Enforcements
Holding health insurers accountable for unfair business practices requires diligence. Physicians must be aware of their contracted rights and hold insurers accountable when those rights are not respected. Learn how the AMA defends physician practices, and how you can defend your practice and your patients.
Complaints about payers or other covered entities’ non-compliance with the Health Insurance Portability and Accountability Act (HIPAA) electronic health care transactions can be submitted in two ways:
- File online through the Office of E-Health Standards and Services (OESS) Administrative Simplification Enforcement Tool (ASET)
- Submit the paper HIPAA non-privacy complaint form, which is available on the Centers for Medicare and Medicaid Services (CMS) website.
Code of Conduct
The AMA House of Delegates has adopted the “Health Insurance Code of Conduct,” consisting of 10 guiding principles critical to patient-centered care. When an insurer pledges to conduct business in adherence to the Code of Conduct, they commit to bringing consistency, accountability and transparency to the health care industry. Learn more about the Code of Conduct, and about how the AMA is seeking insurer buy-in and monitoring adherence to its principles.
Pending actions
The AMA tracks, and sometimes participates in, legal action taken against health insurers in an effort to defend the rights of physicians and patients, as well as to expose insurers’ improper business practices. Learn more about currently pending actions and recent legal activity related to health insurer treatment of physician practices.
Settlement archive
The AMA maintains an online archive of information related to health insurer legal settlements. This archive includes settlement summaries and, when appropriate, contextual explanations of how each settlement protects or otherwise impacts physician practices now and in future dealings with the insurer. Learn more about these past settlements.
Fine updates
The AMA compiles information from state insurance regulatory agencies regarding fines against private health insurers. This information, including descriptions of why each fine was issued and the amount paid, helps physicians better understand the business practices of the insurers with which they contract. Learn more about insurer fines.
Click and Complain
To hold your payers accountable, file your complaint here.
