The Office of Medical Assistance (MA) Programs has issued MA Bulletin 99-07-01, False Claims Act Provisions of Deficit Reduction Act of 2005 Employee Education About False Claims Recovery (www.dpw.state.pa.us/General/Bulletins/003673169.aspx?BulletinDetailId=4044). The bulletin applies to all Medical Assistance providers, including managed care organizations (MCOs). The bulletin provides little specific guidance beyond language contained in § 6032 of the Deficit Reduction Act (DRA) of 2005, which states “A MA provider, including any MCO that receives or makes $5 million in annual MA payments, must comply with § 6032 as a condition of receiving payment under the MA Program.”
By the effective date of January 1 the provider must:
- Establish written policies and procedures including detailed information about federal and state laws regarding false claims and whistleblower protections;
- Include detailed information regarding the agency’s policies and procedures to detect and prevent fraud, waste, and abuse;
- Provide a copy of written policies to all employees, contractors, and agents of vendors; and
- Include information about federal and state laws, written policies and procedures regarding false claims, and policies and procedures regarding whistleblower protections in an employee handbook if the provider maintains one.
MA providers that receive or make annual payments of $5 million or more through MA must complete an annual attestation of compliance with § 6032 of the DRA and submit it to the Bureau of Program Integrity (BPI). The attestation form is attached to the bulletin. The initial attestation form must be submitted no later than December 31. Questions can be addressed to BPI (717-705-6872).
PCPA has informed
members of the requirements of the DRA in past communication (see
Guidance on DRA False Claims Education, December 19, 2006) and is attempting
to confirm requirements for inclusion of funds received by providers through
HealthChoices Behavioral Health MCOs in calculation of the $5 million threshold.
The association has received conflicting interpretations and now awaits a
requested clarification from the Centers for Medicare and Medicaid Services.
