AGENCY: Department of Human Services (Utah). Office of Recovery Services
TITLE: Medicaid invoices
ARRANGEMENT: numerical by daily batch number
DESCRIPTION: This is a record of claims for reimbursement files by medical providers for services covered by medicare and medicaid.
This series includes medical invoices, Health Care Insurance Claim Form, Pharmacy Claim Form, outpatient claims, and long term care turn around documents.
This series includes the name of the client's health insurance (if he has any), the medicaid number of the health care provider, a description of the services performed and the charges, and the signature of the health care provider and the health care financing reviewer.
Retain for 5 year(s)
RETENTION AND DISPOSITION AUTHORIZATION
Retention and disposition for this series were specifically approved by the State Records Committee.
Microfilm master: Retain in Office for 5 years after date of receipt and then destroy.
Computer magnetic storage media: Retain in Office for 5 years after date of receipt and then erase.
The office of record is the Division of Health Care Financing in the Department of Health. Their retention of nine years was approved by the State Records Committee on August 1, 1986. 42 CFR 455 requires the state to investigate complaints of medicaid fraud or abuse, but does not specify how far back in time the agency can investigate. UCA title chapter 20, False Claims Act, makes false claims for medical benefits a second degree felony. UCA 76-1-302 (1) (a) state that a prosecution for a felony must be commenced within 4 years after it is committed. This information could also be used to demand reimbursement from a patient for medical expenses paid by the state. The statue of limitations for such action is 8 years, UCA 78-12-22. 31 USCS 3729 defines false claims for payments against the federal government and includes medical insurance claims. 31 USCS 3731 sets a statue of limitations for bringing action on false claims of 6 years. However, two court cases stated that the statue of limitations for medicare overpayments did not begin to run until after the provider had been audited. U.S. vs. Normandy Nursinh Home, INC. D.C. Mass 1977 428 Federal Supplement 421 Civ A No. 75-950-F, and U.S. vs. Pisani C.A. N.J. 1981 646 Federal Reporter 2nd series 83. According to the Denver Regional office of the Health care Financing Agency, the government has 3 years in which to audit these records. Duplicate copies of the film are made due to the number of bureaus wanting access to them. Once they are ready to be stored, only one copy needs to be kept. This record series has been classifi
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