DRA 6032

1. DRA § 6032 Employee Education & Training about False Claims Recovery

2. References DRA § 6032 Reference Booklet

3. References Medicaid Integrity Program

4. Today, we will cover… What is DRA § 6032 ? Who does DRA § 6032 apply to ? What does DRA § 6032 require? What does the written information need to include? Where can the applicable laws be located? Is there federal guidance for DRA § 6032? Is there a sample of key works to incorporate into the written information? What have other counties done? What have other “entities” done? Where do we go from here?

5. What is DRA § 6032, Part I ? DRA § 6032 It’s a federal mandate. It: Is an integral part of the Medicaid Integrity Program (MIP), a.k.a. DRA § 6034 (See blue/white Medicaid Integrity Program guide) Is part of the Comprehensive Medicaid Integrity Plan (CMIP) and operates concurrently with DRA Sections 6031 and 6034. Requires an “entity” to do something. (See Booklet page 9) Became effective on January 1, 2007. (See Booklet page 9) Can reduce or stop a reimbursement claim for failure to comply. (See Booklet page 9)

6. Who does DRA § 6032 apply to ? DRA § 6032 applies to: Entities receiving or making annual payments, measured from January 1st of each year, totaling $5 million or more under a state plan (See Booklet page 11) “Employees”, “contractors”, subcontractors, and “agents” of the entity including those who are acting on behalf of the “entity” (See Booklet page 11)

7. What does DRA § 6032 require ? DRA § 6032 requires: Written information to be made readily available by the entity to its employees, contractors and agents Employees, contractors and agents to adhere to the written information provided to them by the entity (See Booklet page 9)

8. What must be included in the written information ? The written information: Must include specific details about the federal False Claims Act, the administrative remedies, and whistleblower protections (Cal. Govt. Code § 12653, next page) Must include specific information and references to state laws and regulations regarding false claims, administrative remedies and whistle blower protections Should incorporate the required information into existing employee handbooks (See Booklet page 9)

9. Whistle Blower Protections(Cal. Govt. Code § 12653) California’s Whistle blower protections can be found in Govt. Code § 12653 which states, in summary, as follows . Employers shall not prevent an employee from disclosing information in the furtherance of a false claims action Employers shall not retaliate against an employee in any manner because of acts by or on behalf of the employee in disclosing information in furtherance of a false claims action An employer who violates (1) & (2) above shall be liable for any relief needed to make the reporting employee whole including reinstatement, two times back pay + interest, compensation for any special damage sustained as a result of the employer’s action, punitive damages, litigation costs, and reasonable attorneys' fees. Employees may bring an action in the appropriate superior court of the state for the relief described in (3). Employees who is discriminated against by any employer because of actions taken in the furtherance of a false claim action shall be entitled to the remedies in (3), above, only if; (a) The employee voluntarily disclosed information or acted in furtherance of a false claims action AND (b) The employee was discriminated against for participating in the furtherance of a false claim suit against the employer

10. Where are the laws found ? The various laws can be found as follows: Federal False Claims Act: 31 U.S.C , Chapter 37, § 3729 - § 3733 (See Booklet pages 17-24) Federal Administrative Remedies: 31 U.S.C., Chapter 38, § 3801 - § 3808 (See Booklet pages 25-32) California’s False Claims Act : Govt. Code § 12650 – § 12656 (See Booklet pages 35-47)

11. Is there federal guidance for this ? CMS Posted Guidance in: State Medicaid Director Letter (SMDL) # 06-025, published on December 13, 2006 (See Booklet pages 49-51) The State Pre-print enclosed with SMDL # 06-025 (See Booklet pages 53-55)

12. Is there key wording that we can use in our written information ? Key words can be found in: The False Claims Act and Administrative Remedies Summary. Key words are: Makes, presents, submits or causes to be made, presented, or submitted, a claim or written statement that a person Knows, or has reason to know, is false, fictitious or fraudulent (See Booklet pages 33-34) California’s False Claims Act (See Booklet pages 35 – 47)

13. What are the other counties doing ? Counties that have shared their drafts are: Butte County draft (See Booklet pages 57-58) Mendocino County draft (See Booklet pages 59-64) Orange County draft (See Booklet pages 65-70) Sonoma County draft (See booklet pages 71-78)

14. What are the other entities doing ? Some entities that have posted their written information are: Safeway Employee Notice (See Booklet pages 79-81) Triad Hospital Disclosure Program (See Booklet pages 83-85) Queen’s Health System (See booklet pages 87-90) Yale New Haven Health (See Booklet pages 91-93)

15. Where do we start ? Counties can start by taking first first steps: Determine if you meet the definition of an “entity” at the $5 million threshold Determine if your existing policies and procedures already meet the requirements of DRA § 6032 Determine if your existing policies and procedures are readily available to employees, contractors and agents Determine if your existing policies & procedures contain mechanisms to detect fraud, waste, and abuse

16. Now the work starts.