HIPAA, MSP, and SBC Penalties Indexed as of March 17, 2022

These penalties were indexed in November 2021, but they’re being updated effective March 17, 2022, for violations occurring on/after November 2, 2015.

Regulators also increased the price transparency penalty for hospitals from $304/day maximum fine to $5,500 per day, taking the calendar year max from $100K to over $2 million.  They also increased the $10,000 penalty for a provider’s failure to comply with the No Surprises Act to $10,622.

Assessments on/after Nov 15, 2021 Assessments on/after Nov 15, 2021
HIPAA Privacy & Security violations
  1. Unintentional violations
  2. Due to reasonable cause and not willful neglect
  3. Willful violations corrected within 30 days
  1. Minimum: $120
  2. Minimum: $1,205
  3. Minimum: $12,045
  1. Minimum: $127
  2. Minimum: $1,280
  3. Minimum: $12,794
    • Caps for each violation above
    • Unclear how these published CY caps tie into the 2019 Notice of Enforcement Discretion which should have lowered the CY caps to $25K/$100K/$250K for tiers 1/2/3 above
  • Maximum: $60,226
  • CY cap: $1,806,757
  • Maximum: $69,973
  • CY cap: $1,919,173
  1. Willful violations not corrected within 30 days
  • Minimum: $60,226
  • CY cap: $1,806,757
  • Minimum: $63,973
  • CY cap: $1,919,173
Medicare Secondary Payer (MSP) violations

  1. Employer incenting or coercing someone not to enroll in a group health plan that would be primary to Medicare
  2. Responsible reporting entity (RRE) failing to identify situations where group plan is primary
  1. $9,753
  2. $1,247
  1. $10,360
  2. $1,325
Summary of Benefits and Coverage (SBC) violations
  • $1,190
  • $1,264

 

IMA will continue to monitor regulator guidance and offer meaningful, practical, timely information.

This material should not be considered as a substitute for legal, tax and/or actuarial advice. Contact the appropriate professional counsel for such matters. These materials are not exhaustive and are subject to possible changes in applicable laws, rules, and regulations and their interpretations.

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