1. (1) If the department is aware that an applicant or provider has had an action against them related to the following issues, the applicant will be subject to additional monitoring. The issues include:

   1. (a) claims for excessive charges;
   2. (b) providing unnecessary services;
   3. (c) failing to disclose required information; or
   4. (d) a misdemeanor conviction that involves health care fraud.
2. (2) The department shall refer applicants or providers described in Subsection (1) to OIG to be monitored for at least six months.

KEY: Medicaid

Date of Last Change: January 22, 2024

Notice of Continuation: November 7, 2022

Authorizing, and Implemented or Interpreted Law: 26B-1-213; 26B-3-108(7)