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HIPAA Administrative Simplification

The Department of Health and Human Services (HHS) has now released a interim final rule that increases the maximum Civil Monetary Penalty (CMP) amounts for those agencies that are within the HHS. This was an action that was required by the Federal Civil Penalties Inflation Adjustment Act Improvements Act of 2015, and apart from the demand to make yearly updates to CMPs, aimed to account for inflation.

The final rule will be increasing the CMP amounts and this is to reflect the fact that majority of the CMPs have not changed in the last years and are not adjusted for inflation.

Before the final rule, penalties were not adjusted and this rule adjusts the most recent penalties that were established in 2015, by just one percent; though older penalties were increased by almost 150 percent. Experts say that these penalties would affect a wide range of issues that include failure to provide the required certifications, deliberately providing false claims, misuse of information, and violations of HIPAA Administrative Simplification.

HHS usually reaches a financial settlement before going for maximum penalties. As an example, the Office of the Inspector General (OIG) declared earlier this month that they had reached a $100,000 settlement with some medical billing company in New Jersey for manipulating the Medicare claims to bill Medicare for some medical services that were not provided.

Medical Billing Outsourcing Companies
HHS Office Of The Inspector General

HHS has also increased the penalty for a competitive medical plan or HMO that make use of practices to decrease the enrollment of individuals needing services in future. As per the changes, hospitals with hundred beds or more will now face penalties higher than $103,000 if they deliberately dump those patients who need emergency medical care. This penalty is up from the $50,000 penalty that was established in 1987.

Some of the penalties are relatively small though, like the penalty for payments by Critical Access Hospitals to make physicians decrease or limit the services to patients under their direct care, or those who are entitled to get some medical help. This penalty increased 115 percent from $2,000 to $4,300.

The renewed CMP amounts came to effect with the release of the interim final rule on September 6, 2016.

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