DRA Compliance Statement

DRA Compliance Statement

Deficit Reduction Act of 2005

The Deficit Reduction Act of 2005 (DRA), effective January 1, 2007, requires all entities that receive $5 million or more in annual Medicaid payments to establish written policies that provide detailed information about the Federal False Claims Act, the administrative remedies for false claims and statements, applicable state laws that provide civil or criminal penalties for making false claims and statements, the "whistleblower" protections afforded under such laws and the role of such laws in preventing and detecting fraud, waste and abuse in federal health care programs.

Under the DRA, Magellan is required to disseminate these policies to its employees, contractors, agents or other persons who furnish, or otherwise authorize the furnishing of, health care items or services; perform billing or coding functions; or are involved in the monitoring of health care services provided by Magellan.

For those Magellan contractors, agents or other persons who receive or pay $5 million or more annually under a State Medicaid Program, compliance with the DRA is a condition of continued participation with federal programs. Failure to comply may disqualify contractors, agents or other persons from receiving reimbursement for the period of non-compliance. Knowing non-compliance may violate the Federal False Claims Act as well as disqualify contractors for participation in federal health care programs.

Magellan's Compliance Activities

Magellan is committed to its role in preventing and detecting health care fraud and abuse and complying with applicable federal and state laws. As a part of this effort, Magellan has a comprehensive compliance program to ensure compliance with the DRA including the following:

  1. A Medicaid Fraud and Abuse Program policy that outlines Magellan's comprehensive compliance program for the detection and prevention of fraud, waste and abuse in the Medicaid program. To review the policy, please select the following link: Medicaid Fraud and Abuse Program policy.
  2. A False Claims and Whistleblower Protection policy that includes a summary of the Federal False Claims Act, federal whistleblower protections and the federal administrative remedies for Federal False Claims. To review the policy, please select the following link: False Claims and Whistleblower Protection policy.
  3. A Corporate Compliance Handbook that includes information on Magellan's Fraud and Abuse program. All Magellan employees must complete an annual training on Magellan's Corporate Compliance Handbook. This training includes information on the Federal False Claims Act, applicable state false claims laws including civil or criminal penalties for making false claims and statements, the "whistleblower" protections afforded under such laws and the role of such laws in preventing and detecting fraud, waste and abuse. To review the Compliance Handbook, please select the following link: Compliance Handbook.
  4. A summary of the State False Claims Laws that identify state civil and criminal penalties for false claims and statements along with the whistleblower protections afforded under such laws. To review the summary, please select the following link: State False Claims Laws.

Copies of our False Claims and Whistleblower Protection policy, Medicaid Fraud and Abuse Program policy, State False Claims Laws summary and Compliance Handbook are also available upon request by contacting the Compliance Hotline at (800) 915-2108 or e-mailing us at compliance@magellanhealth.com.

This page last updated 3/13/2012 3:37:47 PM