HHS Releases Inflation-Adjusted Federal Civil Penalty Amounts
The Department of Health and Human Services (HHS) issued its Annual Civil Monetary Penalties Inflation Adjustment. Here are some of the adjustments:
- Medicare Secondary Payer:
- For failure to provide information identifying situations where the group health plan is primary, the maximum penalty increases from $1,157 to $1,181 per failure.
- For an employer who offers incentives to a Medicare-eligible individual to not enroll in employer sponsored group health that would otherwise be primary, the maximum penalty increases from $9,054 to $9,239.
- For willful or repeated failure to provide requested information regarding group health plan coverage, the maximum penalty increases from $1,474 to $1,504.
- Summary of Benefits and Coverage: For failure to provide, the maximum penalty increases from $1,105 to $1,128 per failure.
- Health Insurance Portability and Accountability Act (HIPAA):
|
Tier |
Penalty |
| 1. Did Not Know: Covered entity or business associate did not know (and by exercising reasonable diligence would not have known) that it violated the provision of the Administrative Simplification regulations. |
$114 – $57,051 for each violation, up to a maximum of $1,711,533 for identical provisions during a calendar year. |
| 2. Reasonable Cause: The violation was due to reasonable cause and not to willful neglect. |
$1,141 – $57,051 for each violation, up to a maximum of $1,711,533 for identical provisions during a calendar year. |
| 3. Willful Neglect – Corrected: The violation was due to willful neglect, but the violation is corrected during the 30-day period beginning on the first date the liable person knew (or by exercising reasonable diligence would have known) of the failure to comply. |
$11,410 – $57,051 for each violation, up to a maximum of $1,711,533 for identical provisions during a calendar year. |
| 2. Willful Neglect – Not Corrected: The violation was due to willful neglect and the violation is not corrected as described in Tier 3. |
$57,051 minimum for each violation, up to a maximum of $1,711,533 for identical provisions during a calendar year. |
The adjustments are effective for penalties assessed on or after October 11, 2018, for violations occurring after November 2, 2015.