Legislative auditors say Medicaid inspector general office failed to deliver oversight; options offered to restructure

Legislative auditors told the Rules Review and General Oversight Committee on Oct. 26 that Utah's Office of the Inspector General (OIG) has not meaningfully implemented recommendations from a 2018 review and is not providing the breadth of oversight expected for the state's Medicaid program.

The office of legislative audit general manager Jesse Martinson and co-presenter Matthias Boone said the OIG has concentrated on compliance and claim audits but rarely reviews outcomes, accountable care organizations or other high-dollar program performance. "The OIG has not adequately fulfilled its mandate to provide oversight of Medicaid," Boone told the committee.

Why it matters: The OIG is intended to detect fraud, waste and abuse and to assess program effectiveness across roughly $5 billion in annual Medicaid spending. Auditors said the office's internal reporting has showed math errors, inconsistent methods, and that in five of nine years it failed to recoup enough to cover its operating budget when measured by recoveries alone.

What auditors found: The audit presentation highlighted three recurring problems:…