Are self funded health plan clients subject to compliance audits? Fully insured?
Self-funded plans are undoubtedly subject to compliance audits because they are covered entities. As for fully insured, that’s still a little bit out there—in the past there was a distinction between “hands on” and “hands off” that would allow some employers who were small and fully insured to avoid having to do too much to comply as long as they didn’t have any PHI. That distinction has largely gone away, so it is my belief that more than likely you’re going to see DOL compliance audits include HIPAA privacy-related pieces or a straight HHS audit that would be HIPAA privacy compliant that would apply to any employer sponsoring a health plan.
