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Home > Georgia State False Medicaid Claims Act

Georgia State False Medicaid Claims Act

Most whistleblower claims are brought under the Federal False Claims Act because they mostly involve government fraud at the federal level – IRS taxpayer fraud, education fraud in the Department of Education, government contracting fraud with the Department of Defense, and health care fraud involving claims for Medicare reimbursement. Some health care fraud whistleblowing claims are more properly brought at the state level, however. These include claims of fraud involving Medicaid. Although Medicaid is a federal program, it is administered at the state level.

Georgia has a state law allowing whistleblowers to file a lawsuit on behalf of the state regarding claims of Medicaid fraud. This law is patterned after the Federal False Claims Act and is explained below. If you need help with a Medicaid fraud whistleblower claim, the attorneys at Stacey Evans Law have the experience and expertise to guide you, represent you, and protect you from retaliation. Call our office in Atlanta for help filing a claim under the Georgia State False Medicaid Claims Act.

What Counts as Medicaid Fraud in Georgia?

According to the State False Medicaid Claims Act, any person or company who submits a false claim to Medicaid is liable to the state of Georgia for a civil penalty between $5,500 and $11,000 per claim, plus three times the amount of the loss sustained by the Georgia Medicaid program because of the false claim. This includes the following acts:

  • Knowingly presents or causes a false or fraudulent claim to be presented to the Georgia Medicaid program for payment or approval;
  • Knowingly makes, uses, or causes to be made or used, a false record or statement to get a false or fraudulent claim paid or approved by the Georgia Medicaid program;
  • Conspires to defraud the Georgia Medicaid program by getting a false or fraudulent claim allowed or paid;
  • Has possession, custody, or control of property or money used, or to be used by the Georgia Medicaid program and, 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;
  • Being 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;
  • 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
  • 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.

If the person accused of committing one of the above acts provided the government with information about the violation within 30 days and fully cooperates with any government investigation into the violation, then the person is only liable for up to double the amount of damages instead of triple, provided the person isn’t already part of a criminal prosecution, civil action, or administrative action related to the violation.

The Law Allows Whistleblowers to Sue and Recover Government Losses

The law allows either the Attorney General or a private person to bring a civil action under the State False Medicaid Claims Act. If a private person brings the action, the Attorney General has 60 days to investigate the allegations in the complaint and decide whether to intervene. If the Attorney General declines to intervene, the person bringing the action has the right to proceed with it on their own.

As a whistleblower, you can collect a portion of any damages recovered on behalf of the government. If the government decides to take over the case, you can still be included as a party and participate in the prosecution. At the end, the court will award you anywhere from 15% to 25% of the amount recovered, depending on how much you contributed to prosecuting the case.

If the government decides not to intervene but you pursue the case against the defendant, you’ll be awarded between 25% and 30% of any damages award. With Stacey Evans Law representing you, we’ll advance all the expenses necessary to litigate the case, so it won’t cost you a penny out of pocket to pursue your whistleblower lawsuit.

Can a Medicaid Employee Be a Whistleblower?

It makes sense that an employee working for Georgia Medicaid might spot false claims being submitted to the government, but that doesn’t necessarily mean the employee can be a whistleblower. The law prohibits whistleblower lawsuits brought by a current or former public employee if the allegations were substantially based on

(A) Allegations of wrongdoing or misconduct which such person had a duty or obligation to report or investigate within the scope of his or her public employment or office; or

(B) Information or records to which such person had access as a result of his or her public employment or office

If you are a Medicaid employee who has uncovered false claims or other Medicaid fraud, contact Stacey Evans Law to discuss your legal options, including whether you might be eligible to file a whistleblower lawsuit under the Georgia State Medicaid False Claims Act.

Important Things to Know About the Georgia State Medicaid False Claims Act

Your case doesn’t only have to be based on inside information you gathered at work. Even if your complaint is primarily based on information you learned from administrative or court proceedings, government investigations, or even heard about in the news, you can still receive up to ten percent of the recovery in the case. The court will award you an amount it deems appropriate considering your role in bringing the action and advancing the case to the litigation stage.

If your case is based on information that was already publicly disclosed, then you can only recover if the case was brought by the Attorney General or if you are the original source of the information disclosed or had direct and independent knowledge of the information. Your case can’t be based on allegations in a civil or administrative proceeding where the state is already a party.

Even if you were the person who planned and initiated the violation of the Medicaid False Claims Act, you can still expose the fraud and bring a lawsuit under the law, although the court can reduce your share of any recovery as the judge deems fit. The only time you can’t collect any portion of the recovery is if you were convicted of criminal conduct related to the False Claims Act violation.

It’s important to know that you could be required to pay the defendant’s attorney’s fees if the court finds your lawsuit was clearly frivolous, clearly vexatious, or brought primarily for purposes of harassment.

Georgia Medicaid Whistleblowers Are Protected From Retaliation by Their Employers

The Georgia State Medicaid False Claims Act provides strong protection for employees who choose to speak out against Medicaid fraud in their workplace. Such workers may not be discharged, demoted, suspended, threatened, harassed, or in any manner discriminated against in the terms and conditions of their employment for filing a whistleblower lawsuit or otherwise participating in an investigation. If you are retaliated against, you can sue to get your job back or have any other benefits restored. You can also receive double the amount of back pay owed plus interest, along with any special damages the retaliation caused you. The employer will have to pay your attorney’s fees as well, so you keep the entire settlement or judgment in your favor. Stacey Evans Law can represent you in litigation if you were the victim of retaliation for exercising your protected right to report Medicaid fraud at your workplace.

Call Stacey Evans Law for Help Blowing the Whistle Under the Georgia State Medicaid False Claims Act

Based in Atlanta, Stacey Evans Law represents whistleblowers throughout the state of Georgia exposing health care fraud and violations of the Georgia State Medicaid False Claims Act. For determined, dedicated and dogged assistance exposing fraud and being rewarded for your efforts, call Stacey Evans Law at 404-850-6750.

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