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Guidance on DRA False Claims Education Issued
December 19, 2006

The Centers for Medicare and Medicaid Services (CMS) has issued guidance to state Medicaid directors regarding implementation of § 6032 of the Deficit Reduction Act (DRA) (Public Law 109-171), Employee Education about False Claims Recovery. The Office of Mental Health and Substance Abuse Services (OMHSAS) and the Office of Medical Assistance Programs (OMAP) just received this information and are determining how to proceed with guidance for providers.

Deputy Secretary Joan Erney confirmed that HealthChoices funds count toward the $5 million threshold established in § 6032 for entities to establish written policies for all employees, contractors, or agents that provide detailed information about the False Claims Act and includes information about the entity’s policies and procedures regarding prevention and detection of fraud, waste, and abuse. The CMS guidance states that the requirements should be incorporated into each state’s provider enrollment agreements and that each state must determine how to ensure that entities comply with § 1902(a) (68) of the Social Security Act (established under DRA § 6032), the information that will be included in the Medicaid State Plan, and a description of compliance oversight and frequency of reassessment. OMHSAS and OMAP will work together on these issues. Available from the links are the State Medicaid Directors letter and preprinted pages for the Medicaid State Plan regarding Employee Education about False Claims Recoveries.

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