CMS Final Rule and Section 111 Noncompliance: Reporting Obligations; Audit Methodology; Costly CMPs; Safe Harbor

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Course Details

Course Information

smart_display Format
On-Demand
signal_cellular_alt Difficulty Level
Intermediate
work Practice Area
Health

Date & Time

event Date
Wednesday, January 31, 2024
schedule Time
1:00 p.m. ET./10:00 a.m. PT
timer Program Length
90 minutes

Credit Information

This 90-minute webinar is eligible in most states for 1.5 CLE credits.

$297.00

This CLE webinar will guide practitioners through CMS' recently released final rule implementing civil money penalties (CMPs) for failure to comply with MMSEA Section 111 reporting. The CMP Rule, "Medicare Secondary Payer and Certain Civil Money Penalties," has an effective date of Dec. 11, 2023 and an applicability date on or after Oct. 11, 2024. The CMPs levied may exceed $365,000, as adjusted annually for inflation, for each incident of non-reporting.

Faculty

Catherine E. Goldhaber

Partner-in-Charge

Hawkins Parnell & Young

Ms. Goldhaber defends claims related to product liability, exposure to toxic substances and transportation-related injuries. She handles matters directly in Illinois and Michigan and manages multi-state litigation as national coordinating and trial counsel. Ms. Goldhaber counsels clients in Medicare Secondary Payer (MSP) issues, particularly as the issues arise throughout discovery and in resolution.

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Barrye Panepinto Miyagi

Partner, Practice Leader Medicare Secondary Payer Compliance Group

Taylor, Porter, Brooks & Phillips LLP

Ms. Miyagi advises clients in liability, workers’ compensation, and no-fault matters on MSP compliance-related settlement and trial strategy. She also assists defendants and insurers in evaluating all aspects of mandatory reporting under the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007. Ms. Miyagi has authored MSP compliance best practices for Fortune 500 companies, served as lead MSP compliance counsel in large, multiparty cases, and represented clients on MSP compliance issues in federal and state courts. She and her team resolve MSP issues in single plaintiff and multi-party cases. Ms. Miyagi also handles MSP global lien resolutions on behalf of her clients who seek an efficient means of resolving Medicare and Medicare Advantage Plan interests in mass tort settlements. She has over 30 years of litigation experience defending mass tort and other personal injury cases. Ms. Miyagi has handled large-scale litigation and settlement dockets. She works with plaintiff and defense firms across the nation to establish MSP-compliant settlements. As a result of her experience, Ms. Miyagi brings a unique perspective to MSP compliance issues and is an asset to her clients who seek guidance on all aspects of claim resolution. She is a frequent speaker on MSP Compliance and has presented to the Defense Research Institute, the National MSP Network, RISE, and the Federal Bar Association to name a few.

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Description

The recently released CMP Rule, "Medicare Secondary Payer and Certain Civil Money Penalties," describes CMS' audit methodology, discusses how and when CMPs are imposed, and establishes CMP amounts and methods for calculation. The final rule also provides safe harbor provisions, describes governing time periods, and addresses the notice and appeals process.

The panel will discuss under what circumstances CMS may impose CMPs on responsible reporting entities (RREs) who do not comply with Section 111 reporting obligations, as well as how CMPs are calculated. This discussion will include potential exceptions to Section 111 reporting, CMS audit methodology, safe harbor provisions, and best practices for compliance. The panelists will also address potential risks to Medicare beneficiaries who fail to communicate with Medicare in regard to reported claims.

Pursuant to the MSPA, Medicare is the secondary payer in all cases where another payer, either a group health plan (GHP) or non-group health plan (NGHP) (collectively, RREs), has responsibility for a Medicare beneficiary's medical bills. GHPs who provide medical insurance to beneficiaries are required to Section 111 report coverage to assist Medicare with coordination of benefits. NGHPs have two separate and distinct reporting obligations: (1) where the NGHP assumes ongoing responsibility for medicals (ORM) and the RRE learns, through normal due diligence, that the beneficiary has received (or is receiving treatment), ORM must be reported; and (2) where there is a payment obligation through settlement, judgment, or otherwise to a beneficiary and the beneficiary has alleged and/or released medical expenses, the NGHP must Section 111 report the total payment obligation to claimant (the TPOC).

Listen as our expert panel guides practitioners through CMS' final rule and the consequences for not complying with Section 111 reporting obligations. The panel will describe who is covered by the rule and provide best practices for compliance in order to mitigate the risk of penalties. Attendees will have the opportunity to ask questions during the presentation.

Outline

Section 111 overview and background
- MSPA
- Section 111 of MMSEA
- The SMART Act
Final rule including modifications from the proposed rule
- Purpose
- Covered entities/RREs
  - GHPs
  - NGHPs
- Compliance
- Audit methodology
- Violations
- Penalties
- Reporting exceptions and safe harbor provisions
- Governing time periods including statute of limitations
- Notice and appeals process
Best practices for compliance