Deficit Reduction Act (DRA) Compliance - Do you have everything in place?

(PYA Alert dated January 16, 2008)

Do you realize that we’ve just seen the first anniversary of the requirement for healthcare providers to be in compliance with DRA provisions (as of January 1, 2007)? Oh how time flies…

Medicaid is the country’s largest health program, providing benefits to more than 56 million Americans and with a $300 billion current level of spending - which has steadily increased since the program began 40 years ago. It only makes sense that, with the many settlements and successful investigative efforts to determine fraud and abuse within the Medicare program, the attention would ultimately turn to include Medicaid as well. In essence, the government has now caught up with Medicaid in applying the same standards long familiar to those serving the Medicare population.

The DRA launched a full-fledged assault on Medicaid fraud and abuse, with increasing government scrutiny of Medicaid billings and implications for state false claims acts in conjunction with the Federal False Claims Act. For the first time, larger entities (those paying or receiving more than $5 million in Medicaid funds annually) are required to implement specific compliance activities geared toward detecting, preventing and addressing fraudulent or abusive activity.

These healthcare entities must have written policies and provide education to its employees, contractors and agents about false claims recovery. While this sounds simple, the challenge lies in not only ensuring that the appropriate compliance components are in place but demonstrating that these practices have been effectively implemented and are “living and breathing” within your organization. Entities need to immunize themselves from the potentially devastating effects of lawsuits and governmental investigations accordingly. Are you doing the right things to protect your organization?

With so many changes in the healthcare industry, it can be hard to keep up. Should you have questions or need assistance in this area, please contact Carol Eyer at (800) 270-9629.

The information provided via PYA Alert, Tax Planning Alert, or Audit and Accounting Alert should not be construed as accounting, auditing, consulting, or legal advice on any specific facts or circumstances. The contents are intended for general information purposes only.  Please contact us at (800) 270-9629 to discuss your specific situation or to discuss any specific questions you may have.

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