Make a Referral

Highlights from CMS’ Latest Civil Money Penalties Webinar

January 21, 2026
Back to Blog
Webinar Desktop

by F. Fairchok

Updated: 01/22/26
– CMS provided a link to slides from their January 15 webinar on the What’s New page of the Mandatory Insurer Reporting for NGHP section on CMS.gov.

The Centers for Medicare & Medicaid Services (CMS) hosted a webinar on January 15, 2026 to present updated information around the implementation of Civil Money Penalties (CMP) for Medicare Secondary Payer (MSP) Non-Group Health Plan (NGHP) reporting requirements mandated by Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). The Final Rule for these penalties, published in the Federal Register on October 11, 2023, became applicable on October 11, 2024 with enforcement as of October 11, 2025.

Important Dates
CMS announced that the CMP eligibility date for workers’ compensation records with settlements would be delayed due to issues related to the implementation of Medicare Set-Aside reporting in April 2025. While no-fault and liability records will be audited in February 2026, workers’ compensation will be delayed through July 2026. Some other dates noted are listed below:

    • February 2026 – anticipated completion of first CMP audit with a random sample of 250 new, accepted records from the fourth quarter of 2025 (after October 11, 2025) proportionately representing GHP and NGHP records.
    • March 2026 – Earliest mailing of Informal Notices for records determined to be noncompliant.

RRE Contact Information
CMS encourages Responsible Reporting Entities (RREs) to verify the information registered in their profile reports. Mailings regarding penalties will be sent to the Authorized Representative with the Account Manager also receiving a copy. Of note, CMS stated that “RREs will be held accountable should any CMP correspondence be missed due to inaccurate or outdated information.” Reporting Agents and Account Designees WILL NOT receive this correspondence, so it is imperative that the Authorized Representative and Account Manager information is accurate. Once CMS issues the informal notice of the intention to impose a penalty, the RRE has 30 days to provide mitigating evidence. If that window is missed, because of inaccurate contact information, the RRE will be issued the penalty.

Safe Harbor Reminder
CMS provided a reminder of the conditions that are required for the RRE to use the “safe harbor” for the inability to report claims. Those conditions are as follows:

    • 3 efforts must be made to obtain required beneficiary information and accurate records must be kept for each communication attempt.
    • 2 attempts must be made in writing, mailed or emailed, to the beneficiary and their attorney.
    • 1 attempt can be made via phone call, mail, or email.
    • The order of communication does not matter.
    • Should the RRE receive a written response (verbal does not qualify) from the individual, or their representative, clearly refusing to provide any portion of the requested information, no additional communication attempts are required.

If You Receive a Notice
CMS outlined the process by which they will be sending notices, along with timelines to respond. RREs will receive the first notice, then one of the remaining two depending on circumstances:

    1. Informal Notice: provides basis for CMS determination and summary of non-compliant record. Includes instructions on what to provide, and by when (within 30 days).
    2. Notice of Proposed Determination to Impose a CMP: sent when mitigating evidence was not submitted, not received in time, or deemed insufficient. Appeal rights and instructions will be enclosed with this notification.
    3. Decision Regarding Mitigating Evidence Submission – Approval: sent when CMS accepts the evidence, puts in writing that no CMPs will be imposed, and no further action is required.

RRE Appeal Rights
In the event a determination was made to impose a penalty, the RRE has several ways to appeal the decision:

    • First, the RRE has the right to request a hearing with an Administrative Law Judge (ALJ) within 60 calendar days from receipt of a Proposed Determination.
    • Next, the RRE can appeal the ALJ’s initial decision to the Departmental Appeals Board Appellate Division within 30 calendar days of the ALJ decision.
    • Finally, the RRE can petition for judicial review within 60 days of the Board’s decision, otherwise it’s binding.

The Final Determination is issued when the RRE either did not file an appeal or exhausted all of their appeal rights. At this point the CMP is final, and payment is due within 60 days – to be remitted ONLY via Pay.gov eBill (instructions for account creation and payment process is included with the determination).

Commentary
After 15 years of Mandatory Insurer Reporting, Civil Money Penalties are finally here. With the inflation adjusted maximum penalty in excess of half a million dollars per case, it is vital that RREs keep a keen eye on their data and reporting processes. There are several steps an RRE can take to minimize their risk, and they include:

    • Review your profile report information and communicate within your organization so that the Authorized Representative and Account Manager understand the importance of their awareness in this activity. Establish a process to ensure updates are made to your profile reports if people change roles or leave the organization. Contact your EDI representative to replace the named Account Representative or Account Manager and/or update associated contact information as needed.
    • Review your data and be aware of what you are receiving from CMS in response to your quarterly file. Do you have data sitting on error reports or getting rejected by CMS? If so, those claims could already be late for reporting. The clock starts ticking on the “Date of Incident” for ORM reporting and the “TPOC Date” for settlements. Claims rejected due to errors could slide forward toward penalties if the reporting results are not being monitored.
    • Document, document, document! If you receive the “Informal Notice – Intention to Impose a Civil Money Penalty” you have 30 days to provide mitigating evidence. Having that evidence documented and ready to go could make the difference between responding on time or missing the deadline and complicating the dispute.

If you have questions about Civil Money Penalties, or are looking for further guidance on Medicare Secondary Payer (MSP) compliance, please do not hesitate to email our experienced MSP Reporting services team at [email protected].