Lack of coordination and inadequate oversight could lead to possible overpayments of Georgia’s Medicaid and PeachCare for Kids low-income assistance programs, a state audit has found.
Released Tuesday, July 21, the audit estimated around $41.1 million in Medicaid and PeachCare payments between 2013 and 2019 did not receive enough oversight by the state Department of Community Health (DCH), which oversees the programs and coordinates with outside providers.
The oversight issues could lead to overpayments to beneficiaries and higher monthly fees paid to four managed-care organizations that work with the DCH to provide services. Those organizations contract with doctors, hospitals and other health-care providers.
According to the audit, several DCH divisions are tasked with collaborating with the managed-care organizations to monitor provider contracts, analyze financial data and investigate fraud claims.
The audit found coordination among those divisions has been lax, leading to potential lapses in identifying questionable payments or improper activities on the part of providers. The audit also found information-sharing between DCH and the managed-care organizations should be tightened.
The audit made several recommendations for DCH including to consolidate certain oversight functions, improve communications about overpayment claims and require the managed-care organizations to conduct more risk assessments.
In a response, DCH largely agreed with the audit’s recommendations and outlined steps to make changes in how it coordinates oversight of the programs.
In 2019, DCH oversaw around $10.6 billion in Medicaid and PeachCare payments to more than 2.1 million Georgians. The programs serve low-income families and children, pregnant women, elderly persons and those with disabilities.
The audit comes as state officials field comments on proposals by Gov. Brian Kemp to tweak Georgia’s administration of Medicaid via a reinsurance plan for state subsidies that the governor has touted as a way to help lower premiums. His proposals still need federal approval.