It adds elements of HB315, clarifying the Legislature's intent in creating the inspector to crack down on the waste and abuse of Medicaid funds, after a string of legislative probes that found widespread "upcoding," or overcharging, by doctors and hospitals.
The bill directs the inspector general's office to pursue its watchdog role without alienating the declining number of doctors willing to treat Medicaid patients and to differentiate "between honest mistakes and intentional errors, or fraud" if negotiating a settlement.
A prior version of HB315 would have required whistle-blowing health care workers to first report billing errors to their employer. Now the bill would give employees the option of alerting the inspector.
It would also give Wyckoff's team of auditors access to Utah's Controlled Substance Database, empowering them to pursue patient fraud, or doctor-shopping.
Doing so would set Utah apart from most other states which, according to a report by the Pew Charitable Trusts, focus primarily on "pay and chase" efforts to remedy billing errors.
Fraud and abuse in Medicaid waste money and can subject patients to unnecessary or ineffective tests and treatments, the report says. In 2012, an estimated $19 billion or 7 percent of federal Medicaid funds was absorbed by improper payments, which include fraud and abuse as well as unintentional mistakes such as paperwork errors.