• Liability Insurers and Self-insurers Face Mandatory Medicare Reporting on July 1, 2009
  • April 8, 2009 | Authors: David W. Walulik; Greg E. Mitchell; Charles S. Cassis; Walter E. Haggerty
  • Law Firms: Frost Brown Todd LLC - Office ; Frost Brown Todd LLC - Office ; Frost Brown Todd LLC - Office ; Frost Brown Todd LLC - Office
  • Beginning July 1, 2009, liability insurers will be subject to mandatory reporting under the Medicare, Medicaid, and SCHIP Extension Act of 2007, 42 U.S.C. 1395y(b)(8). After that date, all liability insurers must determine whether tort plaintiffs are eligible for Medicare and report this information to the government to ensure that Medicare remains a secondary payor. Any insurer who fails these requirements is subject to $1,000.00 per day penalties.

    Who Must Report

    42 U.S.C. 1395y(b)(8) requires reports from "liability insurance (including self-insurance) no fault insurance, and workers' compensation laws and plans".

    What Must Be Reported

    42 U.S.C. 1395y(b)(8)(B) states the "required information" shall include the "identity of the claimant" and "such other information as the Secretary shall specify". The Secretary has not yet specified "such information" but is expected to do so on or soon after May 1, 2009.

    The United States Center for Medicare & Medicaid Services ("CMS") is presently holding a series of "town meetings" to address concerns from interested parties before issuing final regulations. Ultimately, CMS will specify the format, manner, and frequency with which the information must be reported.

    Important Events For Implementation

    • 01/01/09 - 06/30/09 Recommended systems development period
    • 05/01/09 - 06/30/09 Electronic registration for liability insurers who are responsible reporting entities. Reporting entities must register to report electronically
    • 07/01/09 - 09/30/09 Testing period for all liability insurers who are responsible reporting entities
    • 10/01/09 - 12/31/09 All liability responsible reporting entities submit their first production files based upon a predetermined schedule
    • 01/01/10 All liability responsible reporting entities will submit production files by this date