Consistent with federal law and performance standards, the Medicaid Fraud and Patient Abuse Division focuses on two core missions:
The Unit is authorized to pursue criminal prosecutions and, when allowed under state law, civil enforcement actions to recover taxpayer funds and protect vulnerable individuals.
Our Medicaid Fraud and Patient Abuse team is located in Salt Lake County and St. George, Utah. Our St. George team is located at 1490 East Foremaster Dr. Ste 220 St. George, Utah 84790.
This team can be reached at (801)281-1259 or by emailing mfcucomplaints@agutah.gov.
Our Medicaid Fraud and Patient Abuse Division investigates and prosecutes crimes against vulnerable adults. Learn more about us.
Do you have a question about what our Medicaid Fraud and Patient Abuse Division does? Start here!
Are you ready to make a report and don’t know where to do? Let us walk you through the process.
We can investigate Medicaid provider fraud, , including billing schemes, kickbacks, false claims, misuse of credentials, and other conduct that harms the Medicaid program. We can also investigate and prosecute abuse, neglect, or exploitation of vulnerable individuals, including older adults, adults with disabilities, and Medicaid recipients, when these offenses occur in a health-care facility or another setting where a provider is paid by Medicaid.
File a Report | Call (801)281-1259 | Email mfcucomplaints@agutah.gov
Medicaid was created in 1965 and began in Utah in 1966. What started as coverage for basic and long-term care has grown into a comprehensive health program that today covers physical health, mental health, dental services, and long-term supports.
Medicaid is a partnership between states and the federal government, with costs shared through federal matching funds. Federal law sets basic coverage requirements, while states have flexibility to design programs that meet local needs.
Nationwide, Medicaid supports hospitals, clinics, mental health providers, long-term care facilities, and at-home care. As of mid-2025, more than 70 million Americans rely on Medicaid, including about 337,000 Utah children and adults.
The Social Security Act (SSA) requires each state to effectively operate a Medicaid Fraud Control Unit (MFCU). In Utah, the Medicaid Fraud and Patient Abuse Division in the Office of the Utah Attorney General serves as the MFCU. The function of a MFCU is to investigate and prosecute Medicaid provider fraud, as well as patient abuse, neglect, and exploitation.
Each MFCU receives a federal grant award equivalent to 90 percent of total expenditures for new Units and 75 percent for all other units. MFCU staff review referrals of possible fraud and patient abuse, neglect, or exploitation to determine the potential for criminal prosecution and/or civil action. If the unit accepts a referral for investigation, the case may result in various possible outcomes. Criminal prosecutions may result in convictions and civil actions may result in civil settlements or judgments. Both criminal prosecutions and civil actions may include the assessment of monetary recoveries.
Examples of Medicaid Fraud:
Resident abuse or neglect is any action or failure to act that causes unjustifiable harm to a healthcare facility resident. Abuse or neglect may include any, or all, of the following:
The Medicaid Fraud and Patient Abuse Division investigates reports of abuse, neglect, and exploitation of a vulnerable adult or child in any residential healthcare setting, including hospitals, nursing homes, assisted living facilities, and for Medicaid recipients in private homes.
A caretaker is any person, entity, corporation, or public institution that assumes the responsibility to provide a vulnerable adult with care, food, shelter, clothing, supervision, medical or other healthcare, or other necessities.
Neglect occurs when a caregiver fails to provide the care, supervision, or services necessary to keep a vulnerable adult safe and healthy. Neglect may be purposeful or unintentional, but it still causes harm.
Examples of Neglect include:
Neglect includes both the lack of proper care and the failure to protect a vulnerable adult from health and safety hazards.
Abuse is any action, or failure to act, that causes a vulnerable adult harm or places them at serious risk of harm. Abuse can be physical, emotional, or sexual.
Examples include:
Abuse may be a single act or a pattern of behavior. Any abuse of a vulnerable adult must be reported immediately under Utah Law by any individual who has knowledge of abuse—there are no exceptions.
