Group Health Plans Undergo Strenuous Labor Department Audits

The U.S. Department of Labor’s Employee Benefits Security Administration (EBSA) has expanded its compliance review regimen to include a review of compliance with the Patient Protection and Affordable Care Act (ACA), the Genetic Information Nondiscrimination Act (GINA), and wellness programs.   As a result, EBSA has broadened the list of documents it requests during a compliance review. EBSA auditors are looking for information and documentation concerning the ACA’s employer shared responsibility requirement and other provisions of the health care reform law.  Specifically, they are looking for information such as the plan’s grandfather status, coverage for adult children, lifetime and annual limits, and claims and appeals procedures. Wellness plans are also being reviewed.  For example, EBSA wants to see how wellness programs are designed along with the required notices that have to be provided with the programs.  These reviews will allow EBSA an inside look at how employers are complying with the laws the agency is tasked to enforce. For a sample audit letter and to see the list of requested documents, click here.