CMS to Begin Enforcing MMSEA Section 111 Reporting Requirements Starting October 2025, by Abbye Alexander, Esq., Christopher Tellner, Esq., and Henry Norwood, Esq., 9-26-2025

The Centers for Medicare & Medicaid Services (CMS) will initiate enforcement actions to ensure compliance with the reporting requirements under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA Section 111) beginning October 2025.

This development will generally impact Responsible Reporting Entities (RREs) for both Group Health Plans (GHPs) and Non-Group Health Plans (NGHPs)—including liability insurers, no-fault insurers, and workers’ compensation plans.

Organizations subject to MMSEA Section 111 reporting obligations should act now to ensure full compliance and prepare for potential audits or face civil money penalties (CMPs).

What Is MMSEA Section 111 Reporting?

MMSEA Section 111 requires covered responsible reporting entities (RREs) to report certain information to CMS to ensure that Medicare does not make primary payments for medical services when another entity (such as a GHP or NGHP) is responsible for the claim.

The reporting process is designed to support CMS in enforcing Medicare’s secondary payer (MSP) rules by identifying instances where Medicare coverage is secondary to other insurance.

Reporting Obligations

• Group Health Plan RREs (GHPs) must report coverage information for Medicare beneficiaries (e.g., active employees, retirees) when a GHP is the primary payer. More about their obligations can be found here.
• Non-Group Health Plan RREs (NGHPs)—including liability insurers, no-fault insurers, and workers’ compensation plans and insurers—must report claims involving settlements, judgments, awards, or other payments made to Medicare beneficiaries. More on this can be found here.

The information must be submitted through CMS’s Coordination of Benefits Secure Website.

Upcoming Enforcement: What’s Changing in October 2025?

Although MMSEA Section 111 reporting has been in place for several years, CMS is beginning active enforcement through:

• Audits of RREs to verify compliance with timely and accurate reporting. As part of this, CMS will audit a random sample of 250 records that were added on a quarterly basis from across all reported records for a total of 1,000 records to be reviewed annually. This sample will reflect a proportionate number of GHP and NGHP records and may shift each quarter as GHP and NGHP record volumes vary.
• Imposition of CMPs for failure to report or for reporting incorrect information, as outlined in the final rule published October 11, 2023 (CMS-6058-F).

Penalty Framework:

• CMPs may be assessed up to $1,000 per day per beneficiary for non-compliance, depending on the nature and duration of the violation.
• Penalties apply to both GHP and NGHP RREs.
• Certain safe harbors exist (i.e. if a good faith effort was made to comply).

For more info regarding penalties see here.

Action Items for Covered Entities

Organizations that are RREs under MMSEA Section 111 should consider taking immediate steps to:

1. Confirm RRE Status
   Determine whether your organization is classified as an RRE under GHP or NGHP categories and understand your specific obligations.
2. Review and Audit Internal Reporting Processes
   Evaluate current data collection, validation, and reporting workflows to ensure they meet CMS requirements.
3. Address Gaps or Errors in Reporting
   Identify any missed reports, incorrect submissions, or compliance gaps that could trigger enforcement action.
4. Engage with Third-Party Administrators (TPAs) and Vendors
   Coordinate with claims administrators or reporting agents to confirm their readiness and ensure they are aligned with CMS standards.
5. Stay Informed on CMS Guidance
   Monitor updates from CMS, including audit protocols, FAQs, etc.

Conclusion

The October 2025 enforcement directive marks the next step in the evolution of MMSEA Section 111 compliance. Covered RREs should treat this as a compliance priority. Proactive steps taken now may significantly reduce the risk of audits, financial penalties, or disruption to Medicare coordination processes.

Authors: Abbye Alexander and Christopher Tellner, Co-Chairs of the Health Care/Managed Care Practice Group and Of Counsel Henry Norwood