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- Health care providers who receive Medicaid reimbursements of 5 million dollars a year or more directly from the Ohio Department of Medicaid (ODM) are required to have policies in place for employees, contractors and agents that contain detailed information about the federal False Claims Act, state laws pertaining to false claims, and whistleblower protections.
- ODM has adopted a new system that requires such providers to attest compliance with these requirements by December 31, 2015 and on an annual basis thereafter.
- Medicaid providers who do not ensure compliance with these requirements may be ineligible to receive Medicaid payments.
Section 6032 of the Deficit Reduction Act of 2005 (“DRA”) requires health care providers who receive Medicaid reimbursements of five million dollars a year or more to have certain written policies in place for their employees, contractors, and agents. These policies must contain detailed information about the federal False Claims Act, administrative remedies for false claims and statements, state laws pertaining to civil or criminal penalties for false claims and statements, and whistleblower protections. Additionally, employees must be educated on these laws. Compliance with the DRA is a condition of receiving Medicaid payments.
If you are an Ohio Medicaid provider, and you receive Medicaid reimbursements directly from the Ohio Department of Medicaid (ODM) in amounts greater than the 5 million dollars a year threshold, then ODM now requires you to attest that you are in compliance with the above described requirements on an annual basis. You must complete this attestation by December 31, 2015. This attestation can be completed HERE.
Since providers need only count amounts received directly from ODM in calculating the $5,000,000 amount, MyCare Ohio payments are not included. Note, however, that simply because a provider does not need to complete the annual attestation does not mean that it will necessarily avoid having to put appropriate policies in place. MyCare Ohio plans are considered covered entities themselves, and are required by law to require their contractors to independently comply with the education requirements. Thus, any provider with a MyCare Ohio contract would be required to have the requisite policies in place – whether or not they were required to attest to ODM.
You should ensure that your entity has in place the required written policies and procedures for all of its employees, contractors and agents. If our firm has handled your labor and employment work, and we drafted or edited your employee handbook, then you should be in compliance with the DRA, as the required DRA language is included in our standard employee policies. Additionally, if you use our firm for your vendor contracting, you should be in compliance as well, since we make sure to put the required DRA language in contracts we review or draft.
If you do not believe you have all the required DRA language in place for your employees, contractors and agents, please contact us immediately, as we can assist you in complying with this requirement prior to the attestation deadline on December 31st.
Answers to Frequently Asked Questions (FAQs) on the DRA requirements have been prepared by CMS, and may be accessed HERE.
A copy of the original Medical Assistance Letter (MAL) sent out by the Ohio Department of Medicaid (fka Ohio Department of Jobs & Family Services) may be accessed HERE. The updated MAL (522) can be accessed HERE.
In addition, you may contact Carol Rolf (Rolf@ROLFLaw.com) or Aric Martin (Martin@ROLFLaw.com) at 866-495-5608 for more information. Employment policies may be obtained from Robert Pivonka (Pivonka@ROLFLaw.com) and contract language may be obtained from Aric Martin.
Please note that this alert is intended to be informational only, and is not intended to be nor should it be relied upon as legal advice. Rolf Goffman Martin Lang LLP will not be responsible for any actions taken or arrangements structured based upon this alert. The receipt of this alert by an organization that is not a current client of Rolf Goffman Martin Lang LLP does not create an attorney-client relationship between the recipient and the law firm.
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