Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007
Although the overall name of the new law includes reference to the state-operated programs of Medicaid and SCHIP, the mandatory reporting requirements found in Section 111 of MMSEA, 42 U.S.C. §1395y(b)(8), pertain only to Medicare beneficiaries.
Medicare beneficiaries include not only persons 65 or older, but also persons of any age who (a) have end stage renal disease (kidney disease/dialysis patients), and (b) apply or will potentially apply for Social Security Disability Insurance (SSDI) (which could include work comp claimants who are permanently and totally disabled).
Medicare is always a secondary payer to liability insurance (including self-insurance), no-fault insurance, and workers compensation. The purpose of MMSEA is to provide verification that Medicare's interests are being considered during the claims process so that a claimant does not receive Medicare benefits when the expense should have been covered by other insurance.
The new law will better enable Medicare to recover its "conditional payments" which must be reimbursed from the proceeds of an award or settlement of an injury claim. MMSEA has a separate section pertaining to group health insurance which has different rules and implementation dates.
The "Teeth" in the law! Failure to comply with the reporting requirements can result in a fine of $1,000 per day per claim file. If Medicare institutes an action to recover funds, it can recover double the amount. Medicare benefits can be terminated if Medicare's recovery rights are not protected.
