Evidence record
Georgia Medicaid Fraud Control Unit: 2024 Onsite Inspection
- Jurisdiction
- Georgia
- Audit organization
- Office of Inspector General, U.S. Department of Health and Human Services
- Publication date
- September 2026
- Source record
- Metadata record
Findings
9
Recommendations
6
Overall conclusion
The Georgia MFCU demonstrated active case progression and collaboration with federal partners, but faced persistent governance and control gaps, including staffing shortages, incomplete supervisory documentation, lack of formal equipment inventory policies, and delays in reporting convictions and adverse actions to OIG and NPDB. The unit concurred with all recommendations and has since implemented process improvements, signaling progress toward stronger compliance with MFCU standards.
Scope
Inspection covered the Georgia MFCU performance for FYs 2021–2023, based on a September 2024 onsite inspection and supporting data from case files, referrals, and audits.
Findings (9)
Each finding has a stable link.
- F-1436
The Georgia MFCU was understaffed during each year of the review period and reported difficulty retaining staff and filling vacancies.
- F-1437
The Unit's policies and procedures manual did not address maintaining an equipment inventory.
- F-1438
The Unit did not adhere to current policies and procedures related to documenting supervisory reviews.
- F-1439
The Unit did not report convictions to the Office of Inspector General (OIG) and adverse actions to the National Practitioner Data Bank (NPDB) within required timeframes.
- F-1440
The Unit received a limited number of fraud referrals from the Program Integrity Unit (PIU) and managed care organizations (MCOs) across FYs 2021–2023, with 38 total referrals (10 percent of 371).
- F-1441
The Unit did not take sufficient steps to ensure that it received patient abuse or neglect referrals from the Healthcare Facility Regulation Division (HFRD).
- F-1442
Twenty-two percent of nonglobal case files were missing or contained late documentation of at least one supervisory review.
- F-1443
The Unit maintained a positive working relationship with federal partners and regularly collaborated, including joint investigations with OIG's Office of Investigations and engagement with USAO; however, reporting delays to Federal partners persisted.
- F-1444
The Unit’s annual training plan did not specify minimum training hour requirements for each professional discipline (investigators, attorneys, auditors), though this was updated after the onsite inspection.
Recommendations (6)
- R-1288
Expand efforts to increase fraud and patient abuse or neglect referrals
Related finding F-1440 - R-1289
Take steps to ensure that periodic supervisory reviews are documented in the case files
Related finding F-1442 - R-1290
Take steps to ensure timely reporting of all convictions and adverse actions to Federal partners
Related finding F-1439 - R-1291
Establish written policies and procedures for maintaining an inventory of the Unit’s equipment
Related finding F-1437 - R-1292
Include information to track equipment in the Unit’s equipment inventory list
Related finding F-1437 - R-1287
Examine position descriptions and salaries to ensure a fair and competitive salary and benefit package that enables the Unit to recruit and retain qualified staff
Related finding F-1436