The Utah Office of Inspector General (UOIG) may request medical records as part of the oversight mission for Medicaid. It is important for providers to submit a complete and legible copy of all medical records including chart notes, orders, detail itemized claims and all other documentation relating to the treatment, services and claims for the Medicaid recipient, when requested. In the event that the UOIG does not receive a complete copy of all medical records within 30 days, the claim payment may be recovered for failure to substantiate that services were provided in accordance with Utah Medicaid policies and rules. The UOIG relies upon policy and rules found in the following:
1. Section I: General Information Provider Manual, Chapter 4;
“Promptly disclose or furnish all information regarding any payment claimed for providing Medicaid services upon request by the State and its designees, including the Office of Inspector General (OIG) and the Medicaid Fraud Control Unit, or the Secretary of the United States Department of Health and Human Services.”
2. Section I: General Information Provider Manual, Chapter 8-1:
“Medical services will be of a quality that meets professionally recognized standards of health care, and will be substantiated by records including evidence of such medical necessity and quality. Those records will be made available to the Medicaid upon request.”
3, Utah Administrative Code Rule R30-1-8b:
“(1) In order to fulfill the duties described in Section 63A-13-202, the Office shall have unrestricted access to all records of state executive branch entities, all local government entities, and all providers relating, directly or indirectly, as stated in 63A-13-301. (2) The Office shall request access to records or documents through a written request. The responding agency or entity must respond to the request within 30 days.”
3. Provider Agreement for Medicaid:
“PROVIDER agrees to provide reasonable access to all requested records relevant to claims submitted for services furnished under any medical assistance programs for auditing and investigative purposes…”
The UOIG works to ensure the Medicaid program is successful and operates in accordance with policy, rules, regulations and laws. On method to ensure compliance with policies is to request and review records from providers. When this office requests medical records, please respond promptly and return a complete copy of all medical records within 30 days. Failure to do so may result in recovery of the paid claim.
If providers have questions regarding this policy or would like training from the UOIG, please contact the UOIG Training Coordinator at (801) 538-6018.
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