The Deficit Reduction Act of 2005 (the “DRA”), signed into law February 8, 2006, contained a number of provisions intended to bolster Medicaid fraud and abuse enforcement. These new provisions mean that there is likely to be an increase in fraud enforcement activities at the state level against those health firms involved directly or indirectly in Medicaid related claims.
First, Congress authorized the establishment of a new Medicaid Integrity Program with specific contractors to monitor fraud and abuse in the various state Medicaid programs. Second, Congress adopted a provision that provides states with an incentive to adopt state false claims acts that substantially mirror the requirements of the Federal False Claims Act. Third, effective January 1, 2007, state Medicaid plans are required to ensure that any entity that receives or makes payments under the state plan of at least $5 million per year must provide certain information to its employees, contractors and agents concerning federal and state false claims act provisions, penalties and protections. In addition to the requirements being imposed on health care entities under the DRA, certain segments of the health care industry and now required to have adopted a corporate compliance program as a result of a contractual obligation, in order to receive accreditation, or because the state has adopted a law or regulation that specifically mandates the creation of such program.
For more details about the proposed rule, click here for a copy of the Special Alert. Epstein Becker & Green has developed a checklist of issues, topics and questions that it believes should be examined as part of an audit of an organization’s compliance program. A copy of this checklist is attached to this Special Alert.