reglab/statecodes huggingface dataset:
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1010 - Action by department -- Notice to recipient.

Effective 5/3/2023
26B-3-1010.
Action by department -- Notice to recipient.
(1)
(a) Within 30 days after commencing an action under Subsection 26B-3-1009(3), the department shall give the recipient, the recipient's guardian, personal representative, trustee, estate, or survivor, whichever is appropriate, written notice of the action by:
(i) personal service or certified mail to the last known address of the person receiving the notice; or
(ii) if no last-known address is available, by publishing a notice:
(A) once a week for three successive weeks in a newspaper of general circulation in the county where the recipient resides; and
(B) in accordance with Section 45-1-101 for three weeks.
(b) Proof of service shall be filed in the action.
(c) The recipient may intervene in the department's action at any time before trial.
(2) The notice required by Subsection (1) shall name the court in which the action is commenced and advise the recipient of:
(a) the right to intervene in the proceeding;
(b) the right to obtain a private attorney; and
(c) the department's right to recover medical assistance directly from the third party.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1012 - Department's right to intervene -- Department's interests protected -- Remitting funds -- Disbursements -- Liability and penalty for noncompliance.

Effective 5/3/2023
26B-3-1012.
Department's right to intervene -- Department's interests protected -- Remitting funds -- Disbursements -- Liability and penalty for noncompliance.
(1) The department has an unconditional right to intervene in an action commenced by a recipient against a third party for the purpose of recovering medical costs for which the department has provided or has become obligated to provide medical assistance.
(2)
(a) If the recipient proceeds without complying with the provisions of Section 26B-3-1011, the department is not bound by any decision, judgment, agreement, settlement, or compromise rendered or made on the claim or in the action.
(b) The department:
(i) may recover in full from the recipient, or any party to which the proceeds were made payable, all medical assistance that the department has provided; and
(ii) retains its right to commence an independent action against the third party, subject to Subsection 26B-3-1009(3).
(3) Any amounts assigned to and recoverable by the department pursuant to Sections 26B-3-1003 and 26B-3-1009 collected directly by the recipient shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services no later than five business days after receipt.
(4)
(a) Any amounts assigned to and recoverable by the department pursuant to Sections 26B-3-1003 and 26B-3-1009 collected directly by the recipient's attorney shall be remitted to the Bureau of Medical Collections within the Office of Recovery Services no later than 30 days after the funds are placed in the attorney's trust account.
(b) The date by which the funds shall be remitted to the department may be modified based on agreement between the department and the recipient's attorney.
(c) The department's consent to another date for remittance may not be unreasonably withheld.
(d) If the funds are received by the recipient's attorney, no disbursements shall be made to the recipient or the recipient's attorney until the department's claim has been paid.
(5) A recipient or recipient's attorney who knowingly and intentionally fails to comply with this section is liable to the department for:
(a) the amount of the department's claim or lien pursuant to Subsection (1);
(b) a penalty equal to 10% of the amount of the department's claim; and
(c) attorney fees and litigation expenses related to recovering the department's claim.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1013 - Estate and trust recovery.

Effective 5/3/2023
26B-3-1013.
Estate and trust recovery.
(1)
(a) Except as provided in Subsection (1)(b), upon a recipient's death, the department may recover from the recipient's recovery estate and any trust, in which the recipient is the grantor and a beneficiary, medical assistance correctly provided for the benefit of the recipient when the recipient was 55 years old or older.
(b) The department may not make an adjustment or a recovery under Subsection (1)(a):
(i) while the deceased recipient's spouse is still living; or
(ii) if the deceased recipient has a surviving child who is:
(A) under 21 years old; or
(B) blind or disabled, as defined in the state plan.
(2)
(a) The amount of medical assistance correctly provided for the benefit of a recipient and recoverable under this section is a lien against the deceased recipient's recovery estate or any trust when the recipient is the grantor and a beneficiary.
(b) The lien holds the same priority as reasonable and necessary medical expenses of the last illness as provided in Section 75-3-805.
(3)
(a) For a lien described in Subsection (2), the department shall provide notice in accordance with Section 38-12-102.
(b) Before final distribution, the department shall perfect the lien as follows:
(i) for an estate, by presenting the lien to the estate's personal representative in accordance with Section 75-3-804; and
(ii) for a trust, by presenting the lien to the trustee in accordance with Section 75-7-510.
(c) The department may file an amended lien before the entry of the final order to close the estate or trust.
(4) Claims against a deceased recipient's inter vivos trust shall be presented in accordance with Sections 75-7-509 and 75-7-510.
(5) Any trust provision that denies recovery for medical assistance is void at the time of its making.
(6) Nothing in this section affects the right of the department to recover Medicaid assistance before a recipient's death under Section 26B-3-1003 or 26B-3-1014.
(7) A lien imposed under this section is of indefinite duration.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1014 - Recovery from recipient of incorrectly provided medical assistance.

