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HHS Releases Inflation-Adjusted Federal Civil Penalty Amounts


Posted On 11/28/2018
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http://www.ubabenefits.com United Benefit Advisors (317) 705-1800 support@ubabenefits.com

By Karen Hsu, Director of Compliance at United Benefit Advisors

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.

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