Utah inspector general recoups $25M for Medicaid

Published: Wednesday, Oct. 9 2013 5:25 p.m. MDT

Utah's Office of Inspector General of Medicaid Services recouped nearly $25 million this year in waste, abuse and potential fraud charges.

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SALT LAKE CITY — Utah's Office of the Inspector General has done it again, wrangling nearly $25 million back to the Medicaid budget.

It's a drop in the bucket as far as the state's nearly $2 billion Medicaid budget is concerned, but the recovery is important enough to warrant necessity of the office, and its staff of about 30 analysts, auditors, investigators and other personnel.

The office recouped $11.5 million in its own investigations, up from last year's $7.5 million, according to annual reports. An additional $13.3 million was collected by the state's Medicaid Fraud Control Unit.

The money returns to the Medicaid general fund, used to provide additional patient care.

The office was created after a 2010 legislative audit revealed plenty of up-coding, where providers billed Medicaid for more costly services than were rendered, and other problems with the state's Medicaid budget. The state pegged Lee Wyckoff to head the office as inspector general of Medicaid services in 2011.

"I am very proud of the continued productivity in our office," Wyckoff said Wednesday.

He said the office performed nearly 1,500 investigations on a $2.5 million operating budget, resulting in a 1008 percent return on investment for taxpayers.

Most of the money recouped from the investigations, some of which are ongoing, is not from malicious fraud, but mistakes or unintentional billing issues.

"Our goal is to establish open communications, transparent operations and increase provider education," Wyckoff said.

Fulfilling part of its mission, the office conducted 26 provider trainings throughout Utah. The trainings educate Medicaid providers on common compliance issues, audit practices of the office and on reducing future waste, abuse and fraud.

The $24.9 million collected this year results from 1,489 investigations examining compliance with Medicaid policies, recipient quality of care and identification of waste, abuse and potential fraud.

It falls short of the $29 million collected in 2012, but includes $13 million in global drug rebate settlements and fraud-related recoveries, one-time money coming to the state.

The office is charged with safeguarding taxpayer assets through minimizing waste, abuse and fraud within the Utah Medicaid system while treating all key stakeholders fairly.

Email: wleonard@deseretnews.com

Twitter: wendyleonards

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