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Auditors Warn Utah Medicaid is Wasting Taxpayers Dollars

A legislative audit was released Tuesday Aug 18th 2009 showing that Medicaid is Wasting Taxpayers Dollars in Utah. Funds assigned to medicaid by the federal and stated government. The audit was performed on behalf of the legislative committee and the findings are highly unexpected.

The audit points out a lack of organization and management of the funding provided for medicaid.  For Utah alone the budget of medicaid is $1.7 billion.  The department that makes up for medicaid took much of the brunt of the report.

Several problems were verified within the report. It is assumed that more then $20 million dollars were lost to unnecessary procedures as well as poor financial management.

In Utah almost 190,000 people are on medicaid and 1 out of every 5 dollars spent by the state
goes to cover medicaid.

 

Several example of specific findings:

1.)  Approval of 127 complex sleep studies without proper approval ($1200 each)

2.)  106 Non approved or covered surgeries

–  Some of these procedures were medically necessary while many others were not
–  65 circumcisions
–  15 face reconstructions
–  3 rhinoplasty

3.)  Lost money due to fraudulent practices

4.)  Only 1% of hospital claims were reviewed

5.)  Breast reconstruction surgery or breast augmentation on a healthy breast

 

Changes:

David Sundwall, the executive director of the Utah Department of Health stated in a written statement:

“We accept all the recommendations of the audit and have begun the work required to implement them“.

He also pointed out that some changes may require additional funding.

Other options are updating a fraudulent protective system that hasn’t been updated since 1987 as well as working with medicaid patients to improve the existing system.

Other states who have had similar audits have found similar findings

 

Oregon [2004]

Received an audit in 2004 and findings included – 1.4 million pills that were missing, thousand who are dead and are still receiving dollar benefits.

Sex changes procedures, penile implants, breast enlargements, breast reductions and ear piercings were all found during the audit.

 

New Jersey [2002]

873 people received benefits through the program had a annual gross income of over $85,000. And 3 residents with an income above $700,000 where taking part in the program and 3 other were between $175,000 and $300,000.

4.6 million dollars that could have been collected was never attempted and was classified as “lost“.

2.1 million was spent by medicaid that should have been covered by several nursing facilities

 Several other states have had similar findings and the difficult current aspect appears to be the oversight of each state medicaid department. Several changes have been proposed and certainly changes are on the horizon.

 

*** For more information on medicaid please check out the following link medicaid