Exploitation occurs when someone misuses a vulnerable adult’s money, dignity, or body for personal gain or advantage.
Financial Exploitation
Financial exploitation happens when someone improperly uses a vulnerable adult’s money, property, or resources. It can be committed by family members, caregivers, friends, or anyone in a position of trust. Exploitation can take many forms, including:
Personal Dignity Exploitation
Personal dignity exploitation happens when someone creates, shares, or displays images or recordings of a vulnerable adult in a way that is humiliating, offensive, or harmful.
This can include:
These actions are harmful even if meant as a “joke,” and they are illegal when they involve a vulnerable adult.
Sexual Exploitation
Sexual exploitation occurs when someone uses a vulnerable adult in any sexualized material or activity, especially when the adult cannot give informed consent.
Examples Include:
A vulnerable adult cannot legally consent to being used in sexualized images or videos. Any such conduct is a serious criminal offense.
Most health care providers are honest and provide quality services. Provider fraud still costs Medicaid millions of dollars each year. Medicaid fraud hurts taxpayers by diverting state funds from their intended purpose. Medicaid fraud hurts participants by limiting the funds available for their medical needs.
Medicaid fraud involves the knowing, intentional, or reckless use of a false statement, a misrepresentation, or the failure to disclose a material fact in providing medical assistance in the Medicaid program. Medicaid fraud can be a misdemeanor or a felony depending upon the cumulative loss amount to the Medicaid program.
There is no single example of Medicaid fraud. Medicaid fraud can include some medical services, or no service at all. Typical fraud schemes include unnecessarily increased costs, the overuse of resources, or inaccurate payments. Here are some common schemes used by criminals who take money from the program:
Medicaid participants can help prevent fraud by staying alert and protecting their information. Examples of ways to protect yourself include:
Utah law requires anyone who has reason to believe that a vulnerable adult or child is, or has been, the subject of abuse, neglect, or exploitation to immediately report the matter, as follows:
Medicaid was created in 1965 and began in Utah in 1966. What started as coverage for basic and long-term care has grown into a comprehensive health program that today covers physical health, mental health, dental services, and long-term supports.
Medicaid is a partnership between states and the federal government, with costs shared through federal matching funds. Federal law sets basic coverage requirements, while states have flexibility to design programs that meet local needs.
Nationwide, Medicaid supports hospitals, clinics, mental health providers, long-term care facilities, and at-home care. As of mid-2025, more than 70 million Americans rely on Medicaid, including about 337,000 Utah children and adults.
The Social Security Act (SSA) requires each state to effectively operate a Medicaid Fraud Control Unit (MFCU). In Utah, the Medicaid Fraud and Patient Abuse Division in the Office of the Utah Attorney General serves as the MFCU. The function of a MFCU is to investigate and prosecute Medicaid provider fraud, as well as patient abuse, neglect, and exploitation.
Each MFCU receives a federal grant award equivalent to 90 percent of total expenditures for new Units and 75 percent for all other units. MFCU staff review referrals of possible fraud and patient abuse, neglect, or exploitation to determine the potential for criminal prosecution and/or civil action. If the unit accepts a referral for investigation, the case may result in various possible outcomes. Criminal prosecutions may result in convictions and civil actions may result in civil settlements or judgments. Both criminal prosecutions and civil actions may include the assessment of monetary recoveries.
Examples of Medicaid Fraud:
Resident abuse or neglect is any action or failure to act that causes unjustifiable harm to a healthcare facility resident. Abuse or neglect may include any, or all, of the following:
The Medicaid Fraud and Patient Abuse Division investigates reports of abuse, neglect, and exploitation of a vulnerable adult or child in any residential healthcare setting, including hospitals, nursing homes, assisted living facilities, and for Medicaid recipients in private homes.
A caretaker is any person, entity, corporation, or public institution that assumes the responsibility to provide a vulnerable adult with care, food, shelter, clothing, supervision, medical or other healthcare, or other necessities.
Neglect occurs when a caregiver fails to provide the care, supervision, or services necessary to keep a vulnerable adult safe and healthy. Neglect may be purposeful or unintentional, but it still causes harm.
