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Bill to create office to investigate Medicaid claims advances

by Eric S. Peterson
- Posted // 2011-02-16 -

A bill to create an office to investigate fraud and abuse in the Medicaid program advanced from the House floor today.

“One of the reasons we’re looking into this is to find ways to save precious dollars we spend on Medicaid and healthcare,” Rep. David Clark, R-Santa Clara told the House floor today. He described the Office of Medicaid Inspector General, his bill would create as one that will interface with the Department of Health to give them “enhanced tools to quit paying the crooks.”

House Bill 84 would also broker a memorandum of understanding with the Utah Attorney General’s Medicaid Fraud Taskforce to cull representative samples of Medicaid claims that would be audited for instances of possible fraud and waste. Rep. David Litvack, D-Salt Lake City questioned the sponsor on how the office could spot waste, which is often a more difficult to categorize than willful acts of fraud and abuse.

Clark pointed out that the office through its audits be able to detect loopholes in the system to eliminate waste. “There are a set of rules on how the game is played and how payments are made,” Clark said. He offered teeth cleaning as an example, pointing out that current Medicaid rules allow for two free teeth cleanings per year, as a means of encouraging preventive teeth care. He pointed out however that the rules only apply to two cleanings per one dentist, which means some individuals could get more than two cleanings by visiting different dentists. By auditing such claims it might be possible to see if this is a serious enough trend to warrant further policy discussions on issues like that.

While the bill's fiscal note anticipates costs of $2.3 million, Clark argued similar offices in other states have been successful in ferreting out waste that results in tens of millions of dollars in savings. The bill passed with a unanimous vote of support.

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