Countdown to CMS Enforcement: CMS to Begin Issuing Section 111 Civil Money Penalties
A critical date for compliance has arrived. In just a few days, beginning on October 11, 2025, the Centers for Medicare & Medicaid Services (CMS) will begin auditing workers’ compensation, general liability, and no-fault claims payers for noncompliance with Section 111 Medicare Reporting requirements. Specifically, the auditing will cause CMS to enforce civil money penalties (CMPs) against Responsible Reporting Entities (RREs) that fail to timely report Medicare beneficiary claims and settlements via Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 as outlined within the Final Rule.
CMS’ Final Rule became applicable on October 11, 2024, meaning that settlements (Total Payment Obligation to the Claimant, or TPOC) and/or claim acceptances (Ongoing Responsibility for Medicare, or ORM) made on or after October 11, 2024 must be reported via the RRE’s Section 111 reporting within 365 days. If such reporting does not occur within the first 365 days, the RRE is subject to civil money penalties of up to $1,474 ($1,000 per day per claim adjusted for inflation) per day per untimely Medicare beneficiary record.
Now that we are almost 365 days removed from the applicability date, CMS may finally begin to enforce late TPOC and ORM acceptance reporting. CMS’ website suggests that even though CMS may begin to issue civil money penalties as early as October 11, 2025, the first round of civil money penalties may not actually be issued until January of 2026: https://www.cms.gov/medicare/coordination-benefits-recovery/mandatory-insurer-reporting-nghp/nghp-civil-money-penalties/.
Sanderson Firm PLLC exclusively specializes in Medicare Secondary Payer compliance and provides both Section 111 reporting services as well as Section 111 audits for RREs. If your organization is in need of a Section 111 reporting solution designed to protect you from civil money penalties, please contact us to discuss our SandersonComply reporting and audit solutions.
