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: which is wholly or partially false, fictitious, or fraudulent; for services which were not rendered or for items or materials which were not delivered; which misrepresents the type, quality, or quantity of items or services rendered; representing charges at a higher rate than those charged by the provider to the general public; for items or services which the person or the provider knew were not medically necessary in accordance with professionally recognized standards; which has previously been paid; 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 where a provider: 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 bills for each component of the product, procedure, or group of procedures: as if they had been provided or performed independently and at separate times; and 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, a person may not: (1) fail to credit the state for payments received from other sources; recover or attempt to recover payment in violation of the provider agreement from: a recipient under a medical benefit program; or the recipient's family; falsify or alter with intent to deceive, any report or document required by state or federal law, rule, or Medicaid provider agreement; retain any unauthorized payment as a result of acts described by this section; or aid or abet the commission of any act prohibited by this section.