Deficit Reduction Act, Section 6032

What does Section 6032 of the Deficit Reduction Act (DRA) say?

Section 6032 of the Deficit Reduction Act of 2005 (DRA) is codified at 42 U.S.C. § 1396a(a)(68). It requires entities that receive or make annual payments under the Medicaid program of at least $5 million to establish written policies for all employees, contractors, and agents. The intent of such policies is to provide guidance on preventing and detecting fraud, waste, and abuse in federal healthcare programs.

Who is subject to it?

Entities subject to Section 6032 of the DRA include:

Healthcare providers
Medicaid Managed Care Organizations (MCOs)
Other entities receiving or making annual payments under the Medicaid program of at least $5 million

What is an entity?

For the purposes of Section 6032 of the DRA, an “entity” refers to any healthcare provider or organization that uses a common tax identification number (TIN). This means that the expenditures of all providers using the same TIN will be aggregated to determine whether the entity meets the $5 million threshold for Medicaid payments.

What is required for providers to be compliant?

Entities subject to Section 6032 of the DRA must:

Develop Written Policies: Establish written policies for all employees, contractors, and agents. These policies should provide detailed information about:

The False Claims Act established under sections 3729 through 3733 of title 31;
Administrative remedies for false claims and statements established under chapter 38 of title 31;
Relevant state laws for civil or criminal penalties for false claims and statements;
Whistleblower protections under these laws; and
The entity's policies and procedures for detecting and preventing fraud, waste, and abuse

Employee Handbook Updates (if one exists): If the entity has an established employee handbook, include the written policies and the provider's commitment to preventing and detecting fraud, waste, and abuse. An entity is not required to develop an employee handbook if one does not exist.

How do I stay up to date on this and other Medicaid topics?

Sign up for the Medicaid Information Bulletin to get regular updates on the Medicaid program: https://medicaid.utah.gov/medicaid-information-bulletins/

Update your provider email address in PRISM for up to date contact information: https://medicaid.utah.gov/accessing-prism/