2021 Georgia Code
Title 49 - Social Services
Chapter 4 - Public Assistance
Article 7B - False Medicaid Claims
§ 49-4-168. Definitions

As used in this article, the term:

1. "Claim" includes any request or demand, whether under a contract or otherwise, for money or property, whether or not the Georgia Medicaid program or this state has title to such money or property, which is made to the Georgia Medicaid program, to any officer, employee, fiscal intermediary, grantee, agent, or contractor of the Georgia Medicaid program, or to other persons or entities if it results in payments by the Georgia Medicaid program, if the Georgia Medicaid program provides, has provided, or will provide any portion of the money or property requested or demanded; if the Georgia Medicaid program will reimburse the contractor, grantee, or other recipient for any portion of the money or property requested or demanded; or if the money or property is to be spent or used on behalf of or to advance the Georgia Medicaid program. A claim includes a request or demand made orally, in writing, electronically, or magnetically. Each claim may be treated as a separate claim.
2. "Knowing" and "knowingly" require no proof of specific intent to defraud and mean that a person, with respect to information:
   1. Has actual knowledge of the information;
   2. Acts in deliberate ignorance of the truth or falsity of the information; or
   3. Acts in reckless disregard of the truth or falsity of the information.
3. "Material" means having a natural tendency to influence, or be capable of influencing, the payment or receipt of money or property.
4. "Obligation" means an established duty, whether or not fixed, arising from an express or implied contractual, grantor-grantee, or licensor-licensee relationship, from a fee based or similar relationship, from statute or regulation, or from retention of any overpayment.
5. "Person" means any natural person, corporation, company, association, firm, partnership, society, joint-stock company, or any other entity with capacity to sue or be sued.

(Code 1981, §49-4-168, enacted by Ga. L. 2007, p. 355, § 3/HB 551; Ga. L. 2012, p. 127, § 2-1/HB 822; Ga. L. 2013, p. 141, § 49/HB 79.)

The 2012 amendment, effective July 1, 2012, in the first sentence of paragraph (1), substituted "money or property, whether or not the Georgia Medicaid program or this state has title to such money or property" for "money, property, or services", deleted "or" following "Georgia Medicaid program,", inserted ", agent," inserted ", has provided,", substituted "demanded; if" for "demanded, or if", and added "; or if the money or property is to be spent or used on behalf of or to advance the Georgia Medicaid program" at the end; substituted "requires no proof of specific intent to defraud and means" for "mean" in the introductory paragraph of paragraph (2); deleted the former second sentence of subparagraph (2)(C), which read: "No proof of specific intent to defraud is required."; added paragraphs (3) and (4); and redesignated former paragraph (3) as present paragraph (5).

The 2013 amendment, effective April 24, 2013, part of an Act to revise, modernize, and correct the Code, revised language in paragraph (2).

- Georgia Taxpayer Protection False Claims Act, § 23-3-120 et seq.

- For article, "A 'False Claims Act' Is Finally Enacted in Georgia: What Georgia Lawyers Should Know About the 'State False Medicaid Claims Act'," see 13 Ga. St. B.J. 12 (2007).

JUDICIAL DECISIONS

Suit barred by res judicata.

- Dismissal of the plaintiffs' suit brought under the Georgia False Medicaid Claims Act, O.C.G.A. § 49-4-168 et seq., was affirmed because the suit was barred by res judicta based on an earlier-filed federal suit against the same pharmaceutical companies for similar claims. Jordan v. State of Ga., 336 Ga. App. 345, 785 S.E.2d 27 (2016).

- In the plaintiff's second amended complaint alleging four schemes that resulted in the presentation of false or fraudulent claims for payment to Medicaid and PeachCare in violation of the Georgia False Medicaid Claims Act (GFMCA), O.C.G.A. § 49-4-168 et seq., the complaint failed to state a claim with regard to balance billing because that scheme related to the billing of patients, not the billing of the Georgia Medicaid program as required to state a claim under the GFMCA; and the GFMCA did not provide civil liability for claims submitted to anyone other than the Georgia Medicaid program. Hill v. Bd. of Regents of the Univ. Sys. of Ga., 351 Ga. App. 455, 829 S.E.2d 193 (2019), cert. denied, No. S19C1531, 2020 Ga. LEXIS 164 (Ga. 2020).

RESEARCH REFERENCES

ALR.

- Measure and elements of damages under State False Claims Acts, 41 A.L.R.7th Art. 2.

Liability for trespass or nuisance in hydraulic fracturing, hydro-fracturing, or hydro-fracking, 41 A.L.R.7th Art. 1.

Recognition and application of tort of negligent assault and battery and indirect battery, 41 A.L.R.7th Art. 8.

Reverse false claims under State False Claims Act, 46 A.L.R.7th Art. 2.