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Sean D. Reyes
Utah Office of the Attorney General
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Medicaid Fraud Control Unit

Mission

The Medicaid Fraud Control Unit’s (MFCU) mission is to protect the integrity of the Medicaid program and the safety and property of  the citizens of the State of Utah through skilled detection, proactive investigation, prevention, prosecution, and financial recovery.

Objectives

  • Prosecute providers in violation of Utah law
  • Stop or prevent the loss of Medicaid funds attributable to fraud, waste, or abuse
  • Recover Medicaid funds lost to fraud, waste, or abuse
  • Make recommendations to prevent fraud, waste, and abuse from recurring in the Medicaid system

Examples of Fraud

  • See also the False Claims Act (see Utah Code Ann. §26-20-1, et seq.)
  • Billing for services not rendered
  • Intentionally billing for services at a rate higher than allowed
  • Billing for ineligible patients
  • Financial exploitation of vulnerable adults
  • Pharmaceutical-related cases
    • Unlawful prescribing or dispensing of controlled substances
    • Actions by the drug manufacturers that are fraudulent

Abuse & Neglect

Abuse or neglect occurs when a caregiver knowingly causes physical harm or fails to provide needed services or protection to a patient.

The Utah Attorney General’s Office’s Medicaid Fraud Control Unit investigates and prosecutes patient abuse and neglect cases when the caregiver is paid through the Medicaid program. The Office is also authorized to investigate abuse or neglect of patients residing in board and care facilities, regardless of the payment source.

Contact us by calling 801-281-1259

 

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