Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter I - Specific Policies By Service › Sec2 144-101-I-1 - GENERAL ADMINISTRATIVE POLICIES AND PROCEDURES › Appendix 144-101-I-1-2 - PERTINENT SECTION S FOR REQUIRED COMPLIANCE UNDER THE FALSE CLAIMS ACT

Current through 2024-29, July 17, 2024
The
False Claims Act
(FCA) referenced in
						31
						U.S.C. §
												3729 provides in pertinent
						part:
"Any person who (1) knowingly presents, or causes to be
						presented, to an officer or employee of the United States Government or a
						member of the Armed Forces of the United States a false or fraudulent claim for
						payment or approval; (2) knowingly makes, uses, or causes to be made or used, a
						false record or statement to get a false or fraudulent claim paid or approved
						by the Government; (3) conspires to defraud the Government by getting a false
						or fraudulent claim paid or approved by the Government; or (4) knowingly makes,
						uses, or causes to be made or used, a false record or statement to conceal,
						avoid, or decrease an obligation to pay or transmit money or property to the
						government, is liable to the United States Government for a civil penalty of
						not less than $5,000 and not more than $10,000 plus three (3) times the amount
						of damages which the Government sustains because of the act of that
						person...."
Compliance with Section 6032 (Employee Education about
						False Claims Recovery) of the
Deficit Reduction Act of 2005
,
						is mandatory for providers or provider entities making or receiving payments of
						at least $5,000,000 under the MaineCare Program in any federal fiscal year. The
						$5,000,000 threshold, for MaineCare purposes, is based upon paid claims or
						amount of contract, net of any adjustments to those claims or contracts. Those
						affected providers or provider entities meeting this threshold include the
						following:
An individual governmental agency, organization, unit,
						corporation, partnership, individuals, or other business arrangement (including
						any Medicaid managed care organization, irrespective of the form of business
						structure or arrangement by which it exists), whether for profit or not for
						profit, that receives or makes payments, under a State Plan approved under
						title XIX or under any waiver of such plan, totaling at least $5,000,000 during
						any federal fiscal year (FFY).
1. The Maine Department of Health and Human Services
						(hereinafter "the Department") will monitor compliance with these federal
						requirements by notifying all entities who met this threshold in the previous
						federal fiscal year. This notification will be completed in June of each
						calendar year thereafter. The Department will incorporate into the provider
						enrollment agreement and any contracts, the responsibilities of the entities in
						implementing Section 6032 (Employee Education about False Claims Recovery) of
						the
Deficit Reduction Act of 2005
.
2. The Department will request copies of the affected
						provider's written policies, including any employee handbooks or instructions,
						if they exist, and the plan to disseminate those policies to staff.
3. The Department will conduct a desk review of the
						entity's written policies and procedures and provide a written response of
						approval and/or suggestions to said policies and dissemination plan. Said
						policies and procedures will include an explanation of the false claims act;
						the entity's policies and procedures for detecting and preventing waste, fraud
						and abuse; the rights of the employee to be protected as whistle blowers and
						telephone numbers and/or addresses for reporting fraud and abuse.
4. Thereafter, the Department will contact entities in
						June on an annual basis for any update or change to its written policies in
						order to assure on-going compliance. The Department will accomplish this
						verification by provider survey.
5. Newly identified entities will be required to submit
						their policies, dissemination plan and any additional information needed by the
						Department to determine compliance with the requirements referenced in #2, 3
						and 4 above.
6. The Department has a range of sanctions contained in
						its administrative regulation for non-compliance with MaineCare policies. These
						sanctions range from requiring a plan of correction to termination from the
						MaineCare Program. These sanctions will be applied to non-compliance with the
						"Employee Education about False Claims Recovery."