Utah Admin. Code R539-5-8 - Review Process, Recovery of Funds, and Penalties
(1)
(a) Funds for self-administered services are
public funds that are appropriated to, and approved by, the division.
(b) Funds are for the delivery of services
for the person during the approved period and for the purposes stipulated in
service code descriptions.
(c)
Public funds are subject to applicable federal, state, and local laws and
regulations pertaining to the use of public funds.
(2) The division may require the person to
use a contracted provider if the SAS employer fails to meet a requirement in:
(a) federal or state law or rule;
(b) the SAS employee agreement; or
(c) the SAS employer agreement.
(3) The support coordinator shall
review any billing quarterly to ensure that, for each service, no duplication
of a service, fraud, or overlap of submitted timesheets has occurred for SAS
and provider-based services.
(4)
The misuse of any funds provided for a purpose other than those in the service
description may subject the caregiver and contracted provider, if applicable,
to administrative sanctions, criminal prosecution, or liability for repayment
of the misused funds.
(5) For any
findings of duplication of services, erroneous timesheet submissions, or
exceeding the amount of service authorized in the person's person-centered
budget, the department:
(a) shall recover any
associated fund; and
(b) may make a
referral to the Utah Office of Inspector General and the Medicaid Fraud Control
Unit if waste, fraud, or abuse of funds is suspected.
Notes
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