By skyforbes 
Ending Quiet Complicity in Georgia Medicaid Fraud
“We’re committed to protecting taxpayer dollars by putting a stop to Medicaid fraud in our state. . . . We won’t tolerate those who violate the public’s trust by abusing a system meant to care for our most vulnerable Georgians.” — Georgia Attorney General Chris Carr
And yet . . .
Medicaid, in theory, stands as a testament to the nation’s responsibility to its most vulnerable: the children who cannot advocate for themselves, the mothers who carry the next generation, the disabled whose dignity depends on care, and the elderly who have labored their lives only to face poverty in their final years. Yet, in practice, it has become a battlefield, where corporate profiteers and political indifference conspire against the very people it was meant to serve.
The system of capitation payments — a mechanism through which Medicaid Managed Care Organizations (MCOs) are paid a fixed sum per enrollee by taxpayers, no matter the actual costs — was heralded as a solution to spiraling healthcare expenses. But under the hands of companies like Centene Corporation and Elevance Health in Georgia, it has become a tool for exploitation. These companies, entrusted with public funds, have instead chosen to deny care, pad their profits, and leave untold thousands without the mental health services they so desperately need.
The revelations are damning. In their own reports filed with the Georgia Department of Community Health (DCH), Amerigroup, a subsidiary of Elevance Health, CareSource, and Peach State Health Plan, a subsidiary of Centene Corporation, admit to violating the Georgia Mental Health Parity Act by illegally redefining “medically necessary” care to suit their bottom line. They employ third-party guidelines designed not by independent experts but by entities willing to validate these denials. The result? Denied care, increased suffering, and, in some cases, lives cut tragically short — all to inflate quarterly earnings.
The cruelty of this system is not a bug; it is a feature. It is the natural outcome of a healthcare system that places profits over people, a system that treats human suffering as a cost to be minimized and human lives as expendable if they do not fit the budget. The tools for enforcement, laid out in federal regulations like 42 CFR § 438.210, exist but are wielded weakly. States may impose sanctions, suspend payments, or terminate contracts, but such actions remain rare, more threat than reality.
Georgia has the power to act decisively, to sever contracts with these companies and hold them accountable. Yet too often, corporate influence silences the cries of the people Medicaid is meant to protect. The same political and economic forces that created this broken system now work to sustain it, ensuring that profits remain untouched, and that justice remains out of reach.
And so we turn to the words of Georgia Attorney General Chris Carr, who, with great fanfare, condemned an individual Medicaid fraudster for placing “personal greed above his responsibilities as a provider.” The scoundrel will “spend time behind bars,” Carr proclaimed, and justice will be done. But where is this fervor when the perpetrators are corporations, their fraud measured not in the tens of thousands of dollars, but in the tens of millions? The same prosecutorial zeal must be applied to these gilded offenders, for justice that bends to wealth and power is no justice at all.
To tolerate such exploitation of the poor and vulnerable is to abandon the principles of justice and humanity. The fight for Medicaid’s integrity is the fight for every child denied care, every parent forced to beg for treatment, and every elder left to suffer in silence. It is a fight against a system that prioritizes profits over lives and against those who would perpetuate that system for their own gain.