Insurers' Reporting Obligations Under Medicare Medicaid SCHIP Extension Act

Complying with MMSEA Requirements for Non-Group Health Plan Payers

Are you ready for the looming deadline?

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

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Conducted on Thursday, September 22, 2011

Recorded event now available

or call 1-800-926-7926
Course Materials

This CLE course will provide counsel with an overview of MSP and MMSEA obligations for insurers and self-insured entities. The panel will outline an effective compliance program to minimize liability for Medicare repayment obligations and discuss the impact of the MMSEA on the defense of general liability claims.


The Medicare Medicaid and SCHIP Extension Act was enacted to close loopholes in Medicare Secondary Payer laws. The Act requires insurers and self-insured entities that make medical payments to Medicare-eligible recipients to report detailed information to CMS when the claim is resolved.

If the MSP repayment is not resolved, the government can sue the insurer. Penalties for noncompliance are steep—double damages and $1,000 per day fines. While reporting obligations are on the payer, it is unclear whether defense counsel can be held responsible for repayment.

Defense counsel must determine through discovery whether plaintiff is or may become Medicare-eligible during the litigation. Counsel can minimize liability for repayment obligations through settlement indemnification provisions and other proactive measures.

Listen as our authoritative panel of attorneys discusses the new reporting requirements of the MMSEA and what steps insurance companies, self-insured companies and their counsel should take to ensure compliance and minimize liability.



  1. Overview of MSP and MSSEA Act
    1. Medicare Secondary Payer Act
    2. Medicare, Medicaid and SCHIP Extension Act
      1. Types of claims covered
      2. Covered entities
      3. Role of third-party administrators
      4. Entities obligated to make MSP reimbursement
  2. MMSEA reporting obligations
    1. Claimant data
    2. Injury/claim data
    3. Obtaining necessary reporting data
    4. Determining eligibility for Medicare
    5. Claims submission process
    6. Timing of reporting obligation
    7. Fines and penalties
  3. Compliance measures
    1. Reporting processes and systems
    2. Medicare set-aside arrangements
    3. Indemnification provisions
    4. Third-party checks to CMS


The panel will review these and other key questions:

  • What must insurance companies and self-insured entities do to ensure compliance with the MMSEA's reporting mandates?
  • Do the reporting requirements of the MMSEA apply to third-party administrators?
  • How should counsel structure settlements to comply with the MMSEA?
  • What are counsel's obligations under the MMSEA?
  • What are the implications of the U.S. v. Stricker case on the government's ability to recover under the Medicare Secondary Payer Act?

Following the speaker presentations, you'll have an opportunity to get answers to your specific questions during the interactive Q&A.


W. Randall (Randy) Bassett
W. Randall (Randy) Bassett

King & Spalding

He is a partner with the firm’s Product Liability Practice where he has over 15 years experience representing...  |  Read More

Tara Kelly
Tara Kelly
BP America

She is an attorney in the Litigation Group at BP America and handles commercial and tort claims associated with the...  |  Read More

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