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All rights reserved, Phelps Dunbar LLP Health Law Update is published as a service to clients and friends of Phelps Dunbar LLP, and should not be construed as legal or professional advice or as opinion on specific fact.

Update - Medicaid Educational Requirements
Regarding False Claims Laws

October 22, 2007

On January 19, Phelps Dunbar distributed a client alert concerning the Deficit Reduction Act's requirements for employee education relating to federal and state false claims laws.  See Client Alert.  As discussed in the linked alert, Section 6032 of the Deficit Reduction Act of 2005, signed into law February 8, 2006, required entities making or receiving $5 million or more annually in Medicaid payments to develop and maintain written policies for their employees, contractors and agents providing detailed information about the federal False Claims Act, any state laws providing civil and criminal penalties for false claims and statements and any whistleblower protections under federal and state laws.

The Deficit Reduction Act directed State Medicaid agencies to amend their State Plans to include this educational requirement by January 1, 2007. In a January 11, 2007 open door forum, CMS indicated that all entities meeting the $5 million threshold must be in compliance regardless of whether the requirement is included in the State Plan.  A Mississippi State Plan amendment was approved on September 6, 2007. Under the new addendum, the Mississippi Division of Medicaid will incorporate the employee education requirements in its Provider Enrollment Agreement, conduct an audit of the affected entities' written policies and procedures and contact affected entities on a yearly basis for any update or change to the entities' written policies.  Sanctions for non-compliance range from requiring a plan of correction to termination from the Medicaid program.

Last week, one of our health care clients received a letter from the Mississippi Division of Medicaid requiring the facility to provide a copy of its false claims policy to the Division within 30 days of receipt of the letter.  See Medicaid Letter.  We are advising our clients to be on the lookout for similar letters.  If you have questions concerning the attachment or about preparing the required policies, please contact one of the health lawyers listed below.

In Louisiana, the Department of Health and Hospitals ("DHH") is still in the process of obtaining approval of its State Plan Amendment from CMS.  Although the State Plan Amendment has not been approved and implementing regulations have not been published by DHH, the Provider Agreement Addendum that is part of the current Louisiana Medicaid PE-50 Provider Enrollment Form imposes a contractual obligation on enrolled Medicaid providers to comply with the employee training and policy requirements of the Deficit Reduction Act.  It should be noted that the Provider Agreement does not restrict compliance to entities that receive $5 million or more annually in Medicaid payments.

Inquiries concerning topics addressed in the Health Law Update may be directed to any of our Health Law attorneys.  Your comments, questions, and suggestions are encouraged.

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