Office of Inspector General

Honor. Performance. Integrity. The Office of Inspector General (OIG) safeguards the integrity of the Georgia Department of Community Health (DCH) from risk internally and externally. Detecting fraud, waste and abuse is the office’s clear charge.

The OIG rigorously reviews, investigates and audits Medicaid providers and recipients to uncover criminal conduct, administrative wrongdoing, poor management practices, and other waste, fraud and abuse. OIG also reviews the State Health Benefit Plan (SHBP), Healthcare Facility Regulation and other offices at DCH.

Additionally, the office provides department oversight, audit and  Third Party Liability (TPL) services. The office has seven units:

  • Medicaid/PeachCare For Kids® Program Integrity Unit -- The Medicaid/PeachCare For Kids® Program Integrity Unit performs utilization reviews and investigates providers suspected of overbilling or defrauding Georgia’s Medicaid program. 
  • Special Investigations Unit-- Examines allegations of fraud, waste and abuse by DCH employees, contractors, sub-contractors and vendors and investigates Medicaid/PeachCare For Kids®. 
  • Office of Audits -- The Office of Audits performs independent, objective assurance and consulting actions intended to enhance the Department’s operations to ensure compliance with State and Federal regulations, including operational and financial activities. 
  • Third-Party Liability Unit -- The Third-Party Liability Unit is responsible for identifying Medicaid beneficiaries who are dually-covered by Medicaid and another medical insurance plan. 
  • Background Investigations Unit -- The Background Investigations Unit performs state and federal criminal history background investigations and credit checks on behalf of the Department, including the Office of Health Care Facility Regulation and the Office of Human Resources. 
  • Data Integrity and Analysis Unit -- The Data Integrity and Analysis Unit is responsible for using data analytics and predictive modeling in the detection of fraud, waste and abuse, including identification of patterns of suspicious behavior or billing anomalies. 
  • OIG Legal/State Health Benefit Plan Fraud Unit -- The Legal/State Health Benefit Plan (SHBP) Unit provides advice and representation for the Division on all legal matters and is responsible for coordinating inquiries related to allegations of fraud, waste and abuse within SHBP.