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

Recording of a 90-minute CLE video webinar with Q&A

This program is included with the Strafford CLE Pass. Click for more information.
This program is included with the Strafford All-Access Pass. Click for more information.

Conducted on Wednesday, January 31, 2024

Recorded event now available

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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.


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.



  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


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?


Goldhaber, Catherine
Catherine E. Goldhaber

Hawkins Parnell & Young

Ms. Goldhaber defends claims related to product liability, exposure to toxic substances and transportation-related...  |  Read More

Miyagi, Barrye
Barrye Panepinto Miyagi, JD, CMSP-F

Partner, Practice Leader Medicare Secondary Payer Compliance Group
Taylor, Porter, Brooks & Phillips

Ms. Miyagi advises clients in liability, workers’ compensation, and no-fault matters on MSP compliance-related...  |  Read More

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