(KCPW News) An audit of Utah’s Medicaid providers released to state lawmakers yesterday details widespread fraud, waste and abuse. For example, 99 percent of claims billed to Medicaid by a Salt Lake City clinic owned and operated by the Utah Department of Health were overbilled. Audit Supervisor Kade Minchey explained that this even included claims submitted by managers within the health department.
“It is concerning to us that we found overcharged claims to the Utah Medicaid program by a clinic owned and operated by the department of health. Clearly a department-operated clinic should be an example of correct coding practices, not of abusive billing practices,” he said.
One of the doctors who overbilled Medicaid when volunteering at the clinic was Dr. David Sundwall, the executive director of the Utah Department of Health. He said he was surprised and embarrassed to learn this, but said the coding process for billing claims is complicated.
“And I’ve learned that we all need to know better what they call evaluation and management codes are, those five codes and how we do that,” he said, adding, “I’m not making excuses, trust me. I think as others have said, the state clinic should be exemplary in coding.”
The audit was spurred in part by a comment Sundwall made to lawmakers in 2009, when he said “I do not think for a minute that if we recover every inappropriately covered Medicaid service, we would find anything close to $20 million in Utah.” But he acknowledged at yesterday’s meeting that the number may indeed be that high.