2006 Utah Code - 26-20-7 — False claims for medical benefits prohibited.

     26-20-7.   False claims for medical benefits prohibited.
     (1) No person may make or present or cause to be made or presented to an employee or officer of the state a claim for a medical benefit, knowing the claim to be false, fictitious, or fraudulent.
     (2) In addition, no person shall knowingly:
     (a) file a claim for a medical benefit for services which were not rendered or for items or materials which were not delivered;
     (b) file a claim for a medical benefit which misrepresents the type, quality, or quantity of items or services rendered;
     (c) file a claim for a medical benefit representing charges at a higher rate than those charged by the provider to the general public;
     (d) file a claim for a medical benefit for items or services which the person or the provider knew were not medically necessary in accordance with professionally recognized standards;
     (e) file a claim for a medical benefit which has previously been paid;
     (f) fail to credit the state for payments received from other sources;
     (g) file a claim for a medical benefit for services also covered by one or more private sources when the person or provider knew of the private sources without disclosing those sources on the claim;
     (h) recover or attempt to recover payment from a recipient under a medical benefit program, or the recipient's family in violation of the provider agreement;
     (i) file a claim for a medical benefit where a provider divides an accepted multiple medical procedure into artificial components or single procedures requesting full medical benefits for performing those component procedures as if they had each been performed independently and at separate times;
     (j) falsify or alter with intent to deceive, any report or document required by state or federal law, rule, or Medicaid provider agreement;
     (k) retain any unauthorized payment as a result of acts described by this section; or
     (l) aid or abet the commission of any act prohibited by this section.

Amended by Chapter 92, 1987 General Session