NEW FEDERAL COMPLIANCE PLAN REQUIREMENTS

IMPLICATIONS FOR MEDICAID PROVIDERS

On February 8, 2006 President Bush signed into law the Deficit Reduction Act of 2005.  The Act is a sweeping cost cutting measure that will trim $11 billion for Medicaid and Medicare programs over the next five (5) years.  Buried amongst these cost cutting measures are new requirements for Mandatory Medicaid Compliance Plans.  Section 6032 of the Act requires entities receiving or making annual Medicaid payments of at least $5 million per year to adopt policies and procedures and educate their employees, contractors and agents on various aspects of healthcare fraud enforcement.  Included in these educational requirements is the establishment of written policies that educate employees, contractors and agents about:

·        The federal False Claims Act;

·        Administrative remedies for false statements under federal law;

·        Any state laws establishing civil or criminal penalties for false claims or statements;

·        Whistle blower protections under any state or federal law;

·        The roles of such laws in preventing and detecting fraud, waste and abuse in federal healthcare programs;

·        The entity's internal policies and procedures for detecting and preventing fraud, waste and abuse;

·        The entity's Employee Handbook now required to contain specific discussion of the federal and state laws described above, the rights of employees to be protected as whistle blowers, and the entity's internal policies and procedures for detecting and preventing fraud, waste and abuse.

The effective date of these new requirements will be determined by each state's Medicaid Program, which must implement these provisions in order to comply with federal law.  However, states are required to implement these changes no later than January 1, 2007.

It is important that Medicaid providers begin to review and revise their current compliance plans and policies, including Employee Handbooks, to ensure that these documents meet the Act's requirements.

Morris Manning & Martin, LLP, can help you comply with these new federal mandates by integrating information into your existing compliance plan or by creating a new comprehensive compliance plan tailored to meet your needs as well as all state and federal requirements.

For more information, please contact D.J. Jeyaram in the firm's healthcare group at 404.495.3656 or djeyaram@mmmlaw.com.