Terms Used In Utah Code > Title 63A > Chapter 13 > Part 3 - Investigation or Audit

• Abuse: means :

  (a)	an action or practice that: (i)  is inconsistent with sound fiscal, business, or medical practices; and (ii)  results, or may result, in unnecessary Medicaid related costs; or

  (b)

  reckless or negligent upcoding. See Utah Code 63A-13-102 Allegation: something that someone says happened. Department: means the Department of Health and Human Services created in Section 26B-1-201. See Utah Code 63A-13-102 Division: means the Division of Integrated Healthcare, created in Section 26B-3-102. See Utah Code 63A-13-102 Executive director: means the executive director of the Department of Government Operations. See Utah Code 63A-1-103 Fraud: Intentional deception resulting in injury to another. Fraud: means an intentional or knowing: (a)  deception, misrepresentation, or upcoding in relation to Medicaid funds, costs, a claim, reimbursement, or services; or (b)  violation of a provision of Sections 26B-3-1102 through 26B-3-1106. See Utah Code 63A-13-102 Health care professional: means a person licensed under: (a)  Title 58, Chapter 5a, Podiatric Physician Licensing Act; (b)  Title 58, Chapter 16a, Utah Optometry Practice Act; (c)  Title 58, Chapter 17b, Pharmacy Practice Act; (d)  Title 58, Chapter 24b, Physical Therapy Practice Act; (e)  Title 58, Chapter 31b, Nurse Practice Act; (f)  Title 58, Chapter 40, Recreational Therapy Practice Act; (g)  Title 58, Chapter 41, Speech-Language Pathology and Audiology Licensing Act; (h)  Title 58, Chapter 42a, Occupational Therapy Practice Act; (i)  Title 58, Chapter 44a, Nurse Midwife Practice Act; (j)  Title 58, Chapter 49, Dietitian Certification Act; (k)  Title 58, Chapter 60, Mental Health Professional Practice Act; (l)  Title 58, Chapter 67, Utah Medical Practice Act; (m)  Title 58, Chapter 68, Utah Osteopathic Medical Practice Act; (n)  Title 58, Chapter 69, Dentist and Dental Hygienist Practice Act; (o)  Title 58, Chapter 70a, Utah Physician Assistant Act; and (p)  Title 58, Chapter 73, Chiropractic Physician Practice Act. See Utah Code 63A-13-102 Inspector general: means the inspector general of the office, appointed under Section 63A-13-201. See Utah Code 63A-13-102 Office: means the Office of Inspector General of Medicaid Services, created in Section 63A-13-201. See Utah Code 63A-13-102 Oversight: Committee review of the activities of a Federal agency or program. Person: means :Utah Code 68-3-12.5 Provider: means a person that provides: (a)  medical assistance, including supplies or services, in exchange, directly or indirectly, for Medicaid funds; or (b)  billing or recordkeeping services relating to Medicaid funds. See Utah Code 63A-13-102 State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5 Waste: includes an activity that: (i)  does not constitute abuse or necessarily involve a violation of law; and (ii)  relates primarily to mismanagement, an inappropriate action, or inadequate oversight. See Utah Code 63A-13-102