Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (“MMSEA”) amended the Medicare Secondary Payer Act (42 U.S.C. Section 1395y) to add mandatory reporting requirements on liability insurers, self-insurers and third-party administrators who pay awards to injured Medicare beneficiaries, whether through settlement agreements or judgments. Effective January 1, 2010, these entities will be required to report certain information on all claimants who are Medicare beneficiaries on or after July 1. Failure to comply with these reporting requirements will result in fines of up to $1,000 per day per claimant. Also, while the reporting requirements are not effective until next year, affected entities must register for online reporting with Medicare by September 30. These reporting requirements, combined with existing rules regarding reimbursement of Medicare liens, require litigants to be particularly diligent when dealing with claimants who are Medicare beneficiaries.
Background of the Medicare Secondary Payer Act
In 1980, Congress enacted the Medicare Secondary Payer Act to help control the rising costs of Medicare and ensure that “primary payers,” including liability insurers and self-insurers, take on the costs of accident-related medical treatment for Medicare beneficiaries. When Medicare makes these payments, it is entitled to reimbursement. Additionally, the act requires a primary payer to place Medicare on notice if it learned that Medicare paid for services for which the primary payer was responsible. Compliance with the reimbursement and notice provisions of the Act has not been consistent, and in December 2007, Section 111 of the MMSEA amended the Act’s notice provisions in an effort to increase compliance with and enforcement of primary payers’ reimbursement obligations.
Section 111′s New Reporting Requirements
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