Effective 5/3/2023
26B-3-1014.
Recovery from recipient of incorrectly provided medical assistance.
The department may:
(1) recover medical assistance incorrectly provided, whether due to administrative or factual error or fraud, from the recipient or the recipient's recovery estate; and
(2) pursuant to a judgment, impose a lien against real property of the recipient.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1015 - TEFRA liens authorized -- Grounds for TEFRA liens -- Exemptions.

Effective 5/3/2023
26B-3-1015.
TEFRA liens authorized -- Grounds for TEFRA liens -- Exemptions.
(1) Except as provided in Subsections (2) and (3), the department may impose a TEFRA lien on the real property of an individual for the amount of medical assistance provided for, or to, the individual while the individual is an inpatient in a care facility, if:
(a) the individual is an inpatient in a care facility;
(b) the individual is required, as a condition of receiving services under the state plan, to spend for costs of medical care all but a minimal amount of the individual's income required for personal needs; and
(c) the department determines that the individual cannot reasonably be expected to:
(i) be discharged from the care facility; and
(ii) return to the individual's home.
(2) The department may not impose a lien on the home of an individual described in Subsection (1), if any of the following individuals are lawfully residing in the home:
(a) the spouse of the individual;
(b) a child of the individual, if the child is:
(i) under 21 years old; or
(ii) blind or permanently and totally disabled, as defined in Title 42 U.S.C. Sec. 1382c(a)(3)(F); or
(c) a sibling of the individual, if the sibling:
(i) has an equity interest in the home; and
(ii) resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility.
(3) The department may not impose a TEFRA lien on the real property of an individual, unless:
(a) the individual has been an inpatient in a care facility for the 180-day period immediately preceding the day on which the lien is imposed;
(b) the department serves:
(i) a preliminary notice of intent to impose a TEFRA lien relating to the real property, in accordance with Section 26B-3-1017; and
(ii) a final notice of intent to impose a TEFRA lien relating to the real property, in accordance with Section 26B-3-1018; and
(c)
(i) the individual does not file a timely request for review of the department's decision under Title 63G, Chapter 4, Administrative Procedures Act; or
(ii) the department's decision is upheld upon final review or appeal under Title 63G, Chapter 4, Administrative Procedures Act.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1016 - Presumption of permanency.

Effective 5/3/2023
26B-3-1016.
Presumption of permanency.
There is a rebuttable presumption that an individual who is an inpatient in a care facility cannot reasonably be expected to be discharged from a care facility and return to the individual's home, if the individual has been an inpatient in a care facility for a period of at least 180 consecutive days.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1017 - Preliminary notice of intent to impose a TEFRA lien.

