This is a reminder that health care employers who receive $5 million or more in revenue from Medicaid (or other state plans for medical assistance) were required, as of January 1, 2007, to provide employees (including management), contractors, and agents with detailed information about false claims, false statements and whistleblower protections under applicable federal and state fraud laws. This requirement was imposed by the Deficit Reduction Act of 2005 (DRA).
Specifically, the DRA amended the federal Social Security Act to require, among other things, that covered entities develop written policies providing “detailed information” about the following:
the federal False Claims Act;
the federal law providing for administrative remedies for false claims and statements (31 U.S.C. § 3801);
any state laws pertaining to civil or criminal penalties for false claims and statements;
whistleblower protections under these federal and state laws; and
the roles of these laws in preventing and detecting fraud, waste and abuse in federal health care programs.
See 42 U.S.C. § 1396a(a)(68). Compliance with the provisions of the DRA is a condition of receiving payments under Medicaid (or other state plans for medical assistance).
The DRA requires that these written policies include detailed provisions regarding the employer's policies and procedures for detecting and preventing fraud, waste, and abuse. Additionally, employee handbooks must include a specific discussion of these laws, the rights of employees to be protected as whistleblowers, and the employer’s policies and procedures for detecting and preventing fraud, waste, and abuse.
The government has not enacted regulations interpreting the DRA. Although the law does not specifically require training regarding these policies, employers clearly must make employees (and contractors and agents) aware of these policies. Covered employers should consider including training on these policies in their orientation training for new employees and inservice training for current employees. Additionally, employers should provide notice of the policies to all employees, post the notice of the policies at the worksite, and ensure that all contractors receive notice of the policies.
Employers’ Bottom Line:
Covered employers who have not complied with the requirements of the DRA should take steps immediately to do so, since the penalties for non-compliance can be harsh. Ford & Harrison attorneys can assist you in developing policies and procedures that comply with the law. If you have any questions regarding this issue or other labor or employment-related issues, please contact the Ford & Harrison attorney with whom you usually work or Tom Keim, firstname.lastname@example.org, 864-699-1129, or Jeffrey Lehrer, email@example.com, 864-699-1152, partners in our Spartanburg, South Carolina office.