In Georgia, strict fraud enforcement raises concerns about access to care

Providers in Atlanta are raising concerns about Georgia's approach to fraud enforcement, citing multiple cases in which the state has levied heavy fines against facilities for making small clerical errors, according to WSB-TV 2 in Atlanta.

Many have voiced concerns about access to care, as some providers are facing staggering fines that threaten to put them out of business. For example, Whitney Fuchs, who operates 28 group homes for the disabled in Atlanta, claims a recent state audit resulted in a $1.5 million fine after state investigators found issues surrounding incorrect signatures and incomplete documentation. A previous investigation by WSB-TV 2 found that state auditors demanded another provider that cares for the disabled return nearly $500,000 in Medicaid payments because of a missing signature on 44 reports.

In April, Georgia officials identified more than $120 million in improper Medicare and Medicaid payments within the state. However, providers argue that the "zero tolerance" policy, which treats documentation errors as fraudulent payments, could force some facilities to file for bankruptcy. Since the media outlet's report, the state has stopped recouping Medicaid payments and is reviewing the auditing process.

States vary in their approach to fraud enforcement. New Mexico came under fire earlier this year for cutting off Medicaid funding to 15 behavioral health providers due to allegations of fraud, many of which went out of business as a result. It was later revealed that the audit did not indicate there was widespread fraud. Months later, the New Mexico Senate passed a law that tightened the requirements for cutting off Medicaid funding to providers.

On the other hand, Washington has faced ongoing criticism regarding its inability to suspend Medicaid payments to providers investigated for credible allegations of fraud. The state's Office of Inspector General recommended that state officials suspend payments during a fraud investigation.

For more:
- here's the WSB-TV 2 investigation

Related Articles:
New Mexico toes the thin line between overzealous detection and legitimate fraud prevention
NM Senate passes bill to prevent prematurely cutting off Medicaid funding to providers
Recent improper billing activity tops $120 million in Georgia
OIG report: Washington needs better policies for suspending providers with credible allegations of fraud

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