Review reveals $24.3M in unauthorized Medicaid payments in Utah

SALT LAKE CITY

The Utah Office of Inspector General has estimated that around $24 million was spent on improper Medicaid payments due to individuals being enrolled in multiple states, as per a recent audit.

These payments, deemed unacceptable, are attributed to delays in the renewal process for interstate benefits and ambiguous policies, the office disclosed on Wednesday.

The findings stem from an audit by the U.S. Department of Health and Human Services Office of Inspector General, which examined whether Utah Medicaid issued payments to beneficiaries who were also receiving funds from other state programs.

The investigation focused on cases where Utah Medicaid beneficiaries later moved to different states and assessed the duration in which benefits from Utah overlapped with those of other states before they ceased.

Utah’s Interim Inspector General, Neil Erickson, expressed that the audit results “will lead to a stronger and more efficient Medicaid system.”

“We anticipate implementing the audit findings, which will align with our commitment to manage Utah’s public funds responsibly and ensure that benefits are distributed accurately and effectively to those eligible,” he stated.

The Utah Office of Inspector General mentioned that Utah Medicaid is in agreement with all recommendations made in the audit and is already taking actions to enact them. This includes introducing a new application process, verifying residency, setting benchmarks, and training caseworkers.

“This audit will contribute to ensuring vital services continue for those in need while enhancing internal processes and best practices,” the office added.

The audit, released on Monday, examined two four-month periods, one in 2021 and another in 2024, revealing that there were 231 concurrently enrolled recipients in one period and 226 in the other.

Focusing on the 2022 calendar year, the audit indicated that Utah Medicaid issued $4.6 million in capitation payments to beneficiaries who did not receive medical care in Utah but were also enrolled in Medicaid in other states. According to the American Academy of Family Physicians, a capitation payment is an agreed sum paid to a physician or group for managing a patient’s care.