Medicare Section 111 Reporting CMPs Are Real: Sanderson Firm Engaged to Defend Against Initial CMPs
The threat of Civil Money Penalties (CMPs) has long loomed over the insurance industry since the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) established Section 111’s mandatory reporting requirements and statutory penalties. For years, however, the prospect of actual CMP enforcement existed largely as an “old wives’ tale,” much like the warnings we heard as children: don’t stay out after dark, don’t trust strangers, and, for those in the insurance industry, make sure you are meeting your Section 111 reporting obligations under the MMSEA.
That started to change when the Centers for Medicare & Medicaid Services (CMS) issued its final rule governing CMPs. Published on October 11, 2023, the rule became applicable October 11, 2024. For the first time, the previously abstract threat of CMPs became a defined framework, process, and practical application came into clearer focus. You can read more about the specifics of the final CMP rule, including how CMS calculates potential penalties, identifies noncompliance, and conducts its audits, in our previous blog.
CMS completed its initial CMP audits in the first and second quarters of this year, and the day the insurance industry had been warned about is upon us: CMS has issued its first CMS informal notices. Receipt of a CMP notice, however, is not the conclusion of a cautionary tale. Instead, it is the beginning of an opportunity to challenge, defend, or, if appropriate, mitigate the proposed penalty.
Current Engagement and The Sanderson Firm Difference
In addition to being known for our expert witness work defending against active False Claims Act or double damages litigation involving Medicare Secondary Payer (MSP) issues, Sanderson Firm’s preeminent MSP attorneys are presently engaged in helping clients navigate and defend against CMPs via CMPComply, which we launched earlier this year in anticipation of CMS issuing just such notices and penalties.
For example, this week we were engaged to work on a “Informal Notice-Intention to Impose a Civil Money Penalty” which was issued to an insurance carrier by CMS. This is the first stage of the CMP process, and we will work with our client throughout the entire CMP process to hopefully eliminate or significantly reduce the imposition of the CMP and provide mitigating evidence to CMS. The client received the notice just last week, so in fact, CMPs are real and are starting to spread.
By aiding clients in investigating the facts surrounding the record at issue, building a strong defense, and ensuring CMS gets the full and accurate picture before any final decision is made with respect to the imposition of a proposed CMP amount, Sanderson Firm is proud to be a prepared and trusted partner selected to stand with our clients in these initial rounds of CMPs.
As a dedicated MSP compliance law firm, Sanderson Firm is uniquely positioned to guide responsible reporting entities (RREs) through the CMP audit and appeal process. Our expert attorneys provide timely navigation and zealous advocacy through the informal and formal appeals process. Retracing and defending claims handling decisions while identifying safe harbors and mitigating evidence. Sanderson Firm does not need to be your Section 111 reporting agent to assist with the CMP process and our current caseload consists of clients where we are not their designated vendor.
To learn more about our CMPComply service, our Section 111 mandatory insurer reporting services, or how our team of experts can assist you with all aspects of MSP compliance, please Contact Us.