While most of the country is engaged in basketball mania, the worker’s compensation community is huddling up to prepare for the Centers for Medicaid & Medicare Services’ (CMS) upcoming “full-court press” following its recent enforcement announcements. Developing a winning strategy for compliance requires careful attention to several key areas, including Section 111 quarterly reporting for ongoing worker’s compensation claims involving Medicare beneficiaries, evaluations of future medical care allocations, and settlement reporting obligations such as Total Payment of Compensation (TPOC). These conversations have taken on renewed urgency in light of CMS’s latest reporting enforcement initiatives:

October 11, 2025: CMS announced that this is the effective enforcement date for CMS to impose penalties for failure to report/noncompliance related to settlements reached on or after October 11, 2024, under Section 111. Failure to report a settlement reached within one year could result in significant penalties.

February, 2026: CMS announced it will begin random quarterly audits of Medicare Secondary Payer records for Section 111 reporting compliance. CMS has engaged a new contractor (CMS’ “referee”), is using AI tools to perform these audits, and plans to publicly report the audit results.

We recommend that self-insured employers and insurance companies develop a winning game plan by evaluating their Section 111 quarterly reporting compliance. This includes reviewing worker’s compensation claim settlements finalized since October 11, 2024, that involved Medicare beneficiaries and resolved a future medical issue, to ensure proper reporting is completed. Accurate and timely reporting can help employers avoid being “whistled” for penalties.

Self-insured employers and administrators should consult with their worker’s compensation counsel to review CMS reporting requirements and confirm Section 111 compliance, helping them stay off the bench and in the game. Please review our prior alerts or contact Ann Stewart or Wes Davis if you have questions regarding reporting responsibilities.

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.