76-8-1203.5. Public assistance fraud by a provider.

435 words·~2 min read·/ut/title-76/chapter-8/76-8-1203-5

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

Effective 5/1/2024

(1)Terms defined in Sections 76-1-101.5 , 76-8-101 , and 76-8-1201 apply to this section.

(2)An actor commits public assistance fraud by a provider if the actor:

(a)is a provider; and

(b)intentionally, knowingly, or recklessly:

(i)receives a payment after failing to comply with the requirements in Subsection 76-8-1203

(1)or 76-8-1203 (2);

(ii)files a claim for payment under a state or federally funded public assistance program for goods or services not provided to or for a client under that program;

(iii)files or falsifies a claim, report, or document required by a state or federal law, a rule, or a provider agreement for goods or services not authorized under the state or federally funded public assistance program for which the goods or services were provided;

(iv)fails to credit the state for payments received from other sources;

(v)bills a client, or the client's family, for:

(A)goods or services not provided; or

(B)an amount greater than that allowed by law or rule; or

(vi)fails to comply with the notification requirements under Subsection 76-8-1203 (2).

(3)Subject to Subsection (5), a violation of Subsection

(2)is, based on the value of payments, assistance, or other benefits received, misappropriated, claimed, or applied:

(a)a second degree felony if the value is or exceeds $5,000;

(b)a third degree felony if the value is or exceeds $1,500 but is less than $5,000;

(c)a class A misdemeanor if the value is or exceeds $500 but is less than $1,500; or

(d)a class B misdemeanor if the value is less than $500.

(4)It is not a defense to prosecution under this section that the actor repaid the funds or benefits obtained in violation of this section.

(a)In determining the value of payments, assistance, or other benefits received to determine the penalty level of an actor's conduct under Subsection (3), the value is calculated by aggregating the values of each instance of public assistance fraud committed by the actor as part of the same facts and circumstances or a related series of facts and circumstances.

(b)The value of a benefit received by an individual is the ordinary or usual charge for similar benefits in the private sector.

(6)This section does not apply to offenses by providers under the state's Medicaid program that are actionable under Title 26B, Chapter 3, Part 11, Utah False Claims Act.

(7)The provisions of Section 35A-1-503 apply to a prosecution brought under this section.

Enacted by Chapter 96 , 2024 General Session