Audit of Capitation Payments Made Concurrently with Another State, Report 2023-03. An Executive Summary is included at the inception of this report. The objectives and scope of the audit are explained on page 10 of this report.

109.00 Audit of Concurrent Capitations Final A2023-03

The Utah Office of the Inspector General of Medicaid Services (UOIG) presents the SFY2025 Annual Report to Governor Cox, the State Legislature, and the citizens of Utah. The UOIG’s goal is to eliminate fraud, abuse, and waste in the Medicaid system, thereby protecting taxpayer dollars. The UOIG conducts audits and investigations and provides oversight of the managed care entities. Medicaid constitutes one of Utah’s largest state expenditures and UOIG staff take their fiduciary responsibility to the taxpayers of Utah seriously.

2025 UOIG Annual Report

The Utah Office of Inspector General (UOIG) has received complaints about inappropriate provider billing practices related to Balance Billing and Factoring, in direct violation of Medicaid policies and regulations. 

UOIG Advisory Opinion Letter Balance Billing BULLETIN

An Audit of the Deficit Reduction Act Section 6032 Compliance for Federal Fiscal Year 2024, Report 2025-03.

109.00 Audit Report DRA 2025 Final Report

Audit Report 2023-01 30 Day

The U.S. Department of Health and Human Services issued a consumer fraud alert for all Native American Communities. To see the full alert see the following website.

The Utah Office of the Inspector General (UOIG) submitted its 2020 Annual Report to the Governor, Speaker of the House, Senate President and to the Executive Appropriations Committee. This is the tenth fiscal year that the UOIG has conducted oversight operations of the Medicaid program. For 2020, the Office recovers funds through three methods: cash collection, OIG directed rebilling of claims and credit adjustments.

Recovery of improperly paid Medicaid funds serves purposes beyond simply bringing funds back into the program. The Office considers recovery of funds a “sentinel event” that many times changes a provider’s future billing practices. In that sense, recovery of funds acts as an educational tool with a correlating cost avoidance amount. During SFY 2020, the Office collected a total of $9,565,485 through all three methods of recovery. This recovery amount was above the Inspector General’s forecast of $3-5 million during an average year. The $3-5 million recovery is the average recovery amount for States of similar size and Medicaid covered population. UOIG saved the state an additional $21 million in cost avoidance attributable to the actions taken by UOIG, including recommendations to the Single State Agency that cause positive change in the program. The full UOIG 2020 Annual Report is available on the Office’s website and by clicking on the following link

The LEIE has been updated on 06 August 2020 with July 2020 Exclusions and Reinstatements. As a reminder, HHS OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture, distribution, prescription, or dispensing of controlled substances. Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP). To avoid CMP liability, health care entities need to routinely check the LEIE to ensure that new hires and current employees are not on the excluded list. Utah Medicaid Providers must review the updated LEIE in accordance with federal law and Utah Medicaid policy. The LEIE is located at: https://oig.hhs.gov/exclusions/exclusions_list.asp

The Utah Office of the Inspector General (UOIG) submitted its 2019 Annual Report to the Governor, Speaker of the House, Senate President and to the Executive Appropriations Committee. This is the ninth fiscal year that the UOIG has conducted oversight operations of the Medicaid program. For 2019, the Office recovers funds through three methods: cash collection, OIG directed rebilling of claims and credit adjustments. Recovery of improperly paid Medicaid funds serves purposes beyond simply bringing funds back into the program. The Office considers recovery of funds a “sentinel event” that many times changes a provider’s future billing practices. In that sense, recovery of funds acts as an educational tool with a correlating cost avoidance amount. During SFY 2019, the Office collected a total of $4,653,957.21 through all three methods of recovery. This recovery amount is consistent with the Inspector General’s forecast of $3-5 million during an average year and consistent with recoveries achieved by States of similar size and Medicaid covered population. An additional $18 million was protected from inappropriate expenditure through a concept known as “Cost Avoidance.” These Cost Avoidance and Collections measures resulted in a combined return on taxpayer investment of 760.41% or of every $1 spent $7.60 was saved. The full UOIG 2019 Annual Report is available on the Office’s website and by clicking on the following link. For more information and media inquiries, please contact UOIG at (801) 538-6532.

Utah voters approved for a full Medicaid Expansion on Tuesday November 6, 2018. Voter approved full expansion replaces the plan that was passed by Utah lawmakers earlier this year to limit Medicaid expansion with a work requirement. The limited Medicaid expansion required a waiver and federal governmental approval because of the work requirement and that it limited expansion specified in the Affordable Care Act. It is anticipated that full Medicaid will cover adults with annual incomes up to 138 percent of the poverty level and it is estimated that the expansion will cover up to 150,000 more people. Utah now joins more than 30 others states that have expanded Medicaid under the 2010 health care law.