February 18, 2020
After years of review the federal government has issued proposed regulations for assessing Medicare Secondary Payer (MSP) reporting penalties. Also referred to as MMSEA or Section 111 reporting, the MSP reporting process requires defendants to report certain settlements with Medicare beneficiaries to the federal government or face $1,000 per day penalties. The proposed regulations reflect the federal government’s renewed attention to and enforcement of the MSP reporting rules.
The Medicare, Medicaid and SCHIP Extension Act (“MMSEA”) requires defendants and healthcare providers to report certain settlements with Medicare beneficiaries. The MMSEA statute includes a $1,000 per day, per claim penalty for inaccurate or untimely reporting. The draft regulations issued on February 18, 2020 propose guidelines for how and when to assess these penalties. Notably, the federal government’s comments to the proposed regulations explicitly warn of enhanced monitoring of MSP processes. Defendants subject to these reporting requirements should take the steps now to update and formalize their MSP compliance program, including MMSEA reporting processes.
The proposed regulations address topics related to the Section 111 reporting penalties, including:
Comments to the proposed rules are due by April 20, 2020. The federal government will issue final regulations following a comment period. A copy of the proposed regulations can be found at this link: https://federalregister.gov/d/2020-03069
The MMSEA settlement reporting obligations are part of the larger MSP “Medicare lien” recovery process. The federal government uses the data collected from the Section 111 reports to identify settlements with potential Medicare liens, pursue lien recovery/reimbursement, and stop Medicare payments where another entity is responsible for payment.
Nelson Mullins attorneys have extensive experience with MMSEA reporting obligations, Medicare and third-party lien resolution and associated requirements. For additional information or to discuss the proposed rules, please contact Eli Poliakoff or Phillip Mullinnix.
These materials have been prepared for informational purposes only and are not legal advice. This information is not intended to create, and receipt of it does not constitute, an attorney-client relationship. Internet subscribers and online readers should not act upon this information without seeking professional counsel.