An audit conducted by the Office of the Legislative Auditor General showed that at least three health clinics in Utah have been upcharging the state Medicaid program, including a clinic owned and operated by the Utah Department of Health, according to a Salt Late Tribune news report.
The audit sampled claims from three clinics that demonstrated high rates of "high-dollar claims," including department-run Health Clinics of Utah-Salt Lake, which overcharged Medicaid by an estimated $118,000. The audit also showed that the department-run clinic’s executive director, David Sundwall, MD, were among those at the clinic who overcharged for services, according to the report.
Dr. Sundwall said he was surprised and embarrassed to find he had been incorrectly coding for procedures and that the accidental upcoding was not intentional.
Although the auditing body has not formally accused any providers of intentional upcoding, the auditors said there is a need for stricter and independent oversight by a state Office of the Inspector General. Utah House Speaker David Clark (R-Utah) has expressed support of the creation of such state oversight. The state has already planned to go-live with a computer system that would monitor for possible fraud starting next year, according to the report.
Read the news report about the Utah state audit.
Read other coverage about Utah fraud and abuse:
- Utah Neurologist Prevails in Lawsuit Against Medicaid Fraud Control Unit Sued for “Abusive Prosecution”
- Utah Files Lawsuit Against Avandia Maker GlaxoSmithKline for Defrauding Medicaid
The audit sampled claims from three clinics that demonstrated high rates of "high-dollar claims," including department-run Health Clinics of Utah-Salt Lake, which overcharged Medicaid by an estimated $118,000. The audit also showed that the department-run clinic’s executive director, David Sundwall, MD, were among those at the clinic who overcharged for services, according to the report.
Dr. Sundwall said he was surprised and embarrassed to find he had been incorrectly coding for procedures and that the accidental upcoding was not intentional.
Although the auditing body has not formally accused any providers of intentional upcoding, the auditors said there is a need for stricter and independent oversight by a state Office of the Inspector General. Utah House Speaker David Clark (R-Utah) has expressed support of the creation of such state oversight. The state has already planned to go-live with a computer system that would monitor for possible fraud starting next year, according to the report.
Read the news report about the Utah state audit.
Read other coverage about Utah fraud and abuse:
- Utah Neurologist Prevails in Lawsuit Against Medicaid Fraud Control Unit Sued for “Abusive Prosecution”
- Utah Files Lawsuit Against Avandia Maker GlaxoSmithKline for Defrauding Medicaid