CMS’ Civil Money Penalty Webinar Recap: Enforcement Timelines and Compliance Expectations

On January 15, 2026, the Centers for Medicare & Medicaid Services (CMS) hosted a webinar regarding Civil Money Penalties (CMPs) which may be issued due to a Responsible Reporting Entity’s (RRE) non-compliance with Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007. CMS has hosted several CMP-related webinars since the Final Rule became effective on December 11, 2023, and this most recent webinar provided industry stakeholders with the following new and existing major takeaways:

New Takeaways:

1. CMS will delay CMPs for workers’ compensation settlements/TPOCs until July 2026.

• On April 4, 2025, CMS expanded Section 111 reporting to require workers’ compensation RREs to report seven (7) new Workers’ Compensation Medicare Set-Aside (WCMSA) data fields through Total Payment Obligation to Claimant (TPOC) reporting. Due to this significant policy change, and consistent with the Final Rule and federal regulations regarding alterations to required Section 111 reporting data elements (§ 402.1(c)(21)(ii)(A)) and (c)(22)(ii)(C)), CMS will not apply CMPs for workers’ compensation TPOCs until July 2026. It is unclear how the July 2026 date was calculated, but CMS is prohibited from assessing CMPs associated with a specific reporting change for a minimum of two (2) reporting periods.

• While CMS generally referenced workers’ compensation “records” (which would broadly include Ongoing Responsibility for Medicals (ORM) and TPOC records) as not being subject to CMPs until July 2026, CMS’ PowerPoint slides only referenced the delayed CMPs as relating to workers’ compensation TPOCs and at one point verbally referenced the delay as only applying to workers’ compensation TPOCs. As such, we believe CMS only intends to suspend workers’ compensation TPOCs from CMPs, meaning workers’ compensation RREs would still be subject to CMPs on their ORM records.

2. In the event that your organization receives CMP correspondence and does not file an appeal or unsuccessfully exhausts all appeal rights, the CMP must be paid electronically at www.pay.gov.   

• Webinar participants immediately expressed concern with this electronic payment method, referencing prior issues with submitting payments through the federal government’s online payment portal. In response, CMS officials referenced an executive order (likely, Executive Order 14247, Modernizing Payments To and From America’s Bank Account – signed on March 25, 2025) which requires payments to the federal government to be made electronically. There are certain limited exceptions (e.g., lack of access to banking, undue hardship, national security, etc.), but it does not appear that RREs would readily qualify under such exceptions.

Previously Known / Re-Confirmed / Clarified Takeaways:

3. CMS anticipates that it will complete its first quarterly audit of 250 records in February 2026, meaning that the earliest estimated mailing of Informal Notice of CMPs to alleged non-compliant RREs will occur in March 2026.

• CMPs became applicable on October 11, 2025. For TPOC and assumption of ORM events occurring on or after this date, RREs are expected to report such events within 365 days. CMS’ first quarterly audit window will include records from the 4th quarter of 2025 (after October 11, 2025).  

• CMS representatives further confirmed that CMS “plan[s] to” publish statistics regarding CMP enforcement, but statistics may be delayed to account for the completion of the appeals process.

• Adjustments for inflation will be locked in based on the date of audit. Therefore, if inflation adjustments change between the quarterly audit date and the civil money penalty date, the CMP amount will be calculated based on the inflation adjustment at the time of the original quarterly audit.

4. CMS will send CMP correspondence (e.g., Informal Notice of CMP) to your Account Representative (AR) and Account Manager (AM) of record; your Reporting Agent will not automatically receive CMP correspondence.

• To the extent that your AR and/or AM are individuals who are unaware of CMPs or lack a general understanding of Medicare Secondary Payer compliance, now is the time to educate your AR and/or AM about CMPs or designate different individuals to these positions. If CMP correspondence is ignored due to your AR and AM failing to appreciate the significance of the correspondence or naturally assuming that some other department (or their Reporting Agent) would have received and be handling the CMP correspondence on their behalf, your organization will be fully responsible for the resulting CMP with no opportunity for appeal.

5. State laws or ethics provisions regarding contacting claimants / plaintiffs who are represented by an attorney are not applicable to Section 111 reporting compliance and CMPs.   

• Often times, RREs are unable to obtain sufficient personal information (e.g., the claimant / plaintiff’s Social Security number) to perform a Section 111 query and determine whether the individual is a Medicare beneficiary. RREs generally only feel comfortable contacting the individual’s attorney given state laws and ethical concerns, but CMS has confirmed it still expects RREs to attempt to contact the individual directly if the RRE has not received a response from their attorney. In other words, if an RRE makes three (3) good faith attempts to obtain the required information from the individual’s attorney but the attorney fails to respond, CMS expects the RRE to contact the claimant / plaintiff directly—otherwise, the RRE will not be afforded the safe harbor exemption and will remain subject to CMPs. If, however, their attorney clearly and unambiguously declines to provide the information requested, the RRE meets the safe harbor exemption and is not required to also directly contact the claimant / plaintiff. Please reference CMS’ 2024 presentation discussing this issue here: https://www.cms.gov/files/document/october-17-2024-medicare-secondary-payer-and-certain-civil-money-penalties-non-group-health-plan.pdf-0.

If you or your organization has any regarding CMS’ most recent CMP webinar or has any concerns about your Section 111 program, please contact us.