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) | $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 willful or repeated failure to provide requested information regarding group health plan coverage | $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.