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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
CLE
ALL

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

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

Benefits

The panel will review these and other important considerations:

  • How does the final rule differ from the proposed rule?
  • Who are RREs?
  • Under what circumstances are CMPs imposed and how are they calculated?
  • What are the safe harbor provisions described in the final rule?
  • What is the appeal process when CMPs are imposed?
  • What does this mean for plaintiff attorneys?