Utah’s Office of the Inspector General, the top cop over Medicaid, recouped $11.5 million in incorrectly billed medical claims in fiscal year 2013.
That’s a return-on-investment for taxpayers of 468 percent, according an annual report that lists the budget for the office at $2.5 million. And that doesn’t include another $13.3 million in collections from cases pursued jointly by the Office of the Inspector General (OIG) and the Utah Attorney General’s Medicaid Fraud Control Unit, the report said.
"I am very proud of the continued productivity in our office," said OIG Lee Wyckoff. "We conducted nearly 1,500 investigations."
Details of the settlements made with providers found to have accidentally, or willfully, overbilled the low-income health program are considered private.
The OIG collected misspent funds from the following groups: pharmacies, optometrists, pharmaceutical settlements, hospitals, doctors’ offices, home health companies, hospice providers, dentists and durable medical equipment makers.
The Legislature created 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.
Early policing efforts stirred the ire of the hospital lobby and gave rise to legislation last year directing the OIG to pursue its watchdog role without alienating the declining number of providers willing to treat Medicaid patients.
To give providers tools and information to reduce the risk of fraud, waste and abuse, the OIG held 26 provider trainings across the state on common compliance problems and audit practices, the reports said.
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