CMS to enforce MMSEA 111 reporting compliance beginning October 2025

Beginning October 11, 2025, failure to comply with the statutory obligation that most insurers of medical claims (including self-insured entities) have to report claims under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA 111) may result in the imposition of civil monetary penalties (CMPs). While this development does not change the existing federal False Claims Act liability risk for causing Medicare to overpay claims because of MMSEA 111 reporting errors, the addition of CMPs for MMSEA 111 noncompliance marks a significant shift in the MMSEA 111 risk profile for insurers, self-insured entities, and third-party administrators that are required to report under MMSEA 111. Stakeholders in the liability, no-fault, workers’ compensation, and group health plan spac