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- Utah's inspector general estimates $24.3 million in unallowable Utah Medicaid payments due to overlapping enrollments in other states.
- Utah Medicaid is implementing new processes and training recommended by the audit.
SALT LAKE CITY — The Utah Office of Inspector General estimates that $24 million was spent in Medicaid payments that were not allowed due to overlapping enrollment in multiple states, according to a recent audit.
These unallowable payments are due to delayed interstate benefit match updates and unclear policies, the office said Wednesday.
The office cited an audit done by the U.S. Department of Health and Human Services Office of Inspector General, which focused on whether Utah Medicaid made payments to beneficiaries who were also receiving payments through other states' programs.
It looked at instances where Utah Medicaid beneficiaries later became residents of other states and how long benefits overlapped with that other state before Utah Medicaid stopped providing benefits.
Neil Erickson, interim inspector general for Utah, said the findings of the audit "will lead to a stronger and more efficient Medicaid system."
"We look forward to Medicaid's implementation of the audit findings, which will advance our commitment to Utah's responsible stewardship of public funds and ensure benefits are provided accurately and effectively to eligible recipients," he said.
The Utah Office of Inspector General said Utah Medicaid agreed with all of the recommendations of the audit and said it is already taking steps to implement them. This includes creating a new application process, residency verification requirements, benchmarks and training for case workers.
"This audit will help ensure the program can continue to provide critical services to those in need while also strengthening internal processes and best practices," the office said.
The audit, which was posted on Monday, looked at two four-month periods — one in 2021 and another in 2024 — and found 231 concurrently enrolled recipients in one and 226 in the other.
Looking at the 2022 calendar year, the audit said Utah Medicaid paid $4.6 million in capitation payments for Utah recipients who did not receive any health care in Utah and were also enrolled in Medicaid in another state. Capitation payments are payment arrangements where a physician or group of physicians receives a set amount of money for a patient, according to the American Academy of Family Physicians.
The audit determined there was a minimum of $3.4 million unallowable capitation payments that year.
