Georgia investigators increasingly use computer data to catch Medicaid fraud

Atlanta Journal-Constitution: Georgia investigators "are collecting millions more dollars each year as they catch more Medicaid fraud and mistakes" and they are increasingly relying on computer data analysis as a helpful tool. These cases often uncover unscrupulous medical providers who develop schemes such as overbilling to defraud the state Medicaid program. ... Some charge for services that were never performed. Attorney General Thurbert Baker's office helps in the investigations and prosecutions. Recovering that money — $26 million in fiscal year 2009 — is welcome, Baker told The Atlanta Journal-Constitution, especially this year as the state faces a $608 million Medicaid funding gap. Computer analysis often works hand-in-hand with old-fashioned investigative work" (Schneider, 4/23).

The Associated Press/Bloomberg BusinessWeek: "Federal prosecutors are seeking to freeze the assets of an in-home health care provider for elderly and disabled people, after West Virginia background checks found many workers with criminal histories, including convicted felons. No criminal charges have been filed against Golden Heart In Home Care LLC of St. Albans. A civil complaint filed in U.S. District Court in Charleston alleges the company hired convicted felons, failed to do background checks and properly train employees, improperly paid them and billed for services it never provided. ... Golden Heart is being investigated by the U.S. Department of Health and Human Services, the FBI, the Internal Revenue Service, the state Medicaid Fraud Control Unit and federal prosecutors" (Raby, 4/22).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.