Envista Forensics

CMS Moves Forward With Hefty Civil Monetary Penalties For Noncompliance

 Thursday, February 9, 2023

 CLM Magazine

Primary workers’ compensation, general liability, and no-fault claims payers should be on alert for civil monetary penalties of up to $1,000 per day, per claim, which will be issued against noncompliant claims payers beginning spring 2023.

On Feb. 18, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a Notice of Proposed Rulemaking regarding scenarios in which civil monetary penalties (CMPs) for noncompliance with Medicare, Medicaid, and SCHIP Extension Act (MMSEA) Section 111 reporting could be issued against non-group health plans (NGHPs, which include workers’ compensation, general liability, and no-fault payers/plans, including self-insurance).

The comment period closed in April 2020, and comments submitted in response to the proposed rule are currently being reviewed by CMS.

The Office of Management and Budget website indicates that the rule will be finalized by Feb. 18, 2023, as MMA Sec. 902 requires Medicare to publish final rules within three years of a proposed or interim final rule.

The final rule will likely not become effective until at least 30 days after it is published in the Federal Register. Thus, one can speculate that the property and casualty industry is about one year out from a final rule on CMPs, and once the final rule is published, CMS may begin penalizing noncompliant workers’ compensation, general liability, and no-fault responsible reporting entities (RREs).
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