The Utah Office of Inspector General

The Utah Office of Inspector General

UOIG Goal Eliminate Medicaid Fraud, Abuse, and Waste

UOIG Mission The Office of Inspector General of Medicaid Services will protect taxpayer dollars by identifying fraud, abuse, and waste risks and vulnerabilities in the State Medicaid Program and by taking action to mitigate or eliminate those risks.

UOIG Oversight Universe Federal PRISM State County IHS DHS FFS Providers Contract Providers Medicaid Program Providers and Contractors PMHP ACO Dental School Districts County Program Funding (Source of Revenue) Grants OR S Management and Oversight Waiver Programs DWS OIG DOH DTS

2 0 1 9 Cla i m s 2 0 2 0 Cla i m s 2 0 1 9 Ex p e n d i t u r e s ACOs 406,517,900 61,913,900 PMHPs 1,049,375,000 1,431,706,700 3,310,305,900 MCEs 185,285,800 366,198,400 Utah Medicaid HCBS Waivers 40,185,000 1,106,680,200 Dental 155,830,000 1,323,030,600 2,862,780,300 ACOs 529,867 2,397,525 PMHPs 2,588,028 6,132,649 MCEs 14,290,779 18,344,088 Utah Medicaid HCBS Waivers 516,603 2,115,390 2,632,272 6,004,823 13,534,918 17,114,605 Recent Utah Medicaid Claims & Expenditures Dental 2 0 2 0 Exp e n d it u r e s

2019 21,212,061 Rebills 2020 3,523,231.85 Credit Adjustments 2,759,470.53 10,221,596.21 19,273,318 Cash Recoveries 3,282,781.54 1,345,903.54 Total Recoveries 1,935,394.09 1,372,659.58 4,653,957.21 UOIG Recent Recoveries Cost Avoidance

UOIG Organization

We Have a Duty to Report Pursuant to Utah Code 63A-13-501, “A health care professional, a provider, or a state or local government official or employee who becomes aware of fraud, waste, or abuse shall report the fraud, waste, or abuse to the Office”

Reporting to the UOIG Suspected Fraud, Waste or Abuse may be reported to The Utah Office of Inspector General. Reports can come from anyone and can be anonymous. 1. Please call the UOIG Hotline: (855) 403-7283 2. Email a completed UOIG Referral Form: [email protected] 3. Or complete a referral online on the UOIG website: https://oig.utah.gov/

Compliance Resources Medicaid Policies Change Frequently Medicaid Information Bulletins (MIBs) Medicaid Provider Manuals Utah State Bulletin/Utah Administrative Rules CMS HHS OIG Compliance Series

Training Opportunities In keeping with the Duties and Powers of the Office, the UOIG offers training to Government Employees, Providers and their staff members, and key community partners and stakeholders regarding: identifying and mitigating risk, identifying emerging fraud schemes, and how to report fraud to the UOIG Upcoming UOIG Fraud, Waste, and Abuse Training: September 8, 2-3:30PM (online) September 16, 9-10:30 AM (online) The UOIG is also available to provide training directly to your organization, and to tailor the content of the training, as appropriate, for each audience.

Register for UOIG Training If you are interested in attending an upcoming UOIG Fraud, Waste, and Abuse training. please follow the QR code below or register at https://docs.google.com/forms/d/e/1FAIpQLSe8wgk-rrWiUAoW2VVgpG wYr2MRFZwRYI36sHP7Pp03d0HgGw/viewform

UOIG Contacts Gene Cottrell Utah’s Inspector General [email protected] John Slade Elise Napper Program Integrity Manager [email protected] Auditor IV - Policy Analyst & Trainer [email protected]