Department of Labor Implements Program to Audit Health Plans


The U.S. Department of Labor is in the process of conducting welfare plan audits designed to verify compliance with various laws including ERISA, the Patient Protection and Affordable Care Act, and the provisions of HIPAA that relate to requirements other than privacy and security of health information (for example, nondiscrimination (including in connection with wellness programs) and special enrollment rights). A sample of a specific document request the DOL is using in connection with these audits is available here (PDF).

Typically, the ability to respond quickly and efficiently to such a request with adequate and accurate documentation will assist in achieving a speedy and favorable audit. As you would expect, generally, we have found it very helpful in the past for a plan sponsor to maintain a binder (or CD) to keep all of this information together and labeled. We recommend sponsors of health plans use the document request provided as a checklist to review their health plan documents with respect to the matters described in the DOL’s current audit program.

In addition, the DOL through the Employee Benefits Security Administration has prepared and made available on its website two compliance tools in question and answer format for use by health plan sponsors to determine if their plans are in compliance with Part 7 of ERISA, one relating to HIPAA and certain other health care-related provisions (available here (PDF)) and the other relating to the Affordable Care Act (available here (PDF)).

The publications contained in this site do not constitute legal advice. Legal advice can only be given with knowledge of the client's specific facts. By putting these publications on our website we do not intend to create a lawyer-client relationship with the user. Materials may not reflect the most current legal developments, verdicts or settlements. This information should in no way be taken as an indication of future results.

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