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How Georgia Healthcare-Related Bills Fared This Legislative Session

Georgia Legislative SessionThe Georgia 2015-2016 legislative session has officially closed. Of the various healthcare-related bills that were introduced throughout the session, here are some significant bills and how they fared this session:

  • SB 145: This bill would have expanded the list of conditions that could be treated with medical marijuana from 8 to 15 including post traumatic stress disorder, HIV/AIDS and autism. Although it passed the House, it was never brought to a vote in the Senate.
  • HB 916: This bill limits the Department of Community Health’s ability to recoup Medicaid funds based on clerical errors. Having been passed by both the House and the Senate, this bill currently awaits Governor Deal’s signature. If signed into law, the bill will give providers an opportunity to fix paperwork errors without penalty.
  • HB 919: This bill would have allowed individuals to receive state tax credits for donations to rural healthcare organizations. However, the Senate never voted on the bill.
  • SB 302: This bill, which requires health insurers to maintain accurate directories of their providers, passed both houses.
  • HB 1055: This bill would have repealed and replaced Georgia Certificate of Need (CON) law. However, it did not make it very far during the 2015-2015 legislative session having failed to make it past crossover day.
  • SB 1/HB 429: This bill was introduced in the Senate but its contents were ultimately combined with HB 429 prior to passing both houses. It requires insurance coverage for treatment of autism spectrum disorders.
  • HB 684: Introduced as a result of the efforts by the Georgia Dental Hygienists’ Association this bill would have allowed dental hygienists in certain settings to perform preventative care services without a dentist present. Neither the House nor the Senate brought it to a vote therefore it did not even make it past crossover day.
  • SB 304: This bill originally addressed the disclosure of certain mental health records with respect to gun background checks. The final bill passed by the legislature focuses on more efficient testing of rape kits.

If you have any questions or need assistance with healthcare regulatory issues, Jeyaram & Associates attorneys can help. Contact DJ Jeyaram at or 678.325.3872.

DCH’s “Engagement Process” Now Official

DCH Policy As of July 2015, the Department of Community’s Health’s “Engagement Process” became an official part of its Policy and Manual, section 402.5(b).

The “Engagement Process” offers providers an opportunity to discuss findings of an audit or other proposed adverse action and to possibly resolve the matter prior to any request for an Administrative Review during an Engagement Conference.

However, we strongly advise you to contact an attorney prior to requesting an Engagement Conference to help ensure the best possible outcome. 

Here is what you need to know:

  • PURPOSE: The purpose of the Engagement Conference is to discuss a proposed adverse action “with the goal of informally resolving the matter.”
  • WHO INITIATES: You. A provider may request an Engagement Conference following receipt of Initial Findings of Notice of Proposed Adverse Action letter
  • PROVIDER TIME DEADLINE: This request must be in writing within seven (7) calendar days of receipt; and submitted to
  • DCH TIME DEADLINE: The Engagement Conference must be held with twenty-one (21) calendar days of the receipt of the Request.
  • WAIVER: If you do not participate in the Engagement Conference and fail to provide the Department prior written notice of your absence, you waive your right to an Engagement Conference. Notice should be submitted to This waiver does not preclude you from requesting an Administrative Review.
  • SETTLEMENT:“The Engagement Conference is considered settlement talks, and therefore, is not admissible in any pending or future proceeding, including Administrative Review or Administrative Hearing.” This includes conduct during conferences, notes, and correspondence.
  • ACCEPTANCE/REJECTION: You have seven (7) calendar days from the date of the Conference to accept or reject the offer in writing.
    • Acceptance must be in writing and waives your right to an administrative review.
    • If you reject the offer, you have the Right to Request an Administrative Review pursuant to Policy and Procedures Manual Sections 402.6 and 505.

Remember to print a copy of any communication you have with DCH and always ask for a “read receipt” when you send an email to DCH.

If you have received a Proposed Adverse Action from the Department, please contact Kimberly Sheridan at or 678-708-4703 for assistance.

What To Do If You Receive A Medicaid Fraud Subpoena In Georgia

medicaid fraudThe Georgia Medicaid Fraud Control Unit (MFCU) investigates and prosecutes fraud and abuse by providers in the Georgia Medicaid program.  One of the first steps MFCU takes when it opens up a case against a provider is often the issuance of an investigative subpoena, requesting specific patient records.

