CMS to enforce MMSEA 111 reporting compliance beginning October 2025

By Emily J. Cook and Sydney Merritt Martinez on September 11, 2025

Starting October 11, 2025, organizations that fail to meet reporting obligations under Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA 111) may face civil monetary penalties (CMPs). While this change does not alter the long-standing reporting requirements or the existing risk of liability under the federal False Claims Act for causing Medicare overpayments due to MMSEA 111 reporting errors, the introduction of CMPs significantly increases the compliance risk for insurers, self-insured entities, and third-party administrators subject to MMSEA 111.

Here is what stakeholders in the liability, no-fault, workers’ compensation, and group health plan spaces need to know.

Tags: False Claims Act, insurers, Medicaid and SCHIP Extension Act of 2007, medical claims, MMSEA 111, Section 111 of the Medicare

Emily J. Cook
In today’s complex and fast-changing healthcare regulatory environment, Emily Jane Cook helps healthcare organizations thrive. Innovative start-ups and established market leaders alike turn to Emily for broad-spectrum strategies to fuel new business initiatives and solve their most pressing compliance, transactional, reimbursement and litigation challenges. Emily is a practice area leader for the Healthcare Regulatory & Compliance practice. In addition to Emily’s role as a national authority on the 340B drug pricing program, Emily helps clients navigate the full suite of federal and state regulations that are essential to healthcare operations. She partners with a wide range of organizations, including non-traditional service providers and new market entrants to identify, protect and expand revenue opportunities, including via private-equity-backed ventures. Her comprehensive counsel encompasses evolving issues such as No Surprises Act (NSA) implementation, development of new provider types, Medicare provider-based and co-location rules, and trends in qui tam litigation and government investigations. She works closely with colleagues in McDermott’s transactional, litigation and private equity practices to deliver fully realized solutions for her clients. Read Emily Cook's full bio.