Effective 5/3/2023
26B-3-1017.
Preliminary notice of intent to impose a TEFRA lien.
(1) Prior to imposing a TEFRA lien on real property, the department shall serve a preliminary notice of intent to impose a TEFRA lien, on the individual described in Subsection 26B-3-1015(1), who owns the property.
(2) The preliminary notice of intent shall:
(a) be served in person, or by certified mail, on the individual described in Subsection 26B-3-1015(1), and, if the department is aware that the individual has a legally authorized representative, on the representative;
(b) include a statement indicating that, according to the department's records, the individual:
(i) meets the criteria described in Subsections 26B-3-1015(1)(a) and (b);
(ii) has been an inpatient in a care facility for a period of at least 180 days immediately preceding the day on which the department provides the notice to the individual; and
(iii) is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual's home;
(c) indicate that the department intends to impose a TEFRA lien on real property belonging to the individual;
(d) describe the real property that the TEFRA lien will apply to;
(e) describe the current amount of, and purpose of, the TEFRA lien;
(f) indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance;
(g) indicate that the individual may seek to prevent the TEFRA lien from being imposed on the real property by providing documentation to the department that:
(i) establishes that the individual does not meet the criteria described in Subsection 26B-3-1015(1)(a) or (b);
(ii) establishes that the individual has not been an inpatient in a care facility for a period of at least 180 days;
(iii) rebuts the presumption described in Section 26B-3-1016; or
(iv) establishes that the real property is exempt from imposition of a TEFRA lien under Subsection 26B-3-1015(2);
(h) indicate that if the owner fails to provide the documentation described in Subsection (2)(g) within 30 days after the day on which the preliminary notice of intent is served, the department will issue a final notice of intent to impose a TEFRA lien on the real property and will proceed to impose the lien;
(i) identify the type of documentation that the owner may provide to comply with Subsection (2)(g);
(j) describe the circumstances under which a TEFRA lien is required to be released; and
(k) describe the circumstances under which the department may seek to recover the lien.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1018 - Final notice of intent to impose a TEFRA lien.

Effective 5/3/2023
26B-3-1018.
Final notice of intent to impose a TEFRA lien.
(1) The department may issue a final notice of intent to impose a TEFRA lien on real property if:
(a) a preliminary notice of intent relating to the property is served in accordance with Section 26B-3-1017;
(b) it is at least 30 days after the day on which the preliminary notice of intent was served; and
(c) the department has not received documentation or other evidence that adequately establishes that a TEFRA lien may not be imposed on the real property.
(2) The final notice of intent to impose a TEFRA lien on real property shall:
(a) be served in person, or by certified mail, on the individual described in Subsection 26B-3-1015(1), who owns the property, and, if the department is aware that the individual has a legally authorized representative, on the representative;
(b) indicate that the department has complied with the requirements for filing the final notice of intent under Subsection (1);
(c) include a statement indicating that, according to the department's records, the individual:
(i) meets the criteria described in Subsections 26B-3-1015(1)(a) and (b);
(ii) has been an inpatient in a care facility for a period of at least 180 days immediately preceding the day on which the department provides the notice to the individual; and
(iii) is legally presumed to be in a condition where it cannot reasonably be expected that the individual will be discharged from the care facility and return to the individual's home;
(d) indicate that the department intends to impose a TEFRA lien on real property belonging to the individual;
(e) describe the real property that the TEFRA lien will apply to;
(f) describe the current amount of, and purpose of, the TEFRA lien;
(g) indicate that the amount of the lien may continue to increase as the individual continues to receive medical assistance;
(h) describe the circumstances under which a TEFRA lien is required to be released;
(i) describe the circumstances under which the department may seek to recover the lien;
(j) describe the right of the individual to challenge the decision of the department in an adjudicative proceeding; and
(k) indicate that failure by the individual to successfully challenge the decision of the department will result in the TEFRA lien being imposed.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1019 - Review of department decision.

Effective 5/3/2023
26B-3-1019.
Review of department decision.
An individual who has been served with a final notice of intent to impose a TEFRA lien under Section 26B-3-1018 may seek agency or judicial review of that decision under Title 63G, Chapter 4, Administrative Procedures Act.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1020 - Dissolution and removal of TEFRA lien.

Effective 5/3/2023
26B-3-1020.
Dissolution and removal of TEFRA lien.
(1) A TEFRA lien shall dissolve and be removed by the department if the individual described in Subsection 26B-3-1015(1):
(a)
(i) is discharged from the care facility; and
(ii) returns to the individual's home; or
(b) provides sufficient documentation to the department that:
(i) rebuts the presumption described in Section 26B-3-1016; or
(ii) any of the following individuals are lawfully residing in the individual's home:
(A) the spouse of the individual;
(B) a child of the individual, if the child is under 21 years old or blind or permanently and totally disabled, as defined in Title 42 U.S.C. Sec. 1382c(a)(3)(F); or
(C) a sibling of the individual, if the sibling has an equity interest in the home and resided in the home for at least one year immediately preceding the day on which the individual was admitted to the care facility.
(2) An individual described in Subsection 26B-3-1015(1)(a) may, at any time after the department has imposed a lien under Sections 26B-3-1015 through 26B-3-1023, file a request for the department to remove the lien.
(3) A request filed under Subsection (2) shall be considered and reviewed pursuant to Title 63G, Chapter 4, Administrative Procedures Act.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1021 - Expenditures included in lien -- Other proceedings.

