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Utah lawmakers reach compromise over Medicaid OIG
HB106 » Two bills rolled into one.
First Published Mar 07 2013 09:00 pm • Last Updated Mar 11 2013 10:06 pm

Two opposing bills — one to free Utah’s inspector general to police Medicaid, and another that some say limits the office’s powers — are now rolled into one.

The comprise measure, a substituted version of HB106 incorporating elements of HB315, was endorsed by a Senate Committee late Thursday and described by Sen. Curtis Bramble, R-Provo, as "a bill that the House, the governor and the Senate could accept."

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The bill would move the inspector general to the Department of Administrative Services, instead of to the State Auditor’s office as originally proposed. The position would not report to the agency’s director, but would be independent — appointed by the governor with consent from the Senate to a four-year term.

Currently the inspector general reports to the governor’s budget director.

It adds elements of HB315, which largely clarifies the Legislature’s intent in creating the OIG two years ago to crack down on the waste and abuse of Medicaid funds, after a string of legislative probes that found widespread "upcoding," or overcharging, by doctors and hospitals.

The bill directs the OIG to pursue its watchdog role without alienating the declining number of doctors willing to treat Medicaid patients and to differentiate "between honest mistakes and intentional errors, or fraud" if negotiating a settlement.

The bill would no longer absolve providers for billing errors stemming from conflicting Utah Department of Health policies, but clarifies that providers may rely on the latest policy descriptions. And it would limit the look-back period for investigations to three years.

Initially, HB315 would have amended the current requirement that whistle-blowing health care workers report billing errors to the OIG by mandating that they first report honest errors to the their employer. Now it would give employees the option.


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