Don't Rule Them Out

The Deficit Reduction Act of 2005 imposes new compliance requirements on health care “covered entities” that receive at least $5 million of aggregate Medicaid payments in a calendar year. Even if you do not cover Medicaid patients, the new DRA rules offer valuable guidance about your training and education activities.

Covered entities must educate their employees, contractors and agents about federal and state false claims laws and about the whistleblower protections under these laws. This education requirement extends to any person or company that provides Medicaid services on behalf of the covered entity, that performs billing or coding functions for it or is involved in monitoring the health care services it provides.

CMS is also requiring covered entities to distribute their compliance policies to their contractors and agents, to educate them about the fraud and abuse provisions of federal and state law, and to confirm that they understand how to report possible fraud or abuse to the covered entity and to state or federal government.

What information does the DRA require covered entities to provide to employees, agents and contractors? They are required to offer detailed written information about federal and state laws that address fraud and abuse, including the federal and state false claims acts; the laws and regulations about false claims remedies; the rules about whistleblower rights and protections; and how federal and state laws work together to detect fraud.

Also, covered entities are supposed to provide detailed written information about their own internal policies and procedures for detecting and preventing waste, fraud and abuse. These policies might include reporting mechanisms, audit and investigating procedures, hotlines, corrective action plans and so forth. In addition, covered entities are supposed to include all of this information in any employee handbooks or other documents that contain their personnel policies.

“But I am not a large medicaid supplier,” you say. “Why should I care about these DRA provisions?” This information can benefit all home care companies in two key ways.

First, these rules identify certain information the government considers essential for home care company compliance policies and training procedures. A company that implements these compliance policies and procedures can ensure that it has embraced the best available practices when it comes to such training and education.