Skip to main content

Annual Increase to Penalty Amounts for Compliance Violations

The Department of Health and Human Services has announced its annual adjustments to civil monetary penalties for HIPAA Administrative Simplification, Medicare Secondary Payer and Summary of Benefits and Coverage violations. The charts below summarize these amounts, which are effective for penalties assessed on or after November 5, 2019, for violations occurring on or after November 2, 2015.

 

HIPAA Administrative Simplification

Penalties for violations of privacy, security, breach notification, and electronic health care transactions

Tier Level

Minimum Penalty

Maximum Penalty

Calendar Year Cap

Tier One (Lack of Knowledge)

$117 (up from $114)

$58,490 (up from $57,051

$1,754,698 (up from $1,711,533)

Tier Two (Reasonable Cause and Not Willful Neglect)

$1,170 (up from $1,141)

$58,490 (up from $57,051)

$1,754,698 (up from $1,711,533)

Tier Three (Willful neglect corrected within 30 days)

$11,698 (up from $11,410)

is $58,490 (up from $57,051)

$1,754,698 (up from $1,711,533)

Tier Four (Willful neglect not corrected within 30 days)

$58,490 (up from $57,051)

$1,754,698 (up from $1,711,533)

$1,754,698 (up from $1,711,533)

 

Medicare Secondary Payer

Penalties for incentivizing individuals to enroll in Medicare

Type of Violation

Penalty Amount

Penalty for offering incentives to Medicare-eligible individuals not to enroll in a plan that would otherwise be primary

$9,472 (up from $9,239)

Penalty for willful or repeated failure to provide requested information regarding group health plan coverage

$1,542 (up from $1,504)

Penalty for responsible reporting entities that fail to provide information identifying situations where the group health plan is primary

$1,211 (up from $1,181)

 

Summary of Benefits and Coverage (SBC)

Penalties for failing to provide participants with an SBC before enrollment or re-enrollment in a group health plan

Type of Violation

Penalty Amount

Willful Failure to provide an SBC

$1,156 (up from $1,128) for each failure

 

This content is being provided as an informational tool. It is believed to be accurate at the time of posting and is subject to change. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this information, Meritain Health® is not exercising discretionary authority or assuming a plan fiduciary role, nor is Meritain Health providing legal advice.