Oct 20, 2023
Department of Health and Human Services (HHS) Announces Civil Monetary Penalties for Certain Violations Effective October 6, 2023
HHS, Annual Civil Monetary Penalties Inflation Adjustment, 45 CFR Part 102, 88 Fed. Reg.69531 (Oct. 6, 2023)
HHS announced adjustments of civil monetary penalties for statutes within its jurisdiction. The latest amounts are based on a cost-of-living increase of 1.07745%. The adjustments are effective for penalties assessed on or after October 6, 2023, for violations occurring on or after November 2, 2015.
HIPAA Administration Simplification
This category encompasses standards for privacy, security, breach notification, and electronic health care transactions.
Tier 1—lack of knowledge
| Prior to 10/6/2023 | Effective 10/6/2023 | |
|---|---|---|
| Minimum Penalty | $127 | $137 |
| Maximum Penalty | $63,973 | $68,928 |
| Calendar Year Cap | $1,919,173 | $2,067,813 |
Tier 2—reasonable cause and not willful neglect
| Prior to 10/6/2023 | Effective 10/6/2023 | |
|---|---|---|
| Minimum Penalty | $1,280 | $1,379 |
| Maximum Penalty | $63,973 | $68,928 |
| Calendar Year Cap | $1,919,173 | $2,067,813 |
Tier 3—willful neglect, corrected within 30 days
| Prior to 10/6/2023 | Effective 10/6/2023 | |
|---|---|---|
| Minimum Penalty | $12,794 | $13,785 |
| Maximum Penalty | $63,973 | $68,928 |
| Calendar Year Cap | $1,919,173 | $2,067,813 |
Tier 4—willful neglect, not corrected within 30 days
| Prior to 10/6/2023 | Effective 10/6/2023 | |
|---|---|---|
| Minimum Penalty | $63,973 | $68,928 |
| Maximum Penalty | $1,919,173 | $2,067,813 |
| Calendar Year Cap | $1,919,173 | $2,067,813 |
Medicare Secondary Payer (MSP)
This statute prohibits a group health plan from ‘taking into account’ the Medicare entitlement of a current employee or a current employee’s spouse or family member and imposes penalties for violations.
- Offering incentives to Medicare-eligible individuals not to enroll in a plan that would otherwise be primary: $11,162 (up from $10,360).
- Failure of responsible reporting entities to provide information identifying situations where the group health plan is primary: $1,428 (up from $1,325).
Summary of Benefits and Coverage (SBC)
An SBC must be provided to participants and beneficiaries before enrollment or re-enrollment in a group health plan.
- The penalty for a health insurer’s or non-federal governmental health plan’s willful failure to provide an SBC is $1,362 (up from $1,264) for each failure.
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