Often the provider has already been looked at by the Georgia Department of Community Health’s Medicaid Program Integrity Unit which handles intake and triage of cases before turning them over to MFCU. In other words, the provider has somehow managed to get on the State’s radar, and it is serious.

Please keep the following in mind if you receive a Medicaid Fraud subpoena:

1. CALL AN EXPERIENCED HEALTHCARE FRAUD ATTORNEY. This is a highly specialized area of the law, and you need someone to represent you that has experience both in defending criminal matters AND in healthcare law. This area of law is like a hybrid car. Just like it takes gas and electric batteries to power a hybrid car, it takes knowledge of criminal and healthcare law to successfully represent a provider facing a Medicaid fraud investigation.

2. Call an attorney BEFORE you respond to the subpoena or talk to an investigator.

3. Remember: the Investigator is NOT your friend. They are doing a job, and their job is find evidence against you. We recently represented a client who was complying with a subpoena from MFCU. Five investigators showed up to get the documents. Since there was no threat of an armed suspect, one can only guess that the use of five investigators to collect documents had to be an intimidation tactic. Likewise, these investigators tried desperately to butter up the employees to get them to talk, and this was with an attorney standing there. Remember: the investigator is NOT your friend.

4. Be Polite and cooperative. If your attorney determines that the subpoena is lawful and enforceable, you have to turn over the documents requested. This can be quite labor- intensive, but you must comply and polite cooperation can only help you in establishing the tone for whatever next steps will be taken.

5. Make copies of every document and electronic file you turnover to MFCU PRIOR to turning them over.

6. DO NOT provide MFCU with anything more than what they have requested in the subpoena- not one document more. And remember, they are only entitled to the records of Medicaid members.

7. Neither you nor your employees are required to speak with the investigator unless individually subpoenaed. Have an attorney present during any interviews.

8. Don’t panic. While a MFCU subpoena should be taken seriously, in Georgia, in 2014, there were 410 Medicaid Fraud Investigations. Of those investigations, only 4 led to indictment.1 The math indicates that MFCU investigates often but indicts with much less frequency.

If you are receive a subpoena from the Georgia Medicaid Fraud Unit, Jeyaram & Associates can help. Contact Kimberly Sheridan at or 678.325.3872.

Court Finds DCH’s Handling of Mass Reprocessing “Inconsistent and Misleading”

DCHIn a decision last week, the Office of State Administrative Hearings (OSAH) reversed the Department of Community Health’s (DCH) denial of a Request for Administrative Review by a group of Children Intervention Services (“CIS”) providers. The CIS providers had requested a review of recoupment actions that stemmed from two 2014 Mass Reprocessings by the Department, one involving NCCI edits that included claims dating back to 2010.  The Department argued that the providers missed the 30 day deadline to file a Request for Administrative Review.

Attorney Kimberly Sheridan of Jeyaram & Associates represented the group of CIS providers in the administrative hearing and argued that the providers should be granted a review because they followed all the instructions specific to the mass reprocessing posted by the Department in several banner messages and emails, as well as in-person conversations. Through the banner and email message instructions, the Department departed from its standard deadlines in its policy manuals.  The Court found that the Department’s position was “illogical and wholly unfair,” and that its instructions to the providers after the mass reprocessing were “inconsistent and misleading.” The Court also said the providers had justifiably relied on these instructions and could not now be penalized for their reliance.

At this time, the Department has not made it known if it will appeal the decision.

If you are a provider subject to a recoupment and need help, or if you need to appeal DCH’s decisions, Jeyaram & Associates has extensive experience and success with these cases. Contact Kimberly Sheridan at or 678.325.3872.

DCH Adopts New Rules for Rural Hospitals

DCH Rural HospitalsA potential solution to rural hospitals’ funding challenges

A few months ago, the Georgia Board of Community Health (DCH) adopted new rules that allow rural hospitals to reduce the scope of services provided and operate as a rural free standing emergency department. This provides an alternative to closing down operations for rural hospitals which may be struggling with funding operations on a full service scale. It also provides an opportunity for rural hospitals that recently ceased operations (and have either maintained a current DCH license or their license expired within the last 12 months) to re-open their doors.

