Flagship Services Group Blog

Opportunity for Improvement

May 5, 2020 3:41:57 PM / by Robert J. Finley

We are living through historic times. COVID-19 may result in permanent changes including how and where we normally work; while, during this same period, the Medicare Secondary Payer (MSP) industry may see CMS finalize and publish regulations regarding how and when to calculate and impose civil monetary penalties (CMPs) upon group health plan (GHP) and non-group health plan (NGHP) responsible reporting entities (RREs) which fail to meet reporting obligations.


The public comment period for the CMPs proposed rule (85 FR 8793-8804) closed on April 20, 2020. CMS does not appear to be extending this deadline. To date, while no public comments have been posted yet by CMS, keep a watchful eye. By comparison, in 2014, the 34 public comments on CMS-6061-ANPRM on CMPs were posted about 15 days following the comment close period. Notwithstanding, MSP industry leaders generally seem to think that the proposed CMPs might be quite similar to any forthcoming final rule in both form and substance.  Publication and effective dates may be the next steps and perhaps as early as 2020 or 2021.


In the wake of COVID-19, perhaps, MSP decision-makers may prioritize an audit of their reporting and recovery compliance program to assess better practices now to avoid CMPs later. With COVID-19 work force reductions and work from home orders, now might be a good time to weigh various reporting alternatives such as system-based versus claims personnel-based reporting solutions. If anything, then the proposed rule for CMPs offers an opportune litmus test on (1) registering and reporting as required by MSP; (2) RREs reporting in a manner that exceeds error tolerances in the proposed rule by the Secretary of the Department of Health and Human Services; and (3) RRE reporting information compared and contrasted with CMS payment recovery efforts from the RRE.


Plant the seeds. Be proactive. Create winning compliance strategies in line with best claims handling procedures and business judgment rule.


Disclaimer: This publication is provided for informational purposes only.  It is not intended to constitute, and shall not be construed as, the rendering of legal, accounting, or business advice or opinion or professional services of any type.  Nothing herein constitutes the views of the firm or its clients or the endorsement of any particular case, principle, or proposition.  The contents of this publication should not be viewed as a substitute for the guidance, advice, or recommendations of a retained professional


Flagship Services Group is the premier Medicare and Medicaid compliance services provider to the property & casualty insurance industry. Our focus and expertise have been the Medicare and Medicaid compliance needs of P&C self-insureds, insurance companies, and third-party administrators. We specialize in P&C mandatory reporting, conditional payment resolution, and set aside allocations. Whether auto, liability, no-fault, or work comp claims, we have assembled the expertise, experience and resources to deliver unparalleled MSP compliance and cost savings results to the P&C industry. To find out more about Flagship, our team, and our customized solutions, please visit us at www.flagshipservicesgroup.com. To speak with us about any of our P&C MSP compliance products and services, you may also contact us at 888.444.4125 or info@flagshipsgi.com.

Tags: MSA, civil monetary penalties, Robert Finley, Flagship Services, CMP, MSP, Medicare, Medicare Second Payers

Robert J. Finley

Written by Robert J. Finley

Robert J. Finley, a partner with Hinshaw & Culbertson LLP, has litigation and trial practice experience focused in tort, employment and healthcare. He also counsels firm clients under health plans, auto, property/casualty, no-fault, and workers compensation policies on Medicare repayment and Medicaid reimbursement compliance. Robert advises Flagship Services Group on high value matters, in administrative hearings, and with educational solutions involving Medicare Secondary Payer issues. For more information, visit: https://www.hinshawlaw.com