Civil Penalties for False or Fraudulent Medicaid Claims

  1. Law
  2. Georgia Code
  3. Social Services
  4. Public Assistance
  5. False Medicaid Claims
  6. Civil Penalties for False or Fraudulent Medicaid Claims

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  1. Any person who:
    1. Knowingly presents or causes to be presented to the Georgia Medicaid program a false or fraudulent claim for payment or approval;
    2. Knowingly makes, uses, or causes to be made or used a false record or statement material to a false or fraudulent claim;
    3. Conspires to commit a violation of paragraph (1), (2), (4), (5), (6), or (7) of this subsection;
    4. Has possession, custody, or control of property or money used or to be used by the Georgia Medicaid program and knowingly delivers, or causes to be delivered, less than all of such property or money;
    5. Is authorized to make or deliver a document certifying receipt of property used, or to be used, by the Georgia Medicaid program and, intending to defraud the Georgia Medicaid program, makes or delivers the receipt without completely knowing that the information on the receipt is true;
    6. Knowingly buys, or receives as a pledge of an obligation or debt, public property from an officer or employee of the Georgia Medicaid program who lawfully may not sell or pledge the property; or
    7. Knowingly makes, uses, or causes to be made or used a false record or statement material to an obligation to pay or transmit property or money to the Georgia Medicaid program, or knowingly conceals or knowingly and improperly avoids or decreases an obligation to pay or transmit property or money to the Georgia Medicaid program,

      shall be liable to the State of Georgia for a civil penalty consistent with the civil penalties provision of the federal False Claims Act, 31 U.S.C. 3729(a), as adjusted by the federal Civil Penalties Inflation Adjustment Act of 1990 (28 U.S.C. 2461; Public Law 101-410), and as further amended by the federal Civil Penalties Inflation Adjustment Improvements Act of 2015 (Sec. 701 of Public Law 114-74), plus three times the amount of damages which the Georgia Medicaid program sustains because of the act of such person.

  2. The provisions of subsection (a) of this Code section notwithstanding, if the court finds that:
    1. The person committing the violation of this subsection furnished officials of the Georgia Medicaid program with all information known to such person about the violation within 30 days after the date on which the defendant first obtained the information;
    2. Such person fully cooperated with any government investigation of such violation; and
    3. At the time such person furnished the Georgia Medicaid program with the information about the violation, no criminal prosecution, civil action, or administrative action had commenced under this article with respect to such violation, and the person did not have actual knowledge of the existence of an investigation into such violation,

      the court may assess not more than two times the amount of the actual damages which the Georgia Medicaid program sustained because of the act of such person.

  3. A person violating any provision of subsection (a) of this Code section shall also be liable to this state for all costs of any civil action brought to recover the damages and penalties provided under this article.
  4. As used in this Code section, the term "Georgia Medicaid program" includes any contractor, subcontractor, or agent for the Georgia Medicaid program, including, but not limited to, a managed care program operated, funded, or reimbursed by the Georgia Medicaid program.

(Code 1981, §49-4-168.1, enacted by Ga. L. 2007, p. 355, § 3/HB 551; Ga. L. 2009, p. 8, § 49/SB 46; Ga. L. 2012, p. 127, § 2-1/HB 822; Ga. L. 2014, p. 77, § 1/HB 973; Ga. L. 2018, p. 240, § 1/SB 321.)

The 2012 amendment, effective July 1, 2012, substituted "material to a false or fraudulent claim" for "to get a false or fraudulent claim paid or approved by the Georgia Medicaid program" in paragraph (a)(2); substituted "knowingly delivers, or causes to be delivered, less than all of such property or money" for ", intending to defraud the Georgia Medicaid program or willfully to conceal the property, delivers, or causes to be delivered, less property than the amount for which the person receives a certificate of receipt" in paragraph (a)(4); substituted "Is" for "Being" at the beginning of paragraph (a)(5); and substituted the present provisions of paragraph (a)(7) for the former provisions, which read: "Knowingly makes, uses, or causes to be made or used a false record or statement to conceal, avoid, or decrease an obligation to pay, repay, or transmit money or property to the State of Georgia."

The 2014 amendment, effective April 15, 2014, substituted the present provisions of paragraph (a)(3) for the former provisions, which read: "Conspires to defraud the Georgia Medicaid program by getting a false or fraudulent claim allowed or paid" and added subsection (d).

The 2018 amendment, effective May 3, 2018, substituted the present provisions of the ending undesignated language of subsection (a) for the former provisions, which read: "shall be liable to the State of Georgia for a civil penalty of not less than $5,500.00 and not more than $11,000.00 for each false or fraudulent claim, plus three times the amount of damages which the Georgia Medicaid program sustains because of the act of such person."

Code Commission notes.

- Pursuant to Code Section 28-9-5, in 2007, "subsection (a) of this Code section" was substituted for "this subsection" in subsection (c).

JUDICIAL DECISIONS

Failure to state claim for reverse false claims.

- In the plaintiff's second amended complaint alleging four schemes that resulted in the presentation of false or fraudulent claims for payment to Medicaid and PeachCare in violation of the Georgia False Medicaid Claims Act, O.C.G.A. § 49-4-168 et seq., the complaint failed to state any cause of action for reverse false claims because the defendants did not owe money to the Georgia Medicaid program as the defendants did not submit any claims to the Georgia Medicaid program that resulted in overpayment. Hill v. Bd. of Regents of the Univ. Sys. of Ga., 351 Ga. App. 455, 829 S.E.2d 193 (2019), cert. denied, No. S19C1531, 2020 Ga. LEXIS 164 (Ga. 2020).

No civil liability for claims when not submitted to Georgia Medicaid program.

- In the plaintiff's second amended complaint alleging four schemes that resulted in the presentation of false or fraudulent claims for payment to Medicaid and PeachCare in violation of the Georgia False Medicaid Claims Act (GFMCA), O.C.G.A. § 49-4-168 et seq., the complaint failed to state a claim with regard to balance billing because that scheme related to the billing of patients, not the billing of the Georgia Medicaid program as required to state a claim under the GFMCA; and the GFMCA did not provide civil liability for claims submitted to anyone other than the Georgia Medicaid program. Hill v. Bd. of Regents of the Univ. Sys. of Ga., 351 Ga. App. 455, 829 S.E.2d 193 (2019), cert. denied, No. S19C1531, 2020 Ga. LEXIS 164 (Ga. 2020).

Failure to state claim for implied false certification.

- In the plaintiff's second amended complaint alleging four schemes that resulted in the presentation of false or fraudulent claims for payment to Medicaid and PeachCare in violation of the Georgia False Medicaid Claims Act, O.C.G.A. § 49-4-168 et seq., the complaint failed to state a claim for implied false certification as written informed consent for the claims submitted by the defendants was not required, and the defendants did not violate any requirement with regard to plans of care. Hill v. Bd. of Regents of the Univ. Sys. of Ga., 351 Ga. App. 455, 829 S.E.2d 193 (2019), cert. denied, No. S19C1531, 2020 Ga. LEXIS 164 (Ga. 2020).

RESEARCH REFERENCES

ALR.

- Measure and elements of damages under State False Claims Acts, 41 A.L.R.7th Art. 2.

Recognition and application of tort of negligent assault and battery and indirect battery, 41 A.L.R.7th Art. 8.

Liability for trespass or nuisance in hydraulic fracturing, hydro-fracturing, or hydro-fracking, 41 A.L.R.7th Art. 1.

Reverse false claims under State False Claims Act, 46 A.L.R.7th Art. 2.


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