Hospitals interested in pursuing this course of action must meet certain conditions including:

  1. The hospital must be located in a rural county (population under 35,000);
  2. The hospital must be located within 35 miles of a licensed general hospital;
  3. The hospital must be open 24 hours a day, 7 days a week; and
  4. The hospital must provide non-elective emergency treatment for periods continuing less than 24 hours.

Like the general and specialized hospitals, the rural free standing emergency department must obtain a permit to operate, as well as a specific license to operate as a rural free standing emergency department.

The new rules also require that specific operational elements be put in place. For example, a free standing emergency department must attempt to enter into an agreement with the surrounding hospitals and provide in that agreement a mechanism for patient transfer.

One controversial requirement set forth in the new rules is the requirement to provide certain medical services to patients such as medical screenings and treatment to stabilize without considering the individual’s ability to pay. Jimmy Lewis, CEO of the Georgia Rural Hospital trade organization, has stated that this rule may be unfair to the new stand-alone EDs because the transferee hospital “most often objects if the patient is a no-pay thus keeping the patient in the ED beyond licensure capability.” See

Furthermore, rural free standing EDs will have to bill Medicare and Medicaid at a lower provider rate rather than the current hospital rates. As of May 20, 2014, the application to become a rural free standing emergency department was made available by DCH. See application-packet-5192014. According to DCH’s instructions, hospitals should submit a completed application along with supporting documentation at least 6 weeks prior to the planned opening date of the facility. If you are a hospital considering taking this step, the following items should be obtainedand/or completed to support your application:

  1. evidence that the hospital’s Certificate of Need authorization is still active;
  2. an application for a permit;
  3. notarized affidavits regarding ownership identification;
  4. a written request to conduct an initial licensure survey; and
  5. a statement from the local fire safety authority stating that an inspection has been made of the premises and that the state and local fire safety requirements have been met and the facility is approved for occupancy.

If you have any questions or would like legal assistance,  please contact Danielle Hildebrand at

CIS Recoupments Begin – Still Time To Appeal

CIS Recoupment ClaimsThe first Special Remittance Advices (“RA”) pursuant to the Department of Community Health’s CIS Claims Reprocessing were issued this week.  Claims originally processed between November 1, 2010, through June 30, 2012, that billed specific CPT codes are subject to this special reprocessing based on the CMS National Correct Coding Initiative mandated by the Affordable Care Act.

Early reports are that the Special RA’s detailing the voided claims have been several hundred pages long with recoupments reported from $5000 to $100,000.

Some providers have indicated that DCH may be willing to enter into payment plans with providers to space-out the recoupment amount and that the Department may also allow denied claims to be re-billed with the proper CPT modifiers to allow for payment.

Section 202 of DCH’s Part I:  Policies and Procedures Manual requires that claims be received within six (6) months after the month in which service was rendered to be reimbursed unless certain exceptions are met.  It is unclear whether DCH considers the Special Reprocessing as meeting the exception requirements.  If it does not, then providers may be limited to six (6) months for re-billing claims.

If you think the Department’s determination of recoupment is incorrect, you can still appeal the determination as described in Part I of this article. It is extremely important that you satisfy all of the appeal requirements and meet all deadlines.  Failing to do so means that you waive your appeal rights and may not be able to challenge the DCH action.

If you’ve received notice that your practice is subject to the reprocessing recoupment and need help or if you need to appeal DCH’s decisions, Jeyaram & Associates can help. Contact DJ Jeyaram at or 678.325.3872.

Media Coverage for Lawsuit Against the State for Severely Disabled

Class Action Lawsuit Against GeorgiaAdditional media coverage on our class action lawsuit against the state for severely disabled:

Jeyaram & Associates and Parker, Hudson, Rainer & Dobbs File Class Action Law Suit Against the State

Class Action Law Suit Against GeorgiaJeyaram & Associates and Parker, Hudson, Rainer & Dobbs have filed suit against the state for withholding millions of tax funds earmarked for severely disabled individuals.

Family members representing people with severe disabilities and a group of their health care providers today filed a class action law suit against the Georgia Department of Behavioral Health and Developmental Disabilities and the Georgia Department of Community Health for withholding funds that were designated for the care of those individuals contrary to controlling law.

