Utah Admin. Code R414-320-15 - Improper Medical Coverage
(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.
Notes
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