A September audit determined that Georgia's Department of Community Health "exposes itself to unnecessary risk of error, misuse, fraud or loss of data'' that could impact claims and payment processing of Medicaid members, reports Georgia Health News.
The audit, reported in a document at the DCH board's September Audit Committee meeting, recommended the agency "allocate necessary resources to implement a formal risk management program to allow management to gain reasonable assurance [that the Department of Community Health] will achieve its objectives in complying with operational, financial reporting and compliance requirements." This includes strengthening IT and cybersecurity controls, and managing organizational risk.
A separate report from a Community Health official cited complaints to Georgia legislators "about large [payment] recoupments associated with clerical errors which put many providers in jeopardy of going out of business."
According to a Community Health spokeswoman, the complaint applied to all healthcare providers in the Medicaid program.
The state Medicaid program covers more than 1.8 million members and Community Health's base budget of $14.8 billion is primarily Medicaid expenditures.
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