Medicaid has recently passed State and Federal Legislation that requires all providers receiving annual Medicaid payments of $5 million dollars or more to educate employees, contractors and agents about Medicaid Fraud, False Claim Laws, and the whistleblower protections available under those laws. 

The $5 million dollar threshold is based on the Federal Fiscal Year (July ? June) and applies when the minimum amount has been paid to one North Carolina Medicaid provider number or to multiple provider numbers associated with the same tax identification number.  This means that County EMS Agencies will be subject to these regulations if the total amount paid by Medicaid to the County Health Department, Mental Health Agency, EMS, or other county departments exceed the $5 million dollar threshold.

An attestation statement must be signed within 30 days of receipt in order to avoid denials from Medicaid.  The attestation statement confirms that the agency:

·         Has established written policies for all employees regarding the False Claim Act, to include definitions and examples of false claims, process for identifying false claims, identifying civil and criminal penalties for false claims, and whistleblower protections for employees reporting false claim incidents

·         Identifies their internal quality assurance policy for detecting and preventing fraud, abuse and waste

·         Include such information in the employee handbook and make these documents available to all employees, contractors and agents

Medicaid has provided clarification that the entity is not required to provide direct face-to-face education of its employees, but must provide either on paper or electronic forms, but must be readily available to all employees, contractors, and agents (such as an internal website or email).  The employees, contractors and agents must be made aware of their existence and location. 

Most standard Compliance Plans should address the issues listed above and should serve the purpose of written policies.  EMSMC has a compliance plan in place for our employees that meet the requirements as stated above.  We have included a Corporate Code of Conduct in our employee handbook and require a signature authorization from each employee that they have read and understood the document, and will abide by the compliance guidelines that we have in place.  If you do not have a compliance plan of your own, we will be happy to share these documents with you. 

We have received letters for several of our clients and will be contacting you individually to have these letters signed and submitted to Medicaid to ensure that there is no interruption in cash flow.