"Looming Reporting Requirements for Settlements Involving Medicare Beneficiaries: Are Even Bigger Changes on the Horizon?"

Jeff Stinson provides a comprehensive overview of 2024 changes to Section 111 reporting requirement for settlements involving Medicare beneficiaries as well as increased enforcement efforts by the Centers for Medicare & Medicaid Services (CMS) in the form of civil monetary penalties.

“It would appear as if CMS is also trying to obtain more data as to how many claims are being settled without CMS-approved MSAs, including nonsubmit or evidence-based MSAs, so that it can potentially develop more stringent requirements on carriers in the future, all in the guise of protecting the trust,” reasoned Stinson.

Although, CMS may face challenges in expanding its authority in the wake of the Loper Bright decision which overruled the decision in Chevron in which a federal agency’s interpretation of the law must be upheld so long as it was a reasonable interpretation and Congress had not addressed the issue specifically.

“While the Medicare Secondary Payer Act (MSPA )is federal law, CMS has published its own administrative guidance with its own interpretation of the statute and continually provides updates,” said Stinson. “In light of Loper Bright, CMS’ interpretation of the MSPA is subject to greater challenge, which could lead to further legislation.”

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