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Medicaid Investigations

Medicaid Investigations Unit (OIG-MIU)

The Medicaid Investigations Unit's primary responsibility is to identify and investigate fraud and abuse within the Medicaid and Peachcare for Kids Programs (both provider and recipient).

When investigations are complete and a complaint has been corroborated, provider cases are referred to the State Health Care Fraud Control Unit and recipient cases are referred to local law enforcement or the district attorney’s office located within the jurisdiction of where the crime occurred. 

We also work with HHS-OIG and the FBI on cases that cross over between Medicaid, Medicare and private insurance.  These cases are usually prosecuted by the US Attorney’s Office.

OIG-MIU Is Made Up of Two Teams:

Investigations Team

• Nine Investigators are assigned to the Unit
• Seven Investigators are located in Atlanta 
• Two Investigators are located in South Georgia
• One Audit Supervisor

Data Analysis Team

• Four Stat Analyst
• Three Research Analyst

Cases Are Generated In The Following Ways:

1. Hotline Calls
2. Complaints Filed Over The Internet
3. Inter-Agency Referrals
4. Referrals From External Agencies Or Sources
5. Data Analysis Or Data Mining

Case Dispositions

1. Civil Recoupment
2. Administrative Actions-(Terminations, Suspensions, Etc..)
3. Criminal Prosecution

Examples of Provider Fraud

1. Billing For Services Not Rendered
2. Identity Theft of A Provider
3. Up Coding
4. Unbundling
5. Kickbacks/Self Referrals
6. Falsifying Documents

Examples of Recipient Fraud

1. False Reporting of Income
2. Identity Theft
3. Allowing Someone Else to Use Medicaid Card
4. Forging Prescription
5. Calling In False Prescriptions

Any DCH employee or private citizen may report fraud or abuse.

Complaints should be forwarded to:

Office of Inspector General
Attn: Medicaid Investigations Unit
2 Peachtree Street, NW 5^th floor
Atlanta, GA 30303

Or

E-mail to pihotline@dch.ga.gov