Georgia Medicaid Managed Care Organizations Received Capitation Payments After Beneficiaries' Deaths

Effective June 1, 2006, Georgia implemented Georgia Families, a managed care program between Georgia and private health plans to provide benefits and health care services to Medicaid, PeachCare for Kids members, Planning for Healthy Babies enrollees, and Georgia Families 360° members. As of July 2016, managed care covered approximately 69 percent of Georgia Medicaid beneficiaries. In State fiscal year 2018, the Georgia Medicaid expenditures for approximately 2 million beneficiaries were $9.9 billion, including $4 billion to managed care. Previous Office of Inspector General reviews identified internal control weaknesses and lack of documented policies and procedures that contributed to States improperly paying for capitation payments on behalf of deceased beneficiaries. We conducted a similar review in Georgia.