-related adjustments to civil monetary penalties for 2021 pursuant to the final rule issued November 15, 2021. The adjustments in the rule are effective for penalties assessed after November 15, 2021, for violations occurring on or after November 2, 2015. The final rule includes the indexed penalty amounts for Health Insurance Portability and Accountability Act (HIPAA) violations, Medicare Secondary Payer violations, and Summary of Benefits and Coverage (SBC) violations.
The HIPAA violations minimum and maximum amounts, and calendar year caps for multiple violations of the same provisions are updated to:
- Tier 1 (lack of knowledge) – minimum penalty is $120, maximum penalty is $60,226, and calendar year cap is $1,806,757.
- Tier 2 (reasonable cause and not willful neglect) – minimum penalty is $1,205, maximum penalty is $60,226, and calendar year cap is $1,806,757.
- Tier 3 (willful neglect, corrected within 30 days) – minimum penalty is $12,045, maximum penalty is $60,226, and calendar year cap is $1,806,757.
- Tier 4 (willful neglect, not corrected within 30 days) – minimum penalty is $60,226, maximum penalty is $1,806,757, and calendar year cap is $1,806,757.
Penalty amounts for violations of the Medicare Secondary Payer rules are updated to:
- Offering incentives to Medicare-eligible individuals not to enroll in a plan that would otherwise be primary – $9,753.
- Failure of responsible reporting entities to provide information identifying situations where group health plan is primary – $1,247.
The willful failure of an insurer or plan sponsor to provide an SBC to participants and beneficiaries is updated to $1,190 for each failure.
The final rule, published in the Federal Register, includes a table for all civil monetary penalty authorities administered by HHS.
