It’s Time to Play the Match Game! It’s Time to Play the Match Game!

It’s Time to Play the Match Game!

Not the 1970’s celebrity game show hosted by Gene Rayburn. The Centers for Medicare and Medicaid Services (CMS) has a different "Match Game" that it is inviting employers to play. This Data Match program is not new (the law was enacted in 1989), but the CMS has coordinated its efforts with the Internal Revenue Service and the Social Security Administration in an effort to increase recovery under Medicare Secondary Payer rules. The goal of this Data Match game is to identify situations where another payer should be primary to Medicare.

Several employers have begun to receive letters from the CMS asking the employer to provide group health care coverage information for Medicare-eligible individuals and their spouses. My advice may seem obvious - don’t ignore the request. This request for information is different than Medicare Part D filing or Section 111 reporting, and it carries significant penalties.

Employers must respond to the request within 30 days or request an extension. Plan ahead since the process is complicated and can take some time to complete. The first step is to register through an online portal on the CMS’ website and set up an account. After the account has connected with the data-match questionnaire, an employer must fill in the requested group health plan (GHP) information, provide information about specific employees, and certify the information is accurate. Employers may need to respond to additional requests for information after this certification.

If you are wondering why you should provide more information to CMS, consider the penalties for noncompliance. CMS may impose fines of $1,000 per person named in the inquiry for whom the employer has not responded or provided incomplete information. It may also subpoena business records and investigate the employer’s GHP to determine compliance. If it determines an employer has been noncompliant, CMS can assess additional fines ($5,000 per situation) for encouraging or enticing employees to enroll in Medicare rather than the employer’s GHP. Plus, the employer could receive a bill for claims Medicare paid as primary rather than being a secondary payer.

For more information on Medicare services for employers, contact Ann Stewart or a member of our Labor, Employment, and Immigration practice.

This publication is intended for general information purposes only and does not and is not intended to constitute legal advice. The reader should consult with legal counsel to determine how laws or decisions discussed herein apply to the reader’s specific circumstances.

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