26B-3-1203. Identifying improper payments -- Repayment -- Prevention.

243 words·~1 min read·/ut/title-26b/chapter-3/26b-3-1203

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

Effective 5/6/2026

(1)Each risk contractor and subcontractor shall quarterly:

(a)identify and document all improper payments;

(b)conduct a root cause analysis for each type of improper payment;

(c)repay all improper payments that are due to the Medicaid program no later than 30 days after the day on which the report described in Subsection

(2)is due; and

(d)develop and implement a corrective action plan that includes improvements in policies, procedures, accounting, financial management, internal controls, information systems, reporting, staffing, or training necessary to address improper payments.

(a)Each risk contractor and subcontractor shall quarterly submit to the division a report of the risk contractor's or subcontractor's improper payments, root cause analyses, and corrective action plan.

(b)The department shall publish the reports described in Subsection (2)(a) on the department's website, unless posting a report would interfere with an ongoing investigation of the:

(i)Office of Inspector General of Medicaid Services created in Section 63A-13-301 ; or

(ii)Utah Medicaid Fraud Control Unit of the attorney general's office.

(3)The department shall make rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to establish:

(a)due dates for the submission of reports described in Subsection

(2); and

(b)sanctions for a risk contractor's or subcontractor's failure to repay as described in Subsection (1)(c) , consistent with Section 26B-3-108 .

Enacted by Chapter 163 , 2026 General Session