DEADLINE IS JANUARY 1, 2007!!!!!
Back in February of this year, President Bush signed the Deficit Reduction Act of 2005 (the “Act”)… and, what it means to you and your corporate compliance program (or lack thereof) could be huge!! For providers that this act applies to, it means that you only have until January 1, 2007 to comply with the provisions of the Act. That’s not a lot of time to accomplish this but failing to do so may directly affect your ability to collect Medicaid payments.
Two significant provisions in the Deficit Reduction Act are:
* Incentives for states to enact their own False Claims Act (FCA). If a state agrees to pass their own False Claims Act that contains the same provisions as the Federal FCA, states will receive an increased share of Medicaid funds.
* A requirement that providers who receive more than $5 million from Medicaid provide staff education regarding the federal and state False Claims Acts. These providers will be required to provide information to staff on the whistleblower protections contained in the False Claims Act.
Applicable providers will need to make sure it has written policies and procedures that address their systems for detecting and preventing fraud, waste and abuse. This will all be a pre-requisite to receiving Medicaid funds. Providers will need to make sure that employee handbooks, policy & procedure manuals and training programs all address these changes. To make a long story short, having an effective Corporate Compliance Program allows you to comply with these provisions.
Up until now, Corporate Compliance Programs have been voluntary. The Office of the Inspector General’s guidance has been just that… guidance. There has been nothing that mandates a written, effective corporate compliance program. The Deficit Reduction Act of 2005 changes that.
If you are a provider who receives more than $5 million in Medicaid payments, the time to act is now. Corporate Compliance Programs that are sitting on a shelf will do you no good. If you don’t have a formal, written Corporate Compliance Program, that you can show is working, it’s time to adopt one. If you have one, it’s probably a good time to take a look at it and make sure that it contains all the requirements of the Deficit Reduction Act and that the program is working.
Why Compliance?
Most medical and life science professionals entered into the profession to treat or help with cures or treatments for patients. Their attention is best left to the healing process and staying current with treatment protocols. Compliance and Risk Dynamics (CRD), a third party group can help a practice deal with many different potential issues
Medicare Part D
CMS is creating rules and guidelines for manufacturers, benefit managers, drug plans and the provider community. Any entity where drugs are prescribed needs to review their protocols and procedures to assure compliance with Medicare regulations.