TITLE 49 SOCIAL SERVICES

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

ARTICLE 7B FALSE MEDICAID CLAIMS

49-4-168. Definitions.

As used in this article, the term:

1. "Claim" includes any request or demand, whether under a contract or otherwise, for money or property, whether or not the Georgia Medicaid program or this state has title to such money or property, which is made to the Georgia Medicaid program, to any officer, employee, fiscal intermediary, grantee, agent, or contractor of the Georgia Medicaid program, or to other persons or entities if it results in payments by the Georgia Medicaid program, if the Georgia Medicaid program provides, has provided, or will provide any portion of the money or property requested or demanded; if the Georgia Medicaid program will reimburse the contractor, grantee, or other recipient for any portion of the money or property requested or demanded; or if the money or property is to be spent or used on behalf of or to advance the Georgia Medicaid program. A claim includes a request or demand made orally, in writing, electronically, or magnetically. Each claim may be treated as a separate claim.
2. "Knowing" and "knowingly" require no proof of specific intent to defraud and mean that a person, with respect to information:
   1. Has actual knowledge of the information;
   2. Acts in deliberate ignorance of the truth or falsity of the information; or
   3. Acts in reckless disregard of the truth or falsity of the information.
3. "Material" means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.
4. "Obligation" means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee based or similar relationship, from statute or regulation, or from retention of any overpayment.
5. "Person" means any natural person, corporation, company, association, firm, partnership, society, joint-stock company, or any other entity with capacity to sue or be sued.

(Code 1981, §49-4-168, enacted by Ga. L. 2007, p. 355, § 3/HB 551; Ga. L. 2012, p. 127, § 2-1/HB 822; Ga. L. 2013, p. 141, § 49/HB 79.)

The 2012 amendment, effective July 1, 2012, in the first sentence of paragraph (1), substituted "money or property, whether or not the Georgia Medicaid program or this state has title to such money or property" for "money, property, or services", deleted "or" following "Georgia Medicaid program,", inserted ", agent," inserted ", has provided,", substituted "demanded; if" for "demanded, or if", and added "; or if the money or property is to be spent or used on behalf of or to advance the Georgia Medicaid program" at the end; substituted "requires no proof of specific intent to defraud and means" for "mean" in the introductory paragraph of paragraph (2); deleted the former second sentence of subparagraph (2)(C), which read: "No proof of specific intent to defraud is required."; added paragraphs (3) and (4); and redesignated former paragraph (3) as present paragraph (5).

The 2013 amendment, effective April 24, 2013, part of an Act to revise, modernize, and correct the Code, revised language in paragraph (2).