Investigation uncovers state regulations jeopardizing care for thousands of disabled Georgians

By Matt Belanger – WSBTV – Atlanta

A Channel 2 Action News investigation uncovered a state crackdown on Medicaid fraud is putting thousands of Georgians with disabilities are at risk of being cut-off from services.

Whitney Fuchs heads the non-profit Georgia Community Support & Solutions, which operates 28 group homes and similar facilities for the disabled in metro Atlanta.

“That would have put us out of business,” Fuchs said.

Fuchs told Channel 2’s Matt Belanger he was handed a $1.5 million dollar penalty after a recent audit by the state. Fuchs said the audit did not find fraud in his operation. He said the errors were paperwork mistakes made by his staff like incorrect signatures or incomplete documentation.

“This is not fraud. People are still receiving services,” Fuchs said.

Our investigation uncovered many facilities for the disabled across Georgia are feeling similar pressure from the state. We revealed the state’s “zero tolerance” policy treats paperwork errors as serious infractions. In some cases, the penalty amounts to tens of thousands of dollars for each mistake.

“That makes me mad. We need to fix that,” said State Representative Pat Gardner, D- 57th District.

Gardner said in some cases the Medicaid repayments are threatening to bankrupt facilities already struggling to keep up with overwhelming demand for services. The waiting list for Medicaid services in Georgia contains more than 7,000 people. Further, Gardner said the money recouped by the state is not earmarked for people with disabilities. Rather, it’s returned to the state’s general fund.

“It’s in nobody’s interest to close down the good providers,” Rep. Gardner said.

Previously, Channel 2 Action News reported how the Griffin Area Resource Center in Spalding County is facing a half-million dollar penalty for paperwork mistakes. In some cases, the only mistake was the executive director, Lisa Sassaman, signed “executive director” as the title after her name instead of “DDP” for developmental Disabilities professional.

“There’s nobody who would say that’s an appropriate penalty for signing your name wrong,” Rep. Gardner said.

Since we started investigating, state leaders have temporarily stopped demanding recoupments and said they are reviewing the auditing process.

A spokesperson responded to our request for information with the following statement: “The Department of Community Health is aware of concerns expressed by the state Legislature and Georgia Medicaid providers regarding recent Georgia Medical Care Foundation (GMCF) Utilization Reviews. DCH’s Inspector General has halted recoupments and is conducting a thorough review of GMCF’s findings to ensure the audit findings in questions fall in line with current Medicaid policy,” wrote Jeremy Arieh, deputy director of communications for the Georgia Department of Community Health which administers Medicaid.

Fuchs said it’s unreasonable to expect providers to flawlessly meet the state’s thousands of pages of regualtions every time Fuchs settled with the state for a smaller penalty, but his staff took 20 percent pay cuts to cover the cost. He said without more reasonable penalties, Georgians with disabilities will ultimately be the ones who pay the price.

“These facilities will close,” Fuchs said. “It’s a claw-back from the state to get money paid for legitimate services back into the state’s budget.”