The Federal Deadline for Pharmacy Compliance Plans Is Approaching...
Are You Ready?

In less than five (5) months, pharmacies that receive 5 million dollars or more per year in Medicaid reimbursement will be required to have a Medicaid Compliance Plan in place. The Deficit Reduction Act of 2006 is a sweeping cost cutting measure that will trim 11 Billion Dollars for the Medicaid and Medicare Programs over the next five (5) years.  Buried amongst these cost cutting measures are new requirements for healthcare providers to enact Medicaid Compliance Plans. 

Though pharmacies are not traditionally thought of as "healthcare providers", the Act extends the Compliance Plan requirement to any entities receiving annual Medicaid reimbursement of at least 5 million dollars.  Many pharmacies are unaware that the Act requires that Compliance Plans be in place by January 1, 2007 and are not prepared to meet this statutory deadline.  The Act requires written policies and procedures that educate pharmacy employees, contractors and agents on various aspects of healthcare fraud enforcement.  Included in these educational requirements are:

• The federal and state "false claims" statutes;
• whistle blower protections under 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; and
• the entity's Employee Handbook is required to contain specific discussion of the federal and state laws described above.

For pharmacy chains with locations in multiple states, the employee and contractor education must be specific to the laws of every state the pharmacy is located.

It is important that Medicaid providers begin to review and revise their current compliance plans and policies, including employees 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 the required information into your existing compliance plan or by creating a new comprehensive compliance plan tailored to meet your needs.