Posted by: Robert Markette
January 03, 2007

Over the Christmas break there was some buzz about the need to update your compliance plans as a result of the Deficit Reduction Act. As I have noted in the past, part of the DRA directed states to beef up their false claims act laws. Congress hoped to tighten down on fraud and abuse further by encouraging states to develop their own mini false claims acts to be used to pursue Medicaid fraud.

In addition to this requirement, the DRA amended the statutory requirements for a state Medicaid plan. One of the new requirements was that by January 1, 2007, state Medicaid plans would require providers who receive more than $5 Million annually to provide additional information to employees about the false claims act provisions. Effectively, providers subject to this requirement will be telling employees how to pursue a false claims act action.

At this point, providers do not need to panic. Although the January 1, 2007 deadline has now passed, the deadline applied to states, not Medicaid providers. Most states have not yet taken any action to implement this provision. At a minimum, the states will need to amend their Medicaid plans, which is no small effort. Depending upon the state, there may even need to be legislation enacted to effect the change.

For providers, this means that you can start to implement the requirement, based upon the language of the DRA, but you might consider waiting. Obviously, states will be varied in their implementation and their may be specific state law requirements that you will need to incorporate into any policy or procedure. The bottom line is that if you have not amended you policies and procedures you are not only not alone, but you are not going to be in any trouble. Technically, until the states amend their plans, providers are in compliance.

Of course, if you receive less than $5 Million a year in reimbursements, this requirement will not apply to you at all and you are free to continue on as before. Frankly, my experience in home care leads me to the conclusion that the vast majority of home health agencies will not be subjected to this new requirement.

Regardless of whether you are subjected to this requirement or not, this provides an additional reminder that there will be a renewed focus on Medicaid fraud and abuse claims. Because the state agencies have fewer providers to monitor, you may expect more enforcement activity, especially if your state implements a tougher false claims act statute.

This should cause all providers home health, hospice, or otherwise to revisit their fraud and abuse compliance plans. Providers who will need to implement the new requirements of the state plan will want to review their compliance plan to make the new policies fit into their current policies and procedures. While you have the manual down, you should review everything in the manual to see if anything needs to be revised. Given that most providers drafted these policies years ago and have not looked at them since, revisions will be appropriate. It is also worthwhile to go over the compliance plan with your employees. As I repeat frequently, policies and procedures of which the employees are unaware are not policies and procedures at all.

For providers who are below the $5 Million threshold, it would still be a good idea to review your policies and procedures as you prepare for the heightened state level fraud and abuse enforcement. This is the time of year for New Years resolutions. Make yours to revisit your compliance plan and follow it in the coming year.

News

More on the DRA of 2005

News

Health Care

Topics

Recent Updates

Archives

Web Resources



	Home \| Attorneys \| Contact Us \| Site Map
	The information you obtain at this site is not, nor is it intended to be, legal advice. You should consult an attorney for individual advice regarding your own situation. Copyright © 2008 by Home Care Law Blog Gilliland & Markette LLP. All rights reserved. You may reproduce materials available at this site for your own personal use and for non-commercial distribution. All copies must include this copyright statement.