Compliance:
LOOK FOR CLARIFICATION ON NEW WHISTLEBLOWER EDUCATION REG
Published on Sun Jan 28, 2007
But read between the lines for the most vital message.
Home care providers are busy sorting out a new rule that calls for educating employees about their role in rooting out Medicaid fraud, waste and abuse.
Background: The Deficit Reduction Act of 2005 requires providers to establish written policies for all employees and contractors providing detailed information about state and federal false claims acts, whistleblower protections, and the entities' policies and procedures for detecting and preventing fraud and abuse. The requirement applies to hospitals, home health agencies, suppliers and other health care "entities" that receive $5 million or more annually from Medicaid.
The reg aims to inform--and protect--whistleblowers, employees and others in a position to detect and report suspected program abuses and fraud.
Some home care providers are subject to the provision that went into effect Jan. 1--at least in theory.
Tripping point: In reality, no one is enforcing the regulation. States are responsible for enforcement, but they have until March 31 to submit to the feds their individual plans for implementing the new rule. States may opt for extensions for submitting their plans, says the Centers for Medicare & Medicaid Services.
Heads up: Look for guidance from your state in the coming months, advises attorney Kathleen Drummy, partner in the Los Angeles office of Davis Wright Tremaine.
States' input will be vital to compliance, insiders say, since a number of specifics on the new requirements will be left up to the states. And without enforcement mechanisms in place, providers are essentially faced with a new rule that's in effect but not enforced. Know If The Rule Applies To You At a special Open Door Forum on Jan. 11, CMS officials fielded questions about the new reg but failed to offer many new specifics.
Hot topic: No one knows for sure how many home care providers will be subject to the new rule. In part that's because confusion reigns on how CMS is defining a health care "entity."
How it ultimately defines the term will prove to be crucial, notes the National Association for Home Care & Hospice.
"A health system comprised of multiple components would be subject to them if any one component meets the $5 million Medicaid threshold," said a CMS representative speaking at the forum.
If CMS maintains this position as its final one, the regulation will affect home care providers that are part of a health system--providers that otherwise would not be affected, notes NAHC.
In other words: If CMS defines "aggregate Medicaid funding" as the total received by a parent company even if that company bills Medicaid using different provider numbers, you may be subject to the education requirement even if your agency doesn't meet the $5 million threshold.
CMS has pledged to offer further guidance [...]
