C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-1, app 144-101-I-1-2
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."
C.M.R. 10, 144, ch. 101, ch. I, § 144-101-I-1, app 144-101-I-1-2