TITLE 49 SOCIAL SERVICES

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

ARTICLE 7B FALSE MEDICAID CLAIMS

49-4-168.1. Civil penalties for false or fraudulent Medicaid claims.

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."