Violation Of The Rules

[Viola Mathenia]

Ifan employer improperly provides an incentive to a Medicare-entitled employee to waive employer-based coverage or otherwise violates the Medicare Secondary Payer rules with respect to that employee and Medicare learns of this, is there any potential adverse consequences to the employee for such violation?

We have client that erroneously thought it could kick dependent spouses covered under the large group plan out at age 65 once they qualified for Medicare. Employer did not incent or encourage them to leave--just gave them the boot. Fortunately, this only happened for two people and has only been going on since the end of 2020. Their insurer is going to let them reinstate back to the beginning of the plan year (March 1) so they will correct going forward and presumably be able to cover prior claims going back a couple of months but I'm wondering what if anything else they need to do given the past violations. I assume without doing anything there is a chance CMS could come in and challenge and make the employer pay for any claims Medicare covered since the individuals were kicked off the plan in late 2020. Fortunately, I think those amounts / claims are pretty limited. Is there an affirmative obligation on the part of the employer to report this and/or make some corrected reimbursements? I cannot seem to find much useful guidance. Thanks.

The penalty for violating the MSP prohibited incentive rules is $5,000 per violation. CMS takes the position that the MSP rules are violated every time a prohibited offer is made, whether orally or in writing.

An employer or other entity is prohibited from offering Medicare beneficiaries financial or other benefits as incentives not to enroll in or to terminate enrollment in a GHP or LGHP that is or would be primary to Medicare. This prohibition precludes the offering of benefits to Medicare beneficiaries that are alternatives to the employer's primary plan (e.g., prescription drugs) unless the beneficiary has primary coverage other than Medicare. An example would be primary plan coverage through his/her own or a spouse's employer. This rule applies even if the payments or benefits are offered to all other individuals who are eligible for coverage under the plan. It is a violation of the Medicare law every time a prohibited offer is made regardless of whether it is oral or in writing. Any entity that violates the prohibition is subject to a civil money penalty of up to $5,000 for each violation.

Thanks very much for this. Do you have a sense of the current enforcement posture here? For example, regarding the penalty of "up to $5,000 for each violation," I think we would have a couple of violations but if the company has reversed the action, would CMS likely pursue action? If it did pursue, how does it decide on the amount to assess? (In my experience in other areas, it seems often they may not routinely pursue the maximum penalty but not sure about these issues.) Also, is there any sort of voluntary correction type program where one can "self-correct" or bring to the attention of CMS and expect to come out with a significantly lower penalty.

In short, what do employers typically do that know they have a violation--obviously we've stopped it and are attempting to correct mostly but is there any duty / benefit to bringing this to the regulator's attention or should they just go forward and sin no more but realize their is some potential exposure?

The only enforcement activity I've seen in this area are demand letters from CMS stating that the employer must pay back Medicare for all claim amounts where Medicare incorrectly paid as primary. I believe they get this information from the data match program. Where the employer fails to repay, the Treasury will send a letter to follow up on the unpaid debt and threaten collections, interest, penalties, costs, etc. on top of it.

This is all good stuff but note that my question involved whether there was any possible adverse consequences to the EMPLOYEE if the employer violated the MSP rules. I never did find an answer to that question,

Thanks a lot for providing a detailed answer! My employer offered me an incentive, and I immediately felt that something was wrong. Thank God I will leave this company in a week. I am moving to another company with a better salary and better policy. Hopefully, I can afford new insurance with this salary. I will not have to worry about my health that much anymore. Thanks to , I can now analyze my expenses and manage my finances in a better way. My main goal now is to at least spend less than I earn, which becomes difficult because of inflation. I have four kids, and I need to provide for all of them.

As from 19 May, new rules to harmonise criminal offences and penalties for the violation of EU restrictive measures enter into force. The new rules will ensure that such violations can be criminally investigated and prosecuted in all Member States. They include a list of criminal offences related to the violation and circumvention of EU sanctions, such as for example: failing to freeze assets; breaching travel bans and arms embargoes; providing prohibited or restricted economic and financial services, transferring funds that should be frozen to a third party or providing false information to conceal funds that should be frozen.

The new rules also establish common basic standards for penalties for both natural and legal persons in all Member States, closing existing legal loopholes and increasing the deterrent effect of violating EU sanctions in the first place. They will also include enhanced rules on freezing and confiscation of proceeds and assets subject to EU sanctions. Furthermore, the new rules will strengthen the cooperation and communication between the competent authorities in a Member State and among Member States in the Union.

Parks Enforcement Patrol Officers, Urban Park Rangers, or the New York City Police Department can issue Civil Court fines or Environmental Control Board violations to anyone inside a park after hours.

To change the text size on NYC.gov you can use your web browser's settings. Most browsers include functionality to let you increase or decrease the text on a web page. For example, to increase text size using:

You can report directly from an individual post, List, or profile for certain violations, including: spam, abusive or harmful content, inappropriate ads, self-harm and impersonation. For information about reporting other types of violations, see the How to report specific types of violations section below.

Note: When reporting potential violations of the X Rules and Terms of Service through the Help Center, you may be asked to allow us to share parts of your report with third parties, such as the affected account.

You can report violations on behalf of another person. Refer to the categories and instructions listed above or contact us to submit your report. You can also report directly from a post or profile (see above section How to report directly from a post, List, or profile).

X acknowledges properly submitted reports within twenty-four hours. Although reports are typically resolved within a few days, resolution times vary and may take thirty days to reach resolution based on factors that are often outside of X's control, such as the need for user input and whether a user chooses to appeal.

We want X to be a place where people can make human connections, find reliable information, and express themselves freely and safely. To make that possible, we do not allow spam or other types of platform manipulation. We define platform manipulation as using X to engage in bulk, aggressive, or deceptive activity that misleads others and/or disrupts their experience.

X allows users to create and/or operate up to ten (10) accounts for different, non-duplicative purposes. Users who already own or operate more than ten accounts will not be impacted by these new limits unless a violation of the X Rules takes place. Some examples of what X considers to be non-duplicative uses include:

Multiple accounts that exhibit a pattern or sole purpose of the preceding behaviors may be suspended by X. Users operating multiple accounts are still subject to all other X Rules, particularly our rules surrounding Platform Manipulation and Spam, and Ban Evasion. Any other violations of Our Rules may also result in all of your accounts being suspended.

Anyone can report accounts or Posts via our dedicated reporting flow. These reports are used in aggregate to help refine our enforcement systems and identify new and emerging trends and patterns of behavior.

The consequences for violating this policy depend on the severity of the violation as well as any previous history of violations. Our action is also informed by the type of spammy activity that we have identified. The actions we take may include the following:

Posts which we believe to be in violation of these policies may not appear in certain parts of the X product, and/or may not be recommended or amplified by X. Learn more about other instances when a Post's visibility may be limited.

By requiring participants to comply with the Nacha Operating Rules and Guidelines, Nacha maintains a high-quality, secure ACH Network. It's essential that non-compliance issues be resolved fairly and efficiently to provide everyone with a reliable ACH Network. To that end, Nacha uses the National System of Fines as an enforcement mechanism for the Rules, allowing Depository Financial Institutions to review, evaluate and correct the circumstances surrounding any alleged Rule violation.

The National System of Fines provides the structure for evaluating alleged Rules violations. Through a formal system of warnings and fines, it corrects infractions and helps ACH Network participants to remain within the Rules' boundaries.

To file an ACH Rules Violation, you must be a Depository Financial Institution (DFI) or an ACH Operator. If you are not a DFI or Operator, please contact your financial institution and they can file on your behalf.

3a8082e126