The Utah Attorney General’s Office recently charged a Medicaid provider with communications fraud and engaging in a pattern of unlawful activity. This case involved a Medicaid provider that was contracted to provide counseling services to incarcerated juveniles. Richard J. Garcia, a Licensed Clinical Social Worker, falsified billing records and submitted fraudulent claims to the state totaling at least $100,000.

The Utah Office of the Inspector General (UOIG) worked with partner agencies, including the Utah Attorney General’s Office, in identifying suspected claims submitted by Garcia. The UOIG utilized sophisticated data analysis systems and investigation techniques to identify abnormalities in Garcia’s billings. Once UOIG investigators were able to identify suspected fraudulent activity, the office worked with partner agencies in referring the case to the Utah Attorney General’s Office for further investigation and possible criminal charges.

With the announcement that charges have been filed against Garcia, taxpayers are further realizing the success of the UOIG in identifying fraud, waste, and abuse within the Medicaid system. The case of Garcia highlights the importance of maintaining a strong oversight activity for the Medicaid program. The UOIG conducts oversight of the program through audits, inspections, investigations, claims reviews, random sampling, and proprietary data analysis. For further information about the UOIG or to report suspected fraudulent activity, please contact us at (801) 538-6087.

On October 19th, the Utah Office of the Inspector General (UOIG) submitted its 2016 Annual Report to the Governor, Speaker of the House, Senate President and to the Executive Appropriations Committee. This is the sixth fiscal year that the UOIG has conducted oversight operations of the Medicaid program. Additionally, July 1, 2016 marked the fifth successful year of UOIG service to the citizens of Utah. For 2016, the UOIG successfully collected $8,031,309, representing a taxpayer return on investment of 307%. An additional estimated $5.2 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 506%; a substantial savings to the taxpayers of Utah. In addition to these successes, the UOIG referred a greater number of fraud cases to Medicaid Fraud Control Unit than any previous year of operations. The UOIG has also improved partnership building through training, education, and outreach programs. The full UOIG 2016 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 Public Information Officer at (385) 831-5397.

The Utah Office of Inspector General (UOIG) continues to develop and strengthen partnerships with Medicaid, the provider community, Accountable Care Organizations (ACOs) and the Medicaid Fraud Control Unit (MFCU).  Most recently, the UOIG hosted a training and information sharing conference to discuss current issues, lessons learned and best practices with ACO and MFCU representatives.  These conferences are held quarterly and have proven to be a valuable tool to build upon already great relationships. Through strong partnerships, the UOIG is able to improve its ability to identify and prevent fraud, waste and abuse within the Medicaid program.  This is one of the many programs that have proven to be successful in protecting taxpayer resources and improving the Medicaid program for the benefit of recipients, the provider community, and citizens of Utah.  Click here for the training slides.  For more information about the UOIG and its programs to identify and prevent fraud, waste and abuse, please contact UOIG Public Information Officer at (385) 831-5397.

The Utah Office of the Inspector General (UOIG) is pleased to announce that Mr. Nathan Johansen has been retained to serve as the Deputy Inspector General for the UOIG. Mr. Johansen will serve directly under Inspector General Gene Cottrell. This new position, a first for the office, will reinforce the UOIG mission with strong, capable and experienced leadership. Mr. Johansen’s background as a senior auditor with over 12 years of extensive auditor experience, will be a great benefit to the UOIG and the taxpayers of the State of Utah. His broad and diverse background, and knowledge of Medicaid, will ensure the UOIG will continue to serve the people of Utah through solid oversight of program operations.

The Utah OIG, in partnership with Utah Medicaid representatives, have completed the 2016 Statewide Medicaid Provider Training circuit. For 2016, a total of 29 Provider Training Sessions were completed throughout the State of Utah. Five new locations were added to the 2016 schedule to include the Intermountain Medical Center in Murray, Lakeview Hospital in Bountiful, St. Mark’s Hospital in Salt Lake City, Bear River Health Department in Tremonton, and the Delta Community Hospital in Delta. Training topics included helpful tips on billing, common billing errors, important changes to the Medicaid program, new updates to the provider portal, and updates on the Provider Reimbursement Information System for Medicaid (PRISM) project. OIG specific topics included background on the creation of the OIG office, tools and resources used in the oversight of the Medicaid program, local and national trends, lessons learned, guidance and a focus on continued partnership development with Medicaid and the provider community.

In addition to partnering with Utah Medicaid for the Statewide Provider Training, the Utah OIG also provides training and guidance to providers and Medicaid representatives on an as needed or requested basis. Providers are welcome to reach out to the OIG to request guidance, training and support on various Medicaid-OIG operations that further the OIG mission to support and protect taxpayer dollars and resources as intended by the legislature in creating the office.

The UOIG has completed it’s A Performance Audit of Utah Department of Workforce Services
Medicaid and CHIP Collection Process. The audit reports can be found here.

HHS OIG recently identified Provo as a hotspot for home health fraud. The full report can be found here.

The UOIG has completed it’s Audit of Medicaid’s Dental Program and Audit of Provider Credit Balances Federal Match Repayment. The audit reports can be found here.

Statewide Provider Training kicks off this week in Tooele. We look forward to meeting providers and discussing Medicaid related issues. A link to the full schedule can be found here.