Section 441.79.15. Education about false claims recovery.

The provisions in this rule apply to any entity that has received medical assistance payments totaling at least $5 million during a federal fiscal year (ending on September 30). For entities whose payments reach this threshold, compliance with this rule is a condition of receiving payments under the medical assistance program during the following calendar year.

         79.15(1) Policy requirements. Any entity whose medical assistance payments meet the threshold shall:

            a.               Establish written policies for all employees of the entity and for all employees of any contractor or agent of the entity, including management, which provide detailed information about:

             (1)             The False Claims Act established under Title 31, United States Code, Sections 3729 through 3733;

             (2)             Administrative remedies for false claims and statements established under Title 31, United States Code, Chapter 38;

             (3)             Any state laws pertaining to civil or criminal penalties for false claims and statements;

             (4)             Whistle blower protections under the laws described in subparagraphs (1) to (3) with respect to the role of these laws in preventing and detecting fraud, waste, and abuse in federal health care programs, as defined in Title 42, United States Code, Section 1320a-7b(f); and

             (5)             The entity’s policies and procedures for detecting and preventing fraud, waste, and abuse.

            b.               Include in any employee handbook a specific discussion of:

             (1)             The laws described in paragraph 79.15(1)“a”;

             (2)             The rights of employees to be protected as whistle blowers; and

             (3)             The entity’s policies and procedures for detecting and preventing fraud, waste, and abuse.

         79.15(2) Reporting requirements.

            a.               Any entity whose medical assistance payments meet the specified threshold during a federal fiscal year shall provide the following information to the Iowa Medicaid enterprise by the following December 31:

             (1)             The name, address, and national provider identification numbers under which the entity receives payment;

             (2)             Copies of written or electronic policies that meet the requirements of subrule 79.15(1); and

             (3)             A written description of how the policies are made available and disseminated to all employees of the entity and to all employees of any contractor or agent of the entity.

            b.               The information may be provided by:

             (1)             Mailing the information to the IME Program Integrity Unit, P.O. Box 36390, Des Moines, Iowa 50315; or

             (2)             Faxing the information to [phone].

         79.15(3) Enforcement. Any entity that fails to comply with the requirements of this rule shall be subject to sanction under rule 441—79.2(249A), including probation, suspension or withholding of payments, and suspension or termination from participation in the medical assistance program.

This rule is intended to implement Iowa Code section 249A.4 and Public Law 109-171, Section 6032.

[ARC 9440B, IAB 4/6/11, effective 4/1/11]