Utah Code 63A-13-602. Rulemaking authority
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The office may make rules, pursuant to
(1) inspecting and monitoring the state Medicaid Program;
Terms Used In Utah Code 63A-13-602
- Abuse: means :(1)(a) an action or practice that:(1)(a)(i) is inconsistent with sound fiscal, business, or medical practices; and(1)(a)(ii) results, or may result, in unnecessary Medicaid related costs; or(1)(b) reckless or negligent upcoding. See Utah Code 63A-13-102
- Division: means the Division of Integrated Healthcare, created in Section 26B-3-102. See Utah Code 63A-13-102
- Office: means the Office of Inspector General of Medicaid Services, created in Section 63A-13-201. See Utah Code 63A-13-102
- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
- Waste: includes an activity that:
(13)(b)(i) does not constitute abuse or necessarily involve a violation of law; and(13)(b)(ii) relates primarily to mismanagement, an inappropriate action, or inadequate oversight. See Utah Code 63A-13-102(2) discovering and investigating potential fraud, waste, or abuse in the State Medicaid program;(3) developing and implementing the principles and standards described in Subsection63A-13-202(1)(q) ;(4) auditing, inspecting, and evaluating the functioning of the division under Subsection63A-13-202(1)(h) ;(5) conducting an audit under Subsection63A-13-202(1)(h) or(2) ; or(6) ordering a hold on the payment of a claim for reimbursement under Section63A-13-205 .