{"data":{"id":"us-ut/utah-code-26b-3-1106","jurisdiction":"us-ut","citation":"Utah Code § 26B-3-1106","heading":"False claims for medical benefits prohibited.","body":"(1) A person may not make or present or cause to be made or presented to an employee or officer of the state a claim for a medical benefit:\n(a) which is wholly or partially false, fictitious, or fraudulent;\n(b) for services which were not rendered or for items or materials which were not delivered;\n(c) which misrepresents the type, quality, or quantity of items or services rendered;\n(d) representing charges at a higher rate than those charged by the provider to the general public;\n(e) for items or services which the person or the provider knew were not medically necessary in accordance with professionally recognized standards;\n(f) which has previously been paid;\n(g) 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; or\n(h) where a provider:\n(i) unbundles a product, procedure, or group of procedures usually and customarily provided or performed as a single billable product or procedure into artificial components or separate procedures; and\n(ii) bills for each component of the product, procedure, or group of procedures:\n(A) as if they had been provided or performed independently and at separate times; and\n(B) the aggregate billing for the components exceeds the amount otherwise billable for the usual and customary single product or procedure.\n(2) In addition to the prohibitions in Subsection (1), a person may not:\n(a) fail to credit the state for payments received from other sources;\n(b) recover or attempt to recover payment in violation of the provider agreement from:\n(i) a recipient under a medical benefit program; or\n(ii) the recipient's family;\n(c) falsify or alter with intent to deceive, any report or document required by state or federal law, rule, or Medicaid provider agreement;\n(d) retain any unauthorized payment as a result of acts described by this section; or\n(e) aid or abet the commission of any act prohibited by this section.","path":["Title 26B Utah Health and Human Services Code","Chapter 26B-3 Health Care - Administration and Assistance","Part 26B-3-11 Utah False Claims Act"],"source_url":"https://le.utah.gov/xcode/Title26B/Chapter3/26B-3-S1106.html","current_through":"2026 General Session","vintage":"","retrieved_at":"2026-09-03T11:34:33Z","sha256":"b2a491b86f5fe4b761f7a9b799744b8ad1f315ac968debba3e5fa26cdfb926a9","source_id":"us-ut","stale":false,"prev":"us-ut/utah-code-26b-3-1105","next":"us-ut/utah-code-26b-3-1107"},"notice":"GroundRules: Original legal text. Not legal advice."}