Utah Admin. Code R986-700-732 - Intentional Program Violation

(1) An Intentional Program Violation (IPV) occurs when a person:

(a) either personally or through a representative;

(b) intentionally, knowingly, or recklessly, as defined in Section 76-2-103 concerning definitions of culpable conduct;

(c) violates a program rule, or helps another person violate a program rule;

(d) in an attempt to:

(i) obtain,

(ii) maintain,

(iii) increase, or

(iv) prevent the decrease or termination of CC payment.

(2) The evidentiary standard for determining an IPV is clear and convincing evidence.

(3) Acts which may constitute an IPV include:

(a) making a false or misleading statement;

(b) misrepresenting, concealing, or withholding information;

(c) posing as someone else;

(d) taking, using, or accepting a CC payment the person knew they were not eligible to receive,

(e) not reporting the receipt of a CC payment the person knew they were not eligible to receive;

(f) not reporting a material change as required by Sections R986-700-727 and R986-100-113; and

(g) committing an act intended to mislead, misrepresent, conceal or withhold a fact, or propound a falsity.

(4) When an IPV is alleged, the Department may:

(a) refer the case for criminal prosecution;

(b) in the case of a client IPV, issue a notice of agency action finding the person committed an IPV, which the person may appeal through the fair hearing process set forth in Rule R986-100;

(c) in the case of a provider IPV which occurred before May 8, 2020, or for which the Director of OCC does not recommend disqualifying the provider, in addition to any increased monitoring or remedial action pursuant to Subsection R986-700-727(6), issue a notice of agency action establishing an overpayment and penalty finding the provider committed an IPV, which the provider may appeal via the fair hearing process set forth in Rule R986-100; or

(d) in the case of a provider IPV for which the Director of OCC recommends disqualifying the provider, in addition to any increased monitoring or remedial action pursuant to Subsection R986-700-727(6), refer the case for an administrative disqualification hearing (ADH) pursuant to Section R986-700-733.

(5) The Department may not disqualify a provider unless an ADH has been held and the ALJ has ordered disqualification or the provider has been criminally convicted.

(6) The Department may not make a concurrent referral for an ADH and a criminal prosecution.

(a) If a case referred for criminal prosecution is dismissed or referred back to the Department without prosecution, the Department may issue a notice of agency action or refer the case for an ADH pursuant to Subsection R986-700-732(4).

(7) A provider found to have committed an IPV will be responsible for repayment of both any related overpayment and a civil penalty pursuant to Subsection 35A-3-603(4).

Notes

Utah Admin. Code R986-700-732

Adopted by Utah State Bulletin Number 2020-10, effective 5/9/2020