Effective 5/3/2023
26B-3-1021.
Expenditures included in lien -- Other proceedings.
(1) A TEFRA lien imposed on real property under Sections 26B-3-1015 through 26B-3-1023 includes all expenses relating to medical assistance provided or paid for under the state plan from the first day that the individual is placed in a care facility, regardless of when the lien is imposed or filed on the property.
(2) Nothing in Sections 26B-3-1015 through 26B-3-1023 affect or prevent the department from bringing or pursuing any other legally authorized action to recover medical assistance or to set aside a fraudulent or improper conveyance.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1022 - Contract with another government agency.

Effective 5/3/2023
26B-3-1022.
Contract with another government agency.
If the department contracts with another government agency to recover funds paid for medical assistance under this part, that government agency shall be the sole agency that determines whether to impose or remove a TEFRA lien under Sections 26B-3-1015 through 26B-3-1023.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1023 - Precedence of the Tax Equity and Fiscal Responsibility Act of 1982.

Effective 5/3/2023
26B-3-1023.
Precedence of the Tax Equity and Fiscal Responsibility Act of 1982.
If any provision of Sections 26B-3-1015 through 26B-3-1023 conflict with the requirements of the Tax Equity and Fiscal Responsibility Act of 1982 for imposing a lien against the property of an individual prior to the individual's death, under 42 U.S.C. Sec. 1396p, the provisions of the Tax Equity and Fiscal Responsibility Act of 1982 take precedence and shall be complied with by the department.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1024 - Legal recognition of electronic claims records.

Effective 5/3/2023
26B-3-1024.
Legal recognition of electronic claims records.
Pursuant to Title 46, Chapter 4, Uniform Electronic Transactions Act:
(1) a claim submitted to the department for payment may not be denied legal effect, enforceability, or admissibility as evidence in any court in any civil action because it is in electronic form; and
(2) a third party shall accept an electronic record of payments by the department for medical services on behalf of a recipient as evidence in support of the department's claim.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1025 - Direct payment to the department by third party.

Effective 5/3/2023
26B-3-1025.
Direct payment to the department by third party.
(1) Any third party required to make payment to the department pursuant to this part shall make the payment directly to the department or its designee.
(2) The department may negotiate a payment or payment instrument it receives in connection with Subsection (1) without the cosignature or other participation of the recipient or any other party.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1026 - Attorney general or county attorney to represent department.

Effective 5/3/2023
26B-3-1026.
Attorney general or county attorney to represent department.
The attorney general or a county attorney shall represent the department in any action commenced under this part.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1027 - Department's right to attorney fees and costs.

Effective 5/3/2023
26B-3-1027.
Department's right to attorney fees and costs.
In any action brought by the department under this part in which it prevails, the department shall recover along with the principal sum and interest, a reasonable attorney fee and costs incurred.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 10 - Medical Benefits Recovery › Section 1028 - Application of provisions contrary to federal law prohibited.

Effective 5/3/2023
26B-3-1028.
Application of provisions contrary to federal law prohibited.
In no event shall any provision contained in this part be applied contrary to existing federal law.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1101 - Definitions.

