Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-310 - Medicaid Primary Care Network Demonstration Waiver
Section R414-310-15 - Improper Medical Coverage
Universal Citation: UT Admin Code R 414-310-15
Current through Bulletin 2024-06, March 15, 2024
(1) Improper medical coverage occurs when:
(a) an
individual receives medical assistance for which the individual is not
eligible, including benefits that the individual receives pending a fair
hearing or during an undue hardship waiver if the enrollee fails to act as
required by the eligibility agency;
(b) an individual receives a benefit or
service that is not part of the benefit package for which the individual is
eligible;
(c) an individual pays
too much or too little for medical assistance benefits; or
(d) the Department pays too much or too
little for medical assistance benefits on behalf of an eligible
individual.
(2) An individual who receives benefits under PCN for which the individual is not eligible must repay the Department for the cost of the benefits that the individual receives.
(3) An alien and the alien's sponsor are jointly liable for benefits that an individual receives for which the individual is not eligible.
(4) An overpayment of benefits includes all amounts paid by the Department for medical services or other benefits on behalf of an enrollee, or for the benefit of the enrollee during a period in which the enrollee is not eligible to receive the benefits.
Disclaimer: These regulations may not be the most recent version. Utah may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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