Terms Used In Utah Code > Title 63A > Chapter 13 > Part 1 - General Provisions

• 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
• Department: means the Department of Health and Human Services created in Section 26B-1-201. 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
• Inspector general: means the inspector general of the office, appointed under Section 63A-13-201. 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
• Oversight: Committee review of the activities of a Federal agency or program.
• Person: means :
       (24)(a) an individual;
       (24)(b) an association;
       (24)(c) an institution;
       (24)(d) a corporation;
       (24)(e) a company;
       (24)(f) a trust;
       (24)(g) a limited liability company;
       (24)(h) a partnership;
       (24)(i) a political subdivision;
       (24)(j) a government office, department, division, bureau, or other body of government; and
       (24)(k) any other organization or entity. See Utah Code 68-3-12.5
• Upcoding: means assigning an inaccurate billing code for a service that is payable or reimbursable by Medicaid funds, if the correct billing code for the service, taking into account reasonable opinions derived from official published coding definitions, would result in a lower Medicaid payment or reimbursement. See Utah Code 63A-13-102