Section 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 ,§ 166, eff. 5/3/2023.Amended by Chapter 48, 2007 General Session.