Office of Inspector General COVID-19 FAQs

  • What changes has the Office of Inspector General made pertaining to provider utilization reviews as a result of the COVID-19 emergency?

    Effective March 1, 2020, the Office of Inspector General has suspended all Medicaid and PeachCare for Kids FFS provider utilization reviews as a result of the COVID-19 emergency to reduce the administrative burden to providers.

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  • What should I do if I am currently on Prepayment Review managed by the Office of Inspector General during the COVID-19 emergency?

    Normal claim processing operations continue during the emergency period. Providers should continue to submit the required documentation through the GAMMIS web portal.

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  • What should I do if I agree with an Initial or Final Findings notification for a utilization review that was performed prior to March 1, 2020, but immediate repayment would result in a hardship?

    Email Shawn Green at shawn.green@dch.ga.gov to request an extension/deferment from the Office of Inspector General. Your request for an extension must identify the reason including any supporting documentation, and the relief requested. Once your request has been received, analyzed, and processed, the Office of Inspector General will notify you of the decision. This process will take five to seven business days.

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  • What should I do to request an extension or defer repayment of a settlement with the Office of Inspector General during the COVID-19 emergency?

    Email Shawn Green at shawn.green@dch.ga.gov to request an extension/deferment from the Office of Inspector General. Your request for an extension must identify the reason including any supporting documentation, and the relief requested. Once your request has been received, analyzed, and processed, the Office of Inspector General will notify you of the decision. This process will take five to seven business days. 

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  • What should I do if I need to request an extension for recoupment associated with a utilization review performed prior to March 1, 2020?

    Email Shawn Green at shawn.green@dch.ga.gov to request an extension/deferment from the Office of Inspector General. Your request for an extension must identify the reason including any supporting documentation, and the relief requested. Once your request has been received, analyzed, and processed, the Office of Inspector General will notify you of the decision. This process will take five to seven business days.

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  • What should I do if I need to file a self-disclosure notification with the Office of Inspector General during the COVID-19 emergency?

    Continue to submit self-disclosure notifications to the Office of Inspector General. The self-disclosure will be processed as normal. If you have additional questions or concerns, contact the reviewer listed via email in the self-disclosure letter.

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  • What should I do if I need to request a payment plan for a self-disclosure notice filed with the Office of Inspector General during the COVID-19 emergency?

    Email Shawn Green at shawn.green@dch.ga.gov to request approval of a payment plan from the Office of Inspector General. Your request for a payment plan must identify the reason including any supporting documentation, and the relief requested. Once your request has been received, analyzed, and processed, the Office of Inspector General will notify you of the decision. This process will take five to seven business days.

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  • What should I do if I need to request a payment plan for a recoupment related to a Beacon quality review performed prior to March 1, 2020?

    Email Shawn Green at shawn.green@dch.ga.gov to request a payment plan from the Office of Inspector General. Your request for a payment plan must identify the reason including any supporting documentation, and the relief requested. Once your request has been received, analyzed, and processed, the Office of Inspector General will notify you of the decision. This process will take five to seven business days.

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  • Does DCH anticipate any changes to FFS pharmacy utilization review operations?

    Currently, in-store (field) reviews have been suspended and the initiation of new, routine desk reviews has been delayed with few exceptions. For reviews prior to March 1, 2020, providers may contact the reviewer to request an extension if needed.

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  • Will the Pharmacy Services Lock-In Program be in place during the COVID-19 emergency?

    Yes. The Pharmacy Services Lock-In Program will continue to be operational during the COVID-19 Emergency.

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  • Who should I contact to report fraudulent activity related to the Georgia Medicaid and PeachCare for Kids programs during the COVID 19 emergency?

    The Office of Inspector General continues to operate during the COVID-19 emergency. To report suspected fraud, waste, or abuse by providers or members of the Georgia Medicaid and PeachCare for Kids programs, please call 404-463-7590 or toll-free at 1-800-533-0686 or through email at oiganonymous@dch.ga.gov. Additional options to report fraud, waste, and abuse can be found at https://dch.georgia.gov/office-inspector-general/report-medicaidpeachcare-kids-fraud .

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