Examples of Neglect include:
Neglect includes both the lack of proper care and the failure to protect a vulnerable adult from health and safety hazards.
Abuse is any action, or failure to act, that causes a vulnerable adult harm or places them at serious risk of harm. Abuse can be physical, emotional, or sexual.
Examples include:
Abuse may be a single act or a pattern of behavior. Any abuse of a vulnerable adult must be reported immediately under Utah Law by any individual who has knowledge of abuse—there are no exceptions.
Exploitation occurs when someone misuses a vulnerable adult’s money, dignity, or body for personal gain or advantage.
Financial Exploitation
Financial exploitation happens when someone improperly uses a vulnerable adult’s money, property, or resources. It can be committed by family members, caregivers, friends, or anyone in a position of trust. Exploitation can take many forms, including:
Personal Dignity Exploitation
Personal dignity exploitation happens when someone creates, shares, or displays images or recordings of a vulnerable adult in a way that is humiliating, offensive, or harmful.
This can include:
These actions are harmful even if meant as a “joke,” and they are illegal when they involve a vulnerable adult.
Sexual Exploitation
Sexual exploitation occurs when someone uses a vulnerable adult in any sexualized material or activity, especially when the adult cannot give informed consent.
Examples Include:
A vulnerable adult cannot legally consent to being used in sexualized images or videos. Any such conduct is a serious criminal offense.
Most health care providers are honest and provide quality services. Provider fraud still costs Medicaid millions of dollars each year. Medicaid fraud hurts taxpayers by diverting state funds from their intended purpose. Medicaid fraud hurts participants by limiting the funds available for their medical needs.
Medicaid fraud involves the knowing, intentional, or reckless use of a false statement, a misrepresentation, or the failure to disclose a material fact in providing medical assistance in the Medicaid program. Medicaid fraud can be a misdemeanor or a felony depending upon the cumulative loss amount to the Medicaid program.
There is no single example of Medicaid fraud. Medicaid fraud can include some medical services, or no service at all. Typical fraud schemes include unnecessarily increased costs, the overuse of resources, or inaccurate payments. Here are some common schemes used by criminals who take money from the program:
Medicaid participants can help prevent fraud by staying alert and protecting their information. Examples of ways to protect yourself include:
Utah law requires anyone who has reason to believe that a vulnerable adult or child is, or has been, the subject of abuse, neglect, or exploitation to immediately report the matter, as follows:
To report Medicaid fraud by a provider, please call our office at (801)281-1259 or you may also fill out an intake form by clicking on the icon. Completed reports may be emailed to mfcucomplaints@agutah.gov.
To report abuse, neglect, or exploitation, please contact Adult Protective Services at (800)371-7897 or local law enforcement. In the case of emergencies, please dial 9-1-1. You may also click on the icon to report abuse online to Adult Protective Services.
The Utah Department of Adult Protective Services is tasked with investigating all incidents of Abuse, Neglect, and Exploitation of Vulnerable Adults, and protecting those individuals from further harm.
“Vulnerable adult” means an elderly adult, or a dependent adult who has a mental or physical impairment which substantially affects that individual’s ability to:
Individuals with knowledge of Abuse, Neglect, or Exploitation of a Vulnerable Adult are REQUIRED by Utah State Law to report to APS. A report can be made by clicking the following link.
The mission of the DCFS is to keep children safe from abuse and neglect and provide domestic violence services by working with communities and strengthening families.
Individuals with knowledge of Abuse or Neglect of a child are REQUIRED by Utah State Law to report to DCFS.
To report suspect child abuse or neglect, click the following link.
The Utah Office of Inspector General (Utah OIG) is an independent government agency tasked to conduct oversight of the Utah Medicaid program. This includes oversight of all programs, funding and services associated directly or indirectly with Medicaid. To contact the Utah OIG, click the following link.
For concerns regarding potential fraud committed against the Utah Medicaid Program, please contact the Medicaid Fraud and Patient Abuse Division directly or click the following link.