Effective 5/3/2023
26B-3-1101.
Definitions.
As used in this part:
(1) "Benefit" means the receipt of money, goods, or any other thing of pecuniary value.
(2) "Claim" means any request or demand for money or property:
(a) made to any:
(i) employee, officer, or agent of the state;
(ii) contractor with the state; or
(iii) grantee or other recipient, whether or not under contract with the state; and
(b) if:
(i) any portion of the money or property requested or demanded was issued from or provided by the state; or
(ii) the state will reimburse the contractor, grantee, or other recipient for any portion of the money or property.
(3) "False statement" or "false representation" means a wholly or partially untrue statement or representation which is:
(a) knowingly made; and
(b) a material fact with respect to the claim.
(4) "Health care provider" means the same as that term is defined in Section 26B-8-411.
(5) "Knowing" and "knowingly":
(a) for purposes of criminal prosecutions for violations of this part, is one of the culpable mental states described in Subsection 26B-3-1108(1); and
(b) for purposes of civil prosecutions for violations of this part, is the required culpable mental state as defined in Subsection 26B-3-1109(1).
(6) "Medical benefit" means a benefit paid or payable to:
(a) a health care provider; or
(b) a recipient or a provider under a program administered by the state under:
(i) Titles V and XIX of the federal Social Security Act;
(ii) Title X of the federal Public Health Services Act;
(iii) the federal Child Nutrition Act of 1966 as amended by Pub. L. No. 94-105; and
(iv) any programs for medical assistance of the state.
(7) "Person" means an individual, corporation, unincorporated association, professional corporation, partnership, or other form of business association.
Renumbered and Amended by Chapter 306, 2023 General Session
Amended by Chapter 331, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1102 - False statement or representation relating to medical benefits.

Effective 5/3/2023
26B-3-1102.
False statement or representation relating to medical benefits.
(1) A person may not make or cause to be made a false statement or false representation of a material fact in an application for medical benefits.
(2) A person may not make or cause to be made a false statement or false representation of a material fact for use in determining rights to a medical benefit.
(3) A person, who having knowledge of the occurrence of an event affecting the person's initial or continued right to receive a medical benefit or the initial or continued right of any other person on whose behalf the person has applied for or is receiving a medical benefit, may not conceal or fail to disclose that event with intent to obtain a medical benefit to which the person or any other person is not entitled or in an amount greater than that to which the person or any other person is entitled.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1103 - Kickbacks or bribes prohibited.

Effective 5/3/2023
26B-3-1103.
Kickbacks or bribes prohibited.
(1) For purposes of this section, kickback or bribe:
(a) includes rebates, compensation, or any other form of remuneration which is:
(i) direct or indirect;
(ii) overt or covert; or
(iii) in cash or in kind; and
(b) does not include a rebate paid to the state under 42 U.S.C. Sec. 1396r-8 or any state supplemental rebates.
(2) A person may not solicit, offer, pay, or receive a kickback or bribe in return for or to induce:
(a) the purchasing, leasing, or ordering of any goods or services for which payment is or may be made in whole or in part pursuant to a medical benefit program; or
(b) the referral of an individual to another person for the furnishing of any goods or services for which payment is or may be made in whole or in part pursuant to a medical benefit program.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1104 - False statements or false representations relating to qualification of health institution or facility prohibited -- Felony.

Effective 5/3/2023
26B-3-1104.
False statements or false representations relating to qualification of health institution or facility prohibited -- Felony.
(1) A person may not knowingly, intentionally, or recklessly make, induce, or seek to induce, the making of a false statement or false representation of a material fact with respect to the conditions or operation of an institution or facility in order that the institution or facility may qualify, upon initial certification or upon recertification, as a hospital, skilled nursing facility, intermediate care facility, or home health agency.
(2) A person who violates this section is guilty of a second degree felony.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1105 - Conspiracy to defraud prohibited.

Effective 5/3/2023
26B-3-1105.
Conspiracy to defraud prohibited.
A person may not enter into an agreement, combination, or conspiracy to defraud the state by obtaining or aiding another to obtain the payment or allowance of a false, fictitious, or fraudulent claim for a medical benefit.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1106 - False claims for medical benefits prohibited.

Effective 5/3/2023
26B-3-1106.
False claims for medical benefits prohibited.
(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:
(a) which is wholly or partially false, fictitious, or fraudulent;
(b) for services which were not rendered or for items or materials which were not delivered;
(c) which misrepresents the type, quality, or quantity of items or services rendered;
(d) representing charges at a higher rate than those charged by the provider to the general public;
(e) for items or services which the person or the provider knew were not medically necessary in accordance with professionally recognized standards;
(f) which has previously been paid;
(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
(h) where a provider:
(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
(ii) bills for each component of the product, procedure, or group of procedures:
(A) as if they had been provided or performed independently and at separate times; and
(B) the aggregate billing for the components exceeds the amount otherwise billable for the usual and customary single product or procedure.
(2) In addition to the prohibitions in Subsection (1), a person may not:
(a) fail to credit the state for payments received from other sources;
(b) recover or attempt to recover payment in violation of the provider agreement from:
(i) a recipient under a medical benefit program; or
(ii) the recipient's family;
(c) falsify or alter with intent to deceive, any report or document required by state or federal law, rule, or Medicaid provider agreement;
(d) retain any unauthorized payment as a result of acts described by this section; or
(e) aid or abet the commission of any act prohibited by this section.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1107 - Knowledge of past acts not necessary to establish fact that false statement or representation knowingly made.