United Cerebral Palsy of Georgia, Inc., Coastal Center for Developmental Services, Inc., Hope Haven of Northeast Georgia and Creative Community Services, Inc. as well as four families representing nearly 12,000 individuals in the State seek the return of hundreds of millions of dollars that should have been used to care for those individuals since 2008.  The exact amount will be determined at trial.

The families filing suit represent clients who depend on vital services from these healthcare providers every single day. These clients are some of the most vulnerable members of our communities.  Their daily lives have been negatively impacted in real and tangible ways, as have those of their families and caregivers.

“My daughter Tammy wants and needs activity.  Sitting in front of a TV set is counterproductive for her,” says Angela Tulloh of Kennesaw.

Marilyn Harvill worries about the ongoing and future care of her son, 53 year old Matt Windham.  “Matt has severe brain damage and needs 24 hour one-on-one care.  I am worried about the services Matt will receive in the future because I wasn’t given any notice of the cuts.”

None of the families affected was notified by the state of the pending cuts and none was given any recourse.

Additionally, an undetermined number of other individuals requiring new services have been turned away due to the improper budget cuts.

Those organizations filing suit are designated Medicaid providers. The two state agencies being sued have failed to reimburse the plaintiffs for services provided under contract to clients with profound intellectual and developmental disabilities. That has led to severe financial harm to these providers. The state has very specific rules and procedures it must follow before reducing already agreed upon payments to providers and families.  None of those procedures has been followed.

These cuts in Medicaid funds were not tied to the recent economic downturn; rather the funds were allocated by the state legislature and simply not paid in full to the providers and clients who depend on them.

“We have gone through our financial resources to keep serving our existing clients, but we have had to turn away other people with severe developmental, medical and behavioral needs.  I don’t know what happens to those people,” says Sally Buchanan, CEO of Creative Community Services of Norcross.

Curt Harrison, Associate Executive Director of United Cerebral Palsy Georgia and South Carolina, says

“So many people rely on us and we’re doing the best we can.  But development of new services and additional employee training have really suffered.  However, we don’t think it’s morally appropriate to cut services.”

 To view this story on Channel 46:

DCH and GaHIN Launch GeorgiaDirect to Automate Healthcare Referrals

GeorgiaDirectThis week,  the Health Information Technology Division (Health IT) of the Georgia Department of Community Health and the Georgia Health Information Network Inc. (GaHIN) launched GeorgiDirect, a free, secure e-mail, and easy-to use messaging service to automate health care referrals between patients, physicians, hospitals, laboratories and other authorized healthcare stakeholders.

The goal of GeorgiaDirect is to “better serve patients and increase efficiencies in health care across Georgia,” said former DCH Commission David A. Cook. Cook also stated, “This network – which should not be confused with a health insurance exchange – will literally transform health care in the years to come, delivering on our goal of a healthy Georgia through greater coordination of care, delivering better health outcomes, increasing administrative efficiencies and more. Additionally, privacy of health information is paramount to the department, and GeorgiaDirect is much more secure for the transmission of information than current methods.”

The more than 2,100 healthcare providers across Georgia who have registered for the free service are able transmit patient health information between authorized providers for a more efficient and secure exchange of patient data versus the current system of faxes, mail, couriers and telephones.

According to a press release by DCH, “GeorgiaDirect was developed using national standards from the Office of the National Coordinator for Health Information Technology’s Direct Project.” GeorgiaDirect also enables healthcare providers to connect with other states, including Alabama, Florida, Hawaii, Mississippi and Wisconsin. The goal is for GeorgiaDirect to expand and include more states so providers can obtain medical records when patients move to another part the country.

To learn more about GeorgiaDirect, you can watch this video or visit the GeorgiaDirect Web site.



Georgia Medicaid Providers Can Now Access HP Online Portal

Georgia Health PortalAccording to a press release issued by the Georgia Chapter of the American Academy of Pediatrics, currently enrolled and future Georgia Medicaid providers can now access the HP online portal to submit their attestation to become eligible for the Affordable Care Act (ACA) Rate Increase. The initial enrollment period will last until July 31, 2013. When accessing the site, click on “Provider Information”, then select “Forms”, and then select the “Enrollment” link.

For more information, click here