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DOL Audits Are on the Rise

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As demonstrated by the Biden administration’s recent release of a new COVID-19 action plan, the U.S. government and regulators play a significant role in shaping the behaviors and policies of employers. With the administration aiming to significantly boost the Department of Labor’s (DOL’s) funding for 2022 and over the next 10 years, more DOL audits could be on the horizon for employers. And if employers are not prepared, a DOL audit or investigation carries significant risk.

More DOL Audits: Increased Risk of a Costly Nightmare

The Employee Benefits Security Administration (EBSA), an agency of the DOL, is responsible for ensuring the security and integrity of private employee benefits plans in the United States. The EBSA does this in a variety of ways, including enforcement mechanisms such as audits. When a health plan is audited, typically there isn’t much advance notice, and organizations cannot stop an audit, whether it is random or for a specific reason. If an audit uncovers violations, then corrective action may be required. Such action may include paying penalties or reprocessing claims.

Additionally, with the increase in legislation and regulations affecting health plans, EBSA audits have increased in scope. With more than 20 primary categories, they now include compliance with ERISA, ACA, and MHPAEA, among others. They also typically take months, if not years, to complete.

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