Utah's Medicaid sheriff faces pressure to go easy on hospitals
A bill that would insulate Utah's Medicaid Inspector General from interest groups angling to weaken his power won committee approval last week.
But on Monday the same Health and Human Services Committee will take up another bill that could expose the Office of the Inspector General (OIG) and limit his ability to crack down on fraud, waste and abuse of Medicaid.
Frank testimony on the first measure, HB106, laid bare behind-the-scenes tensions stemming from corporate influence in politics and the balance of power between the legislative and executive branches of government.
"I will tell you that political pressure is alive and well, functioning and prospering in the state of Utah. And as it relates to the OIG it is very real," Ron Bigelow, the governor's former budget director, told the committee Thursday.
Currently, the office reports to the Governor's Office of Planning and Budget, which Bigelow directed until his retirement this year. HB106 would move the inspector general to the state Auditor's Office, now presided over by a former legislator, John Dougall.
Bigelow said placing the OIG under the state auditor, an independently elected official, would be a more natural fit, and he believes it would be able to function more independently there. It was originally placed under the governor's budget office "with my personal commitment," as a former CPA, to free it to police Medicaid as intended.
"While I was there, I felt I could do that. Obviously I'm no longer there," said Bigelow.
Inspector General Lee Wyckoff was hired following a legislative probe that found widespread upcoding, or overcharging, of Medicaid by health providers. He has recouped $32 million in misspent state funds, and his two-year term ends this fall.
Wyckoff said about 98 percent of the billing errors his office finds are made by "honest people who just missed a technicality."
But his attempts to claw back money for those mistakes have jarred the state's hospitals, which are pushing the bill to curtail the OIG's powers, HB315.
"Guess how people and organizations involved with that $32 million feel about not having that $32 million," said Bigelow. "Whether rightly or wrongly, it is about money."
The bill would also remove the OIG's two-year term limit and a requirement that new hires be Senate-approved. Bigelow urged the committee to keep the term limit in place, saying it was created to protect the office from political pressure.
The bill's sponsor, Rep. Ryan Wilcox, R-Ogden, agreed to consider amending it on the House floor.
Rep. Jim Dunnigan, R-Taylorsville, sponsor of the counter measure, HB315, also supports Wilcox's bill.
"I'm a big supporter of the OIG," he said, noting his bill would strengthen language surrounding the OIG's duty to recover funds.
However, the bill also would direct the OIG to educate hospitals on Medicaid policy and differentiate "between honest mistakes and intentional errors, or fraud, waste, and abuse, for the purpose of entering into settlement negotiations" with providers.
It would direct the OIG to balance the interests of taxpayers in recouping funds with the risks of scaring providers away from Medicaid.
And it would limit the scope of investigations, forbidding the OIG from probing more than three prior years worth of billing data.
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