HHS Announces Civil Penalties for HIPAA, ACA, and MSP Violations - Bim Group

HHS Announces Civil Penalties for HIPAA, ACA, and MSP Violations

READ TIME: 5 MINUTES

On October 6, 2023, the Department of Health and Human Services (HHS) released inflation-related penalty adjustments for violations of the Health Insurance Portability and Accountability Act (HIPAA), Affordable Care Act (ACA), and the Medicare Secondary Payer (MSP) rules.

These adjusted amounts apply to penalties assessed on or after October 6, 2023, for any violations occurring on or after November 2, 2015.

Health Insurance Portability and Accountability Act (HIPAA)

The penalty amounts related to the HIPAA privacy and security rules are broken down into a four-tiered structure
based on the violator’s intention level.

ACA: Summary of Benefits and Coverage (SBC)

The ACA requires plan sponsors and insurers to provide SBCs to eligible employees and their beneficiaries before enrollment (or re-enrollment) in a group health plan. The maximum penalty for failing to provide an SBC to covered individuals increases to $1,362 (from $1,264).

Medicare Secondary Payer (MSP)

The MSP rules prohibit employers and insurers from offering Medicare beneficiaries financial or other incentives that encourage these beneficiaries to waive or terminate group health plan coverage that would be primary to Medicare. The maximum penalty for failing to comply with these MSP rules increased to $11,162 (from $10,360). Additionally, the maximum penalty for failing to inform HHS when a group health plan is or was primary to Medicare increased to $1,428 (from $1,325).

What Employers Should Do Next

To avoid these penalties, employers should review their plan documents and operations, ensuring compliance with the above HHS-related requirements.

 

This information has been prepared for UBA by Fisher & Phillips LLP. It is general information and provided for educational purposes only. It is not intended to provide legal advice. You should not act on this information without consulting legal counsel or other knowledgeable advisors.

Recent Insights

April 30, 2025
ERISA

When is a Plan an ERISA Plan?

READ TIME: 5 MINUTES Key Takeaways from Hansen v. Laboratory Corporation of America A short-term disability (STD) plan is not automatically covered under ERISA just because it’s included in an employer’s benefits package. Even if an employer treats the plan like an ERISA plan – such as including it in a wrap plan or on […]
Read more
April 30, 2025
News

CMS Updates Simplified Method for Determining Creditable Coverage Status for 2026

  READ TIME: 6 MINUTES This month, the Centers for Medicare and Medicaid Services (CMS) announced final instructions for the changes to Medicare Part D prescription drug coverage mandated by the Inflation Reduction Act of 2022 (IRA) which will affect employer-sponsored plans in 2026. The changes are intended to enhance benefits and offer cost savings […]
Read more
April 7, 2025
News

Impact of Executive Order on Sex and Gender Identity

On January 20, 2025, the Trump administration issued an executive order redefining the terms sex, gender identity, and related concepts as they pertain to federal law and policy. These changes will affect compliance requirements across various employee benefit provisions and related regulations. Key Provisions of the Executive Order Revised Definitions The Executive Order revised the […]
Read more
April 7, 2025
HIPAA

Recent HIPAA Amendments and Proposed Regulations

In the last year, two significant HIPAA regulations were issued, impacting employer group health plans. This article summarizes the new rules – one under the privacy rule provisions and one under the security rule provisions – and what employers need to know about the current legal status of these rules and how to prepare for […]
Read more