Last year, the Centers for Medicare & Medicaid Services (CMS) made changes to its reporting rules, Section 111, specifically as it relates to Medicare Set-Asides (MSAs). Section 111 audits will begin next month, related to the rule change that is being enforced as of October 11, 2025, for applicable settlements from October 11, 2024, and forward. Here is what employers and insurance companies need to know.
Effective October 11, 2024, all workers’ compensation settlements that involved 1) an injured worker who is or was on Medicare, and 2) settled out/closed future medical, must be reported to CMS, even if there is a zero MSA, non-submit MSA, or it is below the review threshold. CMS makes it mandatory for self-insured employers and insurance companies to report when these two conditions are satisfied.
Effective April 4, 2025, the Section 111 Report to CMS must include the MSA amount in addition to the date of settlement and total settlement amount.
The effective enforcement date for penalties for failure to report/noncompliance was October 11, 2025, for settlements reached on or after October 11, 2024. There is a one-year lookback; in other words, failure to report a settlement reached on or after October 11, 2024, within one year of the settlement date, can result in penalties of $250 or more per day, adjusted for inflation to $357 per...
PORTLAND, Maine (WGME) -- A week after employees at the Holy Donut on Park Avenue in Portland told the company they were looking to unionize, the company now says those workers made false accusati...