COBI 2015 - Inspector General of Medicaid Services

Overview
Issues
Performance
Background
Financials

Sources Uses

FY 2016 Appropriation

The functions of the inspector general relative to the state Medicaid program include a broad range of activities aimed at preventing fraud, waste, and abuse of state and federal Medicaid funds. This is accomplished by inspecting, monitoring, and auditing 1) the usage of federal and state Medicaid funds 2) agencies and programs for compliance with state and federal requirements, and 3) recordkeeping procedures and record maintenance. In addition, the inspector general is to seek and track the recovery of improperly paid Medicaid funds.

Funding History

Appropriation Overview

During the 2015 General Session, the Legislature appropriated for Fiscal Year 2016, $3,905,100 from all sources for Inspector General of Medicaid Services. This is a 21.7 percent increase from Fiscal Year 2015 revised estimated amounts from all sources. The total includes $1,133,200 from the General/Education Funds, an increase of 4.4 percent from revised Fiscal Year 2015 estimates.

Appropriation Adjustments

In addition to statewide compensation and internal service fund cost increases, the following appropriation adjustments were made during the 2015 General Session:

DescriptionOngoingOne-Time Attorney General Dedicated Credit Adjustments$8,100$0

OngoingOne-TimeFinancing Source

$8,100$0General Fund

This item designates additional funding appropriated to an agency to pay higher costs for Attorney General services, due to statewide and AG-specific compensation increases.

Medicaid Audit Amendments$2,000$0

OngoingOne-TimeFinancing Source

$600$0General Fund

$1,400$0Federal Funds

Enactment of this legislation likely will not materially impact state revenue. Enactment of this legislation may have ongoing costs for the Inspector General of Medicaid Services beginning in FY 2016 of $600 General Fund and $1,400 federal funds to pay for 5 consultations annually from medical or dental professionals for provider audit reviews.

Statute

The statutory authority for the office is located in UCA 63A-13, "Office of Inspector General of Medicaid Services."

House Bill 84, 2011 General Session, created the Office of Inspector General of Medicaid Services within the Governor's Office of Planning and Budget. The bill carried its own appropriation to transfer $2,632,500 ($994,900 General Fund) from the Department of Health to finance the new office's operations. FY 2012 is the first fiscal year of operations for the OIG-Medicaid. House Bill 106, 2013 General Session, moved the Office of Inspector General of Medicaid Services into the Department of Administrative Services as an independent entity within the department. The budget of the office was also moved as provided in the funding detail.

The governor appoints the inspector general with the advice and consent of the Senate for a term of two years.

The appointed inspector general must be a certified public accountant or a certified internal auditor; and have a background in auditing methodology and overall management.

Note that the Governor's Office of Management and Budget is currently revamping the performance measures for programs within the Department of Administrative Services beginning FY 2013 forward.

Intent Language

HB0003: Item 38

Under the terms of 63J-1-603 of the Utah Code, the Legislature intends that appropriations provided for Inspector General of Medicaid Services in Item 14, Chapter 11, Laws of Utah 2014, shall not lapse at the close of FY 2015. Expenditures of these funds are limited to monitor compliance with State and Federal Regulations and implement measures to identify, prevent and reduce fraud, waste, and abuse, and monitor the quality and reliability of Utah Medicaid providers� service delivery and accuracy of billing: $750,000.

SB0002: Item 33

The Legislature intends that the Inspector General of Medicaid Services retain up to an additional $60,000 of Medicaid collections during FY 2016 to pay the Attorney General�s Office for the state costs of the one attorney FTE that the Office of the Inspector General is using.

Display By:

Funding Source

Expenditure Category

Appropriation Type:

Appropriation History by

Programs	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Inspector General of Medicaid Services	0	0	753,400	2,241,700	3,367,700	(158,100)	3,209,600	695,500	3,905,100
Total	$0	$0	$753,400	$2,241,700	$3,367,700	($158,100)	$3,209,600	$695,500	$3,905,100

Sources of Finance	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
General Fund	0	0	0	1,054,600	1,082,200	0	1,082,200	40,300	1,122,500
General Fund, One-time	0	0	255,000	1,700	3,400	0	3,400	7,300	10,700
Federal Funds	0	0	0	0	0	0	0	1,400	1,400
Transfers	0	0	0	0	0	0	0	40,600	40,600
Transfers - Medicaid	0	0	498,400	1,251,200	2,282,100	0	2,282,100	2,500	2,284,600
Pass-through	0	0	0	(210,300)	0	0	0	0	0
Beginning Nonlapsing	0	0	0	586,400	0	441,900	441,900	158,100	600,000
Closing Nonlapsing	0	0	0	(441,900)	0	(600,000)	(600,000)	445,300	(154,700)
Total	$0	$0	$753,400	$2,241,700	$3,367,700	($158,100)	$3,209,600	$695,500	$3,905,100

Categories of Expenditure	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Personnel Services	0	0	666,900	2,002,700	2,638,800	88,100	2,726,900	689,300	3,416,200
In-state Travel	0	0	1,300	5,000	72,900	5,100	78,000	0	78,000
Out-of-state Travel	0	0	300	300	44,600	7,400	52,000	0	52,000
Current Expense	0	0	31,300	105,600	101,900	20,300	122,200	3,600	125,800
DP Current Expense	0	0	53,600	128,100	122,200	(22,800)	99,400	2,600	102,000
DP Capital Outlay	0	0	0	0	177,000	(45,900)	131,100	0	131,100
Other Charges/Pass Thru	0	0	0	0	210,300	(210,300)	0	0	0
Total	$0	$0	$753,400	$2,241,700	$3,367,700	($158,100)	$3,209,600	$695,500	$3,905,100

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Other Indicators	FY11 Actual	FY12 Actual	FY13 Actual	FY14 Actual	FY15 Approp	FY15 Change	FY15 Revised	FY16 Change	FY16 Approp
Budgeted FTE	0	0	7.53	22	28.97	0.03	29	0	29
Actual FTE	0	0	0	22.40	0	0	0	0	0

COBI contains unaudited data as presented to the Legislature by state agencies at the time of publication. For audited financial data see the State of Utah's Comprehensive Annual Financial Reports.