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2018 Georgia Code 49-4-146 | Car Wreck Lawyer

TITLE 49 SOCIAL SERVICES

Section 4. Public Assistance, 49-4-1 through 49-4-193.

ARTICLE 7 MEDICAL ASSISTANCE GENERALLY

49-4-146. Time for action on claim.

The Department of Community Health, within three months of receiving a claim submitted on or after July 1, 1978, shall pay or deny the claim.

(Ga. L. 1977, p. 384, § 15A; Ga. L. 1999, p. 296, § 24.)

JUDICIAL DECISIONS

Restrictions on reimbursement for abortions as denial or reduction of required service.

- Restrictions on reimbursement for abortions contained in Georgia's rules amount to a denial or reduction of a required service to an otherwise eligible recipient solely because of that eligible recipient's condition, i.e., pregnancy, and furthermore, these restrictions are not based on medical necessity or utilization control procedures nor is any contention made by the defendants that the abortions sought by the plaintiffs were not medically necessary or presented utilization control problems; therefore, under 42 C.F.R. § 440.230(c) the Georgia Department of Medical Assistance (now Department of Community Health) must provide reimbursement for these medically necessary abortions. Doe v. Busbee, 481 F. Supp. 46 (N.D. Ga. 1979).

Cases Citing O.C.G.A. § 49-4-146

Total Results: 4  |  Sort by: Relevance  |  Newest First

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State v. Johnson, 499 S.E.2d 56 (Ga. 1998).

Cited 29 times | Published | Supreme Court of Georgia | Apr 13, 1998 | 269 Ga. 370

...Where the criminal act involves the making of a false document, the essence of the crime is the act of falsification itself, which is an act separate and distinct from submitting, sending or using the falsified document. Hence, in State v. Barber, supra, venue for the falsification of medical assistance documents under OCGA § 49-4-146.1(b)(2) was properly found to be in the county where the falsification occurred....
...te or political subdivision, an act which is separate and distinct from the act of falsification. Accord State v. Barber, 260 Ga. 269, 394 S.E.2d 353 (1990), where, in contrast to venue for the falsification of medical assistance benefits under OCGA § 49-4-146.1(b)(2), it was recognized that venue for the obtaining of medical assistance benefits under (b)(1) of that statute would be "the county where a false report was submitted and processed in an attempt to obtain medical assistance." Id., Weltner, J., concurring....
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Malloy v. State, 293 Ga. 350 (Ga. 2013).

Cited 21 times | Published | Supreme Court of Georgia | Jun 17, 2013 | 744 S.E.2d 778, 2013 Fulton County D. Rep. 1847

THOMPSON, Presiding Justice. Appellant Tyrone Cecil Malloy, a Georgia gynecologist, was indicted along with his office manager on two counts of Medicaid fraud in violation of OCGA § 49-4-146.1 (b) (2).1 Specifically, appellant was charged with knowingly and wilfully accepting medical assistance payments to which he was not entitled and in amounts greater than he was entitled from the State of Georgia Medicaid program because...
...Addressing the issue of jurisdiction, we find the instant appeal is properly before this Court. Appellant seeks review of three rulings made by the trial court: the denial of his plea in abatement based on collateral estoppel, the denial of his motion to dismiss in which he challenged the constitutionality of OCGA § 49-4-146.1 (b) (2) as applied to him, and the denial of his special demurrer and motion to strike surplusage in the indictment....
...seek appellate review of the trial court’s denial of his other two motions. See OCGA § 5-6-34 (d). Finally, because this Court has jurisdiction over appellant’s claim that the trial court erred in rejecting his constitutional challenge to OCGA § 49-4-146.1 (b) (2) as applied, this Court also has jurisdiction to consider the other allegations of error presented on appeal....
...a full opportunity to litigate the issue and conclude that preclusive effect should not be given to the administrative determination. 3. Appellant contends the trial court erred in denying his motion to dismiss the indictment on the basis that OCGA § 49-4-146.1 (b) (2) as applied to him is unconstitutionally vague....
...259, 266 (117 SCt 1219, 137 LE2d 432) (1997) (court must resolve statute’s ambiguity in favor of applying it only to conduct which is clearly covered). The trial court found that although the statute did not explicitly state all the manners in which one could violate OCGA § 49-4-146.1 (b) (2), the procedures for which one would not be entitled to payment through the program were listed in the Medicaid manual; thus, the statute in conjunction with the manual provided appellant with appropriate notice as required by law....
...lication by law enforcement — noting that either there was enough evidence to meet the statute’s elements or not. We agree with the trial court. The State’s allegations of fact as recited in the indictment coupled with the applicable law, OCGA§ 49-4-146.1 (b) (2), show appellant had sufficient notice of the prohibited conduct....
...of whether appellant knowingly made false claims, a question of fact which does not overcome the presumption that the statute is constitutional. See generally Buice v. Dixon, 223 Ga. 645, 646-647 (157 SE2d 481) (1967). Accordingly, we find that OCGA § 49-4-146.1 (b) (2) as applied in this case is not unconstitutionally vague, and we affirm the trial court’s denial of appellant’s motion to dismiss the indictment. 4....
...Reconsideration denied July 11, 2013. M. Katherine Durant, D. Lowell Thomas, Thelma W. Cummings Moore, for appellant. Samuel S. Olens, Attorney General, Nancy B. Allstrom, Senior Assistant Attorney General, Henry A. Hibbert, Assistant Attorney General, for appellee. OCGA § 49-4-146.1 (b) (2) makes it unlawful for any person or Medicaid provider “knowingly and willfully to accept medical assistance payments to which he or she is not entitled or in an amount greater than that to which he or she is entitled or knowin...
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State v. Kell, 577 S.E.2d 551 (Ga. 2003).

