Utah Code 76-8-1203.5. Public assistance fraud by a provider
Current as of: 2024 | Check for updates
|
Other versions
(1) Terms defined in Sections 76-1-101.5 , 76-8-101 , and 76-8-1201 apply to this section.
Attorney's Note
Under the Utah Code, punishments for crimes depend on the classification. In the case of this section:| Class | Prison | Fine |
|---|---|---|
| class A misdemeanor | up to 364 days | up to $2,500 |
| class B misdemeanor | up to 6 months | up to $1,000 |
Terms Used In Utah Code 76-8-1203.5
- Act: means a voluntary bodily movement and includes speech. See Utah Code 76-1-101.5
- Actor: means a person whose criminal responsibility is in issue in a criminal action. See Utah Code 76-1-101.5
- Client: means a person who receives or has received public assistance. See Utah Code 76-8-1201
- Conduct: means an act or omission. See Utah Code 76-1-101.5
- Fraud: Intentional deception resulting in injury to another.
- Provider: means a person or entity that receives compensation from any public assistance program for goods or services provided to a public assistance recipient. See Utah Code 76-8-1201
- Public assistance: means the same as that term is defined in Section
35A-1-102 . See Utah Code 76-8-1201 - State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
(2) An actor commits public assistance fraud by a provider if the actor:
(2)(a) is a provider; and
(2)(b) intentionally, knowingly, or recklessly:
(2)(b)(i) receives a payment after failing to comply with the requirements in Subsection 76-8-1203 (1) or 76-8-1203 (2);
(2)(b)(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;
(2)(b)(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;
(2)(b)(iv) fails to credit the state for payments received from other sources;
(2)(b)(v) bills a client, or the client’s family, for:
(2)(b)(v)(A) goods or services not provided; or
(2)(b)(v)(B) an amount greater than that allowed by law or rule; or
(2)(b)(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:
(3)(a) a second degree felony if the value is or exceeds $5,000;
(3)(b) a third degree felony if the value is or exceeds $1,500 but is less than $5,000;
(3)(c) a class A misdemeanor if the value is or exceeds $500 but is less than $1,500; or
(3)(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.
(5)
(5)(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.
(5)(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.