Effective 5/3/2023
26B-3-1107.
Knowledge of past acts not necessary to establish fact that false statement or representation knowingly made.
In prosecution under this part, it is not necessary to show that the person had knowledge of similar acts having been performed in the past on the part of persons acting on his behalf nor to show that the person had actual notice that the acts by the persons acting on his behalf occurred to establish the fact that a false statement or representation was knowingly made.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1108 - Criminal penalties.

Effective 5/3/2023
26B-3-1108.
Criminal penalties.
(1)
(a) Except as provided in Subsection (1)(b) the culpable mental state required for a criminal violation of this part is knowingly, intentionally, or recklessly as defined in Section 76-2-103.
(b) The culpable mental state required for a criminal violation of this part for kickbacks and bribes under Section 26B-3-1103 is knowingly and intentionally as defined in Section 76-2-103.
(2) The punishment for a criminal violation of any provision of this part, except as provided under Section 26B-3-1104, is determined by the cumulative value of the funds or other benefits received or claimed in the commission of all violations of a similar nature, and not by each separate violation.
(3) Punishment for criminal violation of this part, except as provided under Section 26B-3-1104, is:
(a) a second degree felony if the value of the property or service is or exceeds $5,000;
(b) a third degree felony if the value of the property or service is or exceeds $1,500 but is less than $5,000;
(c) a class A misdemeanor if the value of the property or service is or exceeds $500 but is less than $1,500; or
(d) a class B misdemeanor if the value of the property or service is less than $500.
Amended by Chapter 111, 2023 General Session
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1109 - Civil penalties.

Effective 5/3/2023
26B-3-1109.
Civil penalties.
(1) The culpable mental state required for a civil violation of this part is "knowing" or "knowingly" which:
(a) means that person, with respect to information:
(i) has actual knowledge of the information;
(ii) acts in deliberate ignorance of the truth or falsity of the information; or
(iii) acts in reckless disregard of the truth or falsity of the information; and
(b) does not require a specific intent to defraud.
(2) Any person who violates this part shall, in all cases, in addition to other penalties provided by law, be required to:
(a) make full and complete restitution to the state of all damages that the state sustains because of the person's violation of this part;
(b) pay to the state its costs of enforcement of this part in that case, including the cost of investigators, attorneys, and other public employees, as determined by the state; and
(c) pay to the state a civil penalty equal to:
(i) three times the amount of damages that the state sustains because of the person's violation of this part; and
(ii) not less than $5,000 or more than $10,000 for each claim filed or act done in violation of this part.
(3) Any civil penalties assessed under Subsection (2) shall be awarded by the court as part of its judgment in both criminal and civil actions.
(4) A criminal action need not be brought against a person in order for that person to be civilly liable under this section.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1110 - Revocation of license of assisted living facility -- Appointment of receiver.

Effective 5/3/2023
26B-3-1110.
Revocation of license of assisted living facility -- Appointment of receiver.
(1) If the license of an assisted living facility is revoked for violation of this part, the county attorney may file a petition with the district court for the county in which the facility is located for the appointment of a receiver.
(2) The district court shall issue an order to show cause why a receiver should not be appointed returnable within five days after the filing of the petition.
(3)
(a) If the court finds that the facts warrant the granting of the petition, the court shall appoint a receiver to take charge of the facility.
(b) The court may determine fair compensation for the receiver.
(4) A receiver appointed pursuant to this section shall have the powers and duties prescribed by the court.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1111 - Presumption based on paid state warrant -- Value of medical benefits -- Repayment of benefits.

