Utah Administrative Code
Topic - Health
Title R414 - Integrated Healthcare
Rule R414-320 - Medicaid Health Insurance Flexibility and Accountability Demonstration Waiver
Section R414-320-15 - Improper Medical Coverage
Universal Citation: UT Admin Code R 414-320-15
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 an 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 the UPP program for which the individual is not eligible must repay the Department for the cost of the benefits that he receives.
(3) 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 that 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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