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Georgia False Medicaid Claims Act Does Not Meet Social Security Act Requirements

Georgia False Medicaid Claims ActIn response to a request to review the amended Georgia False Medicaid Claims Act, the U.S. Inspector General wrote to Toni Prine, interim Inspector General for the State of Georgia. In a letter dated April 3, 2013, the U.S. Inspector General determined that the amended Georgia False Medicaid Claims Act does not meet the requirements of section 1909(b) of the Social Security Act.

Some key differences between the Federal False Claims Act and the Georgia Act include the following:

1. The Federal Act “establishes liability for knowingly presenting, or causing to be presented, a false or fraudulent claim for payment or approval.” The Georgia Act requires that the claim be submitted to the Georgia Medicaid Program.

2. The Federal Act establishes liability for “conspiring to commit a violation of another subsection” of the Act, but the Georgia Act does not establish liability for this conduct.

3. The Federal Act states that a qui tam action shall be dismissed “if substantially the same allegations or transactions as alleged in the action or claim were publicly disclosed in a congressional; Government Accountability Offic[e]; or other Federal report, hearing, audit, or investigation.” However, the Georgia Act does not set forth a provision that is as effective at facilitating qui tam actions.

Section 1909 of the Social Security Act provides a financial incentive to states that enact a law regarding submission of false or fraudulent claims to the state’s Medicaid program. Georgia must resubmit an amended Act by August 31, 2013.