Effective 5/3/2023
26B-3-1111.
Presumption based on paid state warrant -- Value of medical benefits -- Repayment of benefits.
(1) In any civil or criminal action brought under this part, a paid state warrant, made payable to the order of a party, creates a presumption that the party received funds from the state.
(2) In any civil or criminal action brought under this part, the value of the benefits received shall be the ordinary or usual charge for similar benefits in the private sector.
(3) In any criminal action under this part, the repayment of funds or other benefits obtained in violation of the provisions of this part does not constitute a defense to, or grounds for dismissal of that action.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1112 - Violation of other laws.

Effective 5/3/2023
26B-3-1112.
Violation of other laws.
(1) The provisions of this part are:
(a) not exclusive, and the remedies provided for in this part are in addition to any other remedies provided for under:
(i) any other applicable law; or
(ii) common law; and
(b) to be liberally construed and applied to:
(i) effectuate the chapter's remedial and deterrent purposes; and
(ii) serve the public interest.
(2) If any provision of this part or the application of this part to any person or circumstance is held unconstitutional:
(a) the remaining provisions of this part are not affected; and
(b) the application of this part to other persons or circumstances are not affected.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1113 - Medicaid fraud enforcement.

Effective 5/3/2023
26B-3-1113.
Medicaid fraud enforcement.
(1) This part shall be enforced in accordance with this section.
(2) The department is responsible for:
(a)
(i) investigating and prosecuting suspected civil violations of this part; or
(ii) referring suspected civil violations of this part to the attorney general for investigation and prosecution; and
(b) promptly referring suspected criminal violations of this part to the attorney general for criminal investigation and prosecution.
(3) The attorney general has:
(a) concurrent jurisdiction with the department for investigating and prosecuting suspected civil violations of this part; and
(b) exclusive jurisdiction to investigate and prosecute all suspected criminal violations of this part.
(4) The department and the attorney general share concurrent civil enforcement authority under this part and may enter into an interagency agreement regarding the investigation and prosecution of violations of this part in accordance with this section, the requirements of Title XIX of the federal Social Security Act, and applicable federal regulations.
(5)
(a) Any violation of this part which comes to the attention of any state government officer or agency shall be reported to the attorney general or the department.
(b) All state government officers and agencies shall cooperate with and assist in any prosecution for violation of this part.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 3 - Health Care - Administration and Assistance › Part 11 - Utah False Claims Act › Section 1115 - Limitation of actions -- Civil acts antedating this section -- Civil burden of proof -- Estoppel -- Joint civil liability -- Venue.

Effective 5/3/2023
26B-3-1115.
Limitation of actions -- Civil acts antedating this section -- Civil burden of proof -- Estoppel -- Joint civil liability -- Venue.
(1) An action under this part may not be brought after the later of:
(a) six years after the date on which the violation was committed; or
(b) three years after the date an official of the state charged with responsibility to act in the circumstances discovers the violation, but in no event more than 10 years after the date on which the violation was committed.
(2) A civil action brought under this part may be brought for acts occurring prior to the effective date of this section if the limitations period set forth in Subsection (1) has not lapsed.
(3) In any civil action brought under this part the state shall be required to prove by a preponderance of evidence, all essential elements of the cause of action including damages.
(4) Notwithstanding any other provision of law, a final judgment rendered in favor of the state in any criminal proceeding under this part, whether upon a verdict after trial or upon a plea of guilty or nolo contendere, shall estop the defendant from denying the essential elements of the offense in any civil action under this part which involves the same transaction.
(5) Civil liability under this part shall be joint and several for a violation committed by two or more persons.
(6) Any action brought by the state under this part shall be brought in district court in Salt Lake County or in any county where the defendant resides or does business.
Renumbered and Amended by Chapter 306, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 4 - Health Care - Delivery and Access › Part 1 - Utah Emergency Medical Services System › Section 101 - Definitions.

Effective 7/1/2024
26B-4-101.
Definitions.
Reserved.
Amended by Chapter 307, 2023 General Session
Amended by Chapter 307, 2023 General Session, (Coordination Clause)
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 4 - Health Care - Delivery and Access › Part 1 - Utah Emergency Medical Services System › Section 102 - Department powers.

