Terms Used In Utah Code > Title 63A > Chapter 13 > Part 3 - Investigation or Audit

• 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
• Allegation: something that someone says happened.
• 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
• Executive director: means the executive director of the Department of Government Operations. See Utah Code 63A-1-103
• Fraud: Intentional deception resulting in injury to another.
• Fraud: means an intentional or knowing:
       (6)(a) deception, misrepresentation, or upcoding in relation to Medicaid funds, costs, a claim, reimbursement, or services; or
       (6)(b) violation of a provision of Sections 26B-3-1102 through 26B-3-1106. See Utah Code 63A-13-102
• Health care professional: means a person licensed under:
       (8)(a) Title 58, Chapter 5a, Podiatric Physician Licensing Act;
       (8)(b) Title 58, Chapter 16a, Utah Optometry Practice Act;
       (8)(c) Title 58, Chapter 17b, Pharmacy Practice Act;
       (8)(d) Title 58, Chapter 24b, Physical Therapy Practice Act;
       (8)(e) Title 58, Chapter 31b, Nurse Practice Act;
       (8)(f) Title 58, Chapter 40, Recreational Therapy Practice Act;
       (8)(g) Title 58, Chapter 41, Speech-Language Pathology and Audiology Licensing Act;
       (8)(h) Title 58, Chapter 42a, Occupational Therapy Practice Act;
       (8)(i) Title 58, Chapter 44a, Nurse Midwife Practice Act;
       (8)(j) Title 58, Chapter 49, Dietitian Certification Act;
       (8)(k) Title 58, Chapter 60, Mental Health Professional Practice Act;
       (8)(l) Title 58, Chapter 67, Utah Medical Practice Act;
       (8)(m) Title 58, Chapter 68, Utah Osteopathic Medical Practice Act;
       (8)(n) Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act;
       (8)(o) Title 58, Chapter 70a, Utah Physician Assistant Act; and
       (8)(p) Title 58, Chapter 73, Chiropractic Physician Practice Act. 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
• Provider: means a person that provides:
       (11)(a) medical assistance, including supplies or services, in exchange, directly or indirectly, for Medicaid funds; or
       (11)(b) billing or recordkeeping services relating to Medicaid funds. 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