Corporate Compliance

Audit reveals Utah's vulnerability to Medicaid fraud, waste, and abuse

Compliance Monitor, August 26, 2009

The Utah Medicaid program has significant room for improvement when it comes to program integrity, according to a report released by the Utah Office of Legislative Auditor General.
In the report, A Performance Audit Of Fraud, Waste, and Abuse Controls in Utah’s Medicaid Program, the agency lists two areas of cost savings that that could save the state and federal government more than $20 million in Medicaid costs. 
  • Prior authorization. The report says that authorization for services prior to their implementation could be a great way to prevent overutilization of Medicaid services; however the reports says the state’s Bureau of Program Integrity does not properly use this strategy. The report estimates a 1% change in the approval rate for the prior authorization process could save $700,000 ($210,000 in state dollars).
  • Improved recovery effort. The report suggests the state step up its fraud, abuse, and waste recovery effort. The report estimates a 3% increase in this area could save $20.2 million ($5.8 million in state dollars) over time.

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