Effective 5/3/2023
Superseded 7/1/2024
26B-4-102.
Department powers.
The department shall:
(1) coordinate the emergency medical services within the state;
(2) administer this part and the rules established pursuant to it;
(3) establish a voluntary task force representing a diversity of emergency medical service providers to advise the department and the committee on rules;
(4) establish an emergency medical service personnel peer review board to advise the department concerning discipline of emergency medical service personnel under this part;
(5) adopt rules in accordance with Title 63G, Chapter 3, Utah Administrative Rulemaking Act, to:
(a) license ambulance providers and paramedic providers;
(b) permit ambulances, emergency medical response vehicles, and nonemergency secured behavioral health transport vehicles, including approving an emergency vehicle operator's course in accordance with Section 26B-4-118;
(c) establish:
(i) the qualifications for membership of the peer review board created by this section;
(ii) a process for placing restrictions on a license while an investigation is pending;
(iii) the process for the investigation and recommendation by the peer review board; and
(iv) the process for determining the status of a license while a peer review board investigation is pending;
(d) establish application, submission, and procedural requirements for licenses, designations, and permits; and
(e) establish and implement the programs, plans, and responsibilities as specified in other sections of this part;
(6) develop and implement, in cooperation with state, federal, and local agencies empowered to oversee disaster response activities, plans to provide emergency medical services during times of disaster or emergency;
(7) establish a pediatric quality improvement resource program; and
(8) develop and implement a statewide program to provide support and counseling for personnel who have been exposed to one or more stressful incidents in the course of providing emergency services which shall include:
(a) ongoing training for agencies providing emergency services and counseling program volunteers;
(b) critical incident stress debriefing for personnel at no cost to the emergency provider; and
(c) advising the department on training requirements for licensure as a behavioral emergency services technician.
Renumbered and Amended by Chapter 307, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 4 - Health Care - Delivery and Access › Part 1 - Utah Emergency Medical Services System › Section 103 - Waiver of rules and education and licensing requirements.

Effective 5/3/2023
Superseded 7/1/2024
26B-4-103.
Waiver of rules and education and licensing requirements.
(1) Upon application, the department, or the committee with the concurrence of the department, may waive the requirements of a rule the department, or the committee with the concurrence of the department, has adopted if:
(a) the person applying for the waiver satisfactorily demonstrates that:
(i) the waiver is necessary for a pilot project to be undertaken by the applicant;
(ii) in the particular situation, the requirement serves no beneficial public purpose; or
(iii) circumstances warrant that waiver of the requirement outweighs the public benefit to be gained by adherence to the rule; and
(b) for a waiver granted under Subsection (1)(a)(ii) or (iii):
(i) the committee or department extends the waiver to similarly situated persons upon application; or
(ii) the department, or the committee with the concurrence of the department, amends the rule to be consistent with the waiver.
(2) A waiver of education or licensing requirements may be granted to a veteran, as defined in Section 68-3-12.5, if the veteran:
(a) provides to the committee or department documentation showing military education and training in the field in which licensure is sought; and
(b) successfully passes any examination required.
(3) No waiver may be granted under this section that is inconsistent with the provisions of this part.
Renumbered and Amended by Chapter 307, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 4 - Health Care - Delivery and Access › Part 1 - Utah Emergency Medical Services System › Section 104 - Public awareness efforts.

Effective 5/3/2023
Superseded 7/1/2024
26B-4-104.
Public awareness efforts.
The department may:
(1) develop programs to inform the public of the emergency medical service system; and
(2) develop and disseminate emergency medical training programs for the public, which emphasize the prevention and treatment of injuries and illnesses.
Renumbered and Amended by Chapter 307, 2023 General Session
2023 Utah Code › Title 26B - Utah Health and Human Services Code › Chapter 4 - Health Care - Delivery and Access › Part 1 - Utah Emergency Medical Services System › Section 105 - Emergency medical communications.

Effective 5/3/2023
Superseded 7/1/2024
26B-4-105.
Emergency medical communications.
Consistent with federal law, the department is the lead agency for coordinating the statewide emergency medical service communication systems under which emergency medical personnel, dispatch centers, and treatment facilities provide medical control and coordination between emergency medical service providers.
Renumbered and Amended by Chapter 307, 2023 General Session