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Utah Administrative Code (Current through November 1, 2019) |
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R414. Health, Health Care Financing, Coverage and Reimbursement Policy |
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R414-320. Medicaid Health Insurance Flexibility and Accountability Demonstration Waiver |
R414-320-15. Improper Medical Coverage
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(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.