The LEIE has been updated on 07 November 2017 with October 2017 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

Utah has been approved by CMS to expand Medicaid to cover additional adults that previously were not eligible for Medicaid. Utah is one of the first in the nation to be approved to expand Medicaid to provide additional access and coverage to treatment for substance use and mental health disorders. This is a significant improvement in access to Utah Medicaid in three ways:

1. Income eligibility levels have been expanded to cover more low income adults. This expansion took effective July 1, 2017.
2. Providing full Medicaid coverage for the chronically homeless, and those in need of substance abuse and mental health treatment.
3. An increase in the number of treatment beds that will be available for mental health and substance use disorder treatment. The number of beds that are available will be expanded to allow for greater access for treatment.

This expansion to Utah Medicaid will take effect immediately and will help further protect vulnerable populations in Utah. Utah Office of Inspector General (UOIG) will continue to monitor the Utah Medicaid program to include this expanded Medicaid coverage to ensure taxpayer dollars are always properly used. Please follow UOIG, the Utah Department of Health or contact Utah Medicaid to learn more.

One of the most effective ways to identify fraud in the health care system is to receive tips from persons with actual knowledge of suspected fraudulent activity. Tips can be the most effective method in finding fraud than any other form of oversight.

If you suspect Medicaid fraud is occurring in Utah, please help stop it by reporting the activity to the Utah Office of Inspector General. We will investigate those tips. By reporting suspected Medicaid fraud, you can help protect Utah taxpayers, the Medicaid program and the honest providers and recipients who are part of the program.

Utah Medicaid began moving policy out of Provider Manuals and into the Utah Administrative Code within Title R414 in July 2017. This is a significant change in the way Utah Medicaid will manage, update, and publish policies. All providers must be aware of this change in policy management. By moving policy to the Admin Rules, providers will have an opportunity to review and comment on policy changes. Provider Manuals will continue to be streamlined with several manuals already consolidated and archived. When reviewing Utah Medicaid policy, providers must review the Utah Administrative Code (Title R414) and the Provider Manuals together.

Title R414 can be accessed at: https://rules.utah.gov/publicat/code/r414/r414.htm

Provider Manuals can be accessed at:

Publications

The public, providers, and other interested groups may follow proposed rule changes and comment on those changes through the Utah State Bulletin containing Official Notices of Utah State Government. The Utah State Bulletin and public notice information is located at:
https://rules.utah.gov/publications/utah-state-bull/

Utah Office of Inspector General (UOIG) is pleased to participate in the annual Statewide Provider Training. For 2017, the Statewide Provider Training will be presented via webinars in the coming months. Rather than on-site visits throughout the state, Medicaid trainers are working on a web-based training and outreach program. This new forum will provide current information with frequent updates, and should reach a larger, more diverse group of providers and participants. The Policy and Training Coordinator will present a section for the UOIG.

Utah Medicaid Providers will be notified when more information becomes available on our training page at: https://medicaid.utah.gov/medicaid-provider-training

Please watch for a future MIB that will include additional information about Statewide Provider Training.

Utah Medicaid has published a new Medicaid Information Bulletin (MIB) for October 2017. This MIB contains new and important information about the Utah Medicaid program. Please review this MIB to learn more about changes in the program to include important policy updates. Access the MIB here:

https://medicaid.utah.gov/Documents/manuals/pdfs/Medicaid%20Information%20Bulletins/Traditional%20Medicaid%20Program/2017/October2017-MIB.pdf

Utah Medicaid providers have a duty to be aware of changes in the Medicaid program and to follow all current policies. MIBs are a useful tool to stay informed about those changes,

The Federal Anti-Kickback statute prohibits knowingly and willfully soliciting, receiving, offering, or paying anything of value to induce referrals of items or services payable by a federal health care program. Kickbacks are harmful to Medicaid as they can distort medical decision-making, result in over-utilization of services, increase costs to the Utah Medicaid program, and create unfair competition by directly or indirectly forcing out competitors not willing to pay kickbacks. Report suspected violations to the Utah Office of Inspector General.

Collusion among providers occurs when competing providers (competing groups) agree on fees charged & capitation rates accepted to benefit the entire group. Providers could come together to agree on fees to charge or behavior to take that will be of benefit to the entire group. This results in all providers having a better bottom line at the cost of the Utah Medicaid program and taxpayers of Utah. Colluding to benefit the competing providers is a serious violation and unethical behavior. Never fall for collusion in any form. Report suspected collusion to the Utah Office of Inspector General for investigation.

If you are a Utah Medicaid provider or know a Medicaid provider that would like the Utah Office of Inspector General (UOIG) to present a short training at their office, please contact the UOIG Policy and Training Coordinator at: [email protected]

UOIG can provide a short presentation to a provider’s office during lunch or other convenient time. We are also excited to participate in seminars and conferences focused on related issues. If you are interested, please reach out to arrange a good time. We want to visit you and provide a good presentation about who we are and what the UOIG does for the taxpayers of Utah.”

Utah law requires that a health care professional, a provider, or a state or local government official or employee who becomes aware of fraud, waste, or abuse to report the fraud, waste, or abuse to the Utah Utah Office of Inspector General (UOIG) or Medicaid Fraud Control Unit (MFCU).

A person who reports fraud, waste or abuse to UOIG may request that the person’s name not be released in connection with the investigation. The person’s identity may not be released to any person or entity other than the UOIG, MFCU or law enforcement, unless a court orders that the person’s identity be released.

See Utah Code 63A-13-501 for more information: https://le.utah.gov/xcode/code.html