Cited 20 times | Published | Supreme Court of Georgia | Feb 24, 2003 | 276 Ga. 423, 2003 Fulton County D. Rep. 1327

...Yancey, Brunswick, for appellee in No. S02G1144. THOMPSON, Justice. We granted certiorari to the Court of Appeals in these consolidated cases to determine where venue lies in the prosecution of cases of Medicaid fraud committed by a fraudulent scheme or device under OCGA § 49-4-146.1(b)(1)(C)....
...718(2), 563 S.E.2d 459 (2002), those cases are reversed. Case No. S92G0997 In one count of a multi-count indictment returned in Fulton County, Michael J. Kell was charged with obtaining Medicaid benefits by a fraudulent scheme or device under OCGA § 49-4-146.1(b)(1)(C)....
...use venue lies in DeKalb County where the fraudulent claims were received and processed by EDS. Culver, supra at 302(1)(b). [2] Case No. S02G1144 JoAnn Cash was charged, tried, and convicted in Glynn County of two counts of Medicaid fraud under OCGA § 49-4-146.1(b)(1)(C)....
...d not lie in Glynn County, but in DeKalb County where the requests for medical assistance payments were submitted and processed. Cash, supra at 721(2). As noted above, defendants Kell and Cash were charged in separate indictments with violating OCGA § 49-4-146(b)(1)(C) of the Georgia Medical Assistance Act ("Act"), OCGA § 49-4-140 et seq., in that they obtained payments under the Act to which they were not entitled or in amounts greater than which they were entitled by use of a "fraudulent sch...
...for the prosecution of Medicaid fraud, we look to where the "crime was committed." The proscribed conduct in both cases was the "obtaining" of medical assistance payments to which one is not entitled by means of a "fraudulent scheme or device." OCGA § 49-4-146.1(b)(1)(C)....
...by some planned action or method." Thus, at its inception the offense is committed by a plan or scheme to obtain the illegal payments, and it is concluded when the proceeds are attained. It is, therefore, an ongoing crime which occurs in any county in which an act in furtherance of the crime is committed. Since under OCGA § 49-4-146.1(b)(1)(C) it is also unlawful for one to "attempt to obtain" illegal payments by use of a fraudulent scheme or device, it would be illogical to require prosecution only where the claims are processed because in the case of attempted Medicaid fraud the crime may never reach that level of completion....
...For the same reasons, in Cash's case, venue would be proper either in Glynn, Fulton or DeKalb Counties. Neither Johnson, supra, nor State v. Barber, 260 Ga. 269, 394 S.E.2d 353 (1990) compels a contrary result. In those cases, any discussion of venue in the context of prosecutions under OCGA § 49-4-146.1(b)(1) is contained merely in dicta and thus is not binding with regard to the issue presently before the Court. In fact, in Barber, supra, we unanimously vacated a writ of certiorari as improvidently granted, and the only reference to venue under OCGA § 49-4-146.1(b)(1) was in a single-Justice concurrence which was *554 both dicta and which lacks any precedential value. Thus, this Court has not, until now, spoken definitively on the issue of venue in Medicaid fraud prosecutions under OCGA § 49-4-146.1(b)(1)(C). In accordance with the foregoing, we now hold that prosecutions for Medicaid fraud under OCGA § 49-4-146.1(b)(1)(C) may be brought in any county in which an act in furtherance of the crime took place....
...All the Justices concur. NOTES [1] Kell and codefendant Michael D. Culver were jointly indicted and tried in Fulton County. They were both convicted as charged and filed consolidated appeals in the Court of Appeals. Culver's conviction for Medicaid fraud under OCGA § 49-4-146.1(b)(1)(C) was reversed because the evidence was legally insufficient to support the verdict....
...State, 265 Ga. 399(1), 456 S.E.2d 503 (1995), the issue presently under consideration by this Court is not applicable to him. However, Kell's case bears Culver's name. [2] Kell's remaining convictions were affirmed. Culver, supra. [3] In addition to OCGA § 49-4-146.1(b)(1)(C), other forms of Medicaid fraud are set forth in the statute....
...Subsection (b)(1)(A) is violated when a person obtains payments by "[k]nowingly and willfully making a false statement or false representation"; subsection (b)(1)(B) is violated when a person obtains or attempts to obtain payments to which they are not entitled by "[d]eliberate concealment of any material fact." Under OCGA § 49-4-146.1(b)(2) it is unlawful for a "provider knowingly and willfully to accept medical assistance payments to which he is not entitled or in an amount greater than that to which he is entitled, or knowingly and willfully to falsify any report o...
...r this article." We do not reach the question of venue for alternative forms of Medicaid fraud under the statute. But see State v. Barber, 193 Ga.App. 397, 388 S.E.2d 350 (1989) (venue for the falsification of medical assistance documents under OCGA § 49-4-146.1(b)(2) was found to be in the county where the falsification occurred).
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State v. Barber, 394 S.E.2d 353 (Ga. 1990).

Cited 2 times | Published | Supreme Court of Georgia | Jun 22, 1990 | 260 Ga. 269

...i, and the writ is therefore vacated. All the Justices concur. WELTNER, Justice, concurring. I concur in vacating the grant of certiorari. The Court of Appeals considered only the venue for the trial of a defendant charged with the violation of OCGA § 49-4-146.1 (b) (2). [1] I write to point out that, under the indictment, Barber also could be tried for violating OCGA § 49-4-146.1 (b) (1) (A)....