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New Fraud and Abuse Compliance Information Requirements

Gerald Billow November 1, 2006

A federal law, effective January 1, 2007, mandates the Commonwealth, as part of the state plan, to require any health care provider that receives at least $5,000,000 in Medicaid payments to establish written policies for employees and contractors about fraud and abuse matters. Those policies must:

(1) provide detailed information about federal and state laws pertaining to false claims and statements, including whistleblower protections under such laws;

(2) include detailed provisions regarding the entity's policies and procedures for detecting and preventing fraud, waste and abuse; and

(3) be included in any employee handbook.

Centers for Medicare & Medicaid Services has not yet issued any memoranda or guidelines for implementing his mandate created by Section 6032 of the Deficit Reduction Act of 2005; nor has the Commonwealth amended its state plan to include these requirements.  Nevertheless, it is not too early to implement these requirements.  Health care providers should immediately review and, if necessary, amend their existing compliance programs and employee handbooks to assure that they meet the new requirements.

Posternak attorneys have worked with health care providers to assure compliance with fraud and abuse statutes and regulations.  For more information, please contact any of the following attorneys:

Gerald J. Billow

James P. Hawkins

Barry L. Mintzer

Ruselle W. Robinson

Client Advisory is provided for information purposes only, and does not constitute legal advice.  According to Mass. SJC Rule 3:07, this material may be considered advertising. ©2006 Posternak Blankstein & Lund LLP.  All rights reserved.

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