Corporate Compliance

Q&A: How CMS responds to HIPAA complaints

Compliance Monitor, November 11, 2009

 Q: How does CMS handle a Health Insurance Portability and Accountability Act (HIPAA) complaint once received?

A: Upon receipt of a complaint, CMS will notify the filed against entity of the complaint, and provide them with an opportunity to demonstrate compliance, or to submit a corrective action plan. CMS has the discretion to conduct compliance reviews or on-site evaluations of covered entities' procedures to verify that they are compliant with the standard transactions or use the national identifiers. CMS also has the authority to impose financial penalties on any entity that is not compliant and has failed to correct their systems.

This Q&A is adapted from the CMS FAQ website page. To view this and other FAQs click here.

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