The United States Department of Health and Human Services – Office of Inspector General is tasked with fighting waste, abuse, and fraud of many healthcare programs, including Medicare. If you suspect waste, abuse, or fraud within the Medicare program, you can report it by clicking the following link.
The HHS/OIG has the authority to exclude individuals and entities from Federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud. Those that are excluded can receive no payment from Federal healthcare programs for any items or services they furnish, order, or prescribe. This includes those that provide health benefits funded directly or indirectly by the United States.
To look up an individual or entity for an exclusion, click the following link.
The Utah Department of Workforce Services investigates fraud committed by those who apply for State benefits, such as Medicaid, SNAP (food stamps), childcare, and other financial benefits. To contact DWS, click the following link.
The Long-Term Care Ombudsman advocates for the rights of residents of long-term care facilities to ensure and enhance the quality of life and care of residents.
To contact the Long-Term Care Ombudsman, click the following link.
Utah False Claims Act UCA § 26B-3-1101 et seq.
Abuse, Neglect or Exploitation of a Vulnerable Adult UCA § 76-5-111 et seq.
Unlawful Dealing of Property by a Fiduciary UCA § 76-6-513
Abuse or Neglect of a Child with a Disability UCA § 76-5-110
Endangerment of a Child or Vulnerable Adult UCA § 76-5-112.5
Reporting requirements UCA § 62A-3-305
Mandatory Reporting by Health Care Professionals
False Claims Act 31 UCS § 3729
Health Care Fraud 18 USC § 1347
False Statements Relating to Health Care Matters 18 USC § 1035
Salt Lake City – On Monday, May 12, 2025, Deaun Larson Holdaway was sentenced to two concurrent prison terms by Judge Parker in the Third District Court. Holdaway pleaded guilty to one count of False Claims for Medical Benefits, in violation of Utah Code §26B-3-1106(1)(a) and (c), a second-degree felony, and one count of Public Assistance Fraud, in violation of Utah Code §76-8-1203, a third-degree felony. For her criminal acts, Holdaway was sentenced to an indeterminate term of not less than one year nor more than fifteen years in the State Prison. Holdaway was also sentenced to a term of one to five years in the Utah State Prison for the Public Assistance Fraud, which will run concurrently. A restitution hearing is scheduled for July 21, 2025.
In February 2021, the Department of Health and Human Services, Licensing Division, referred a case to the Medicaid Fraud and Patient Abuse Division (Medicaid Fraud Division) at the Office of the Utah Attorney General including allegations that a Medicaid provider, Measures of Affect Theoretically Relative (MATR), had submitted claims to Medicaid for services which were not provided by qualified professionals and were documented in a fraudulent manner. MATR was a behavioral health company offering substance use disorder treatment. MATR had a residential treatment center in Mt. Pleasant and multiple offices in other areas of the state.
Holdaway, along with two other individuals, was responsible for submitting claims to Medicaid for services allegedly provided in all MATR locations. In total, over 7,700 claims were submitted to Medicaid throughout the period of March 11, 2019, through June 8, 2022, resulting in Medicaid funds in the amount of over $12.9 million being paid to MATR. None of these services would have been paid if the Utah Medicaid program had known that services had been provided by unqualified individuals and that falsified information had been entered into medical records, by Holdaway and others.
The Medicaid Fraud Division’s investigation also identified evidence of public assistance fraud. Records demonstrated that Holdaway received public assistance benefits for herself by failing to properly report her employment and income from MATR. Holdaway also assisted others in committing public assistance fraud. From September 2016, through February 2020, Holdaway received benefits in the form of SNAP, Special Payments, Financial Assistance, and/or Medical Assistance. In reality, Holdaway was the third highest paid worker at MATR, receiving compensation of over $1.36 million from January 2019, through August 2022. The Medicaid Fraud and Patient Abuse Division of the Utah Attorney General’s Office filed charges against Holdaway in March 2024.
Medicaid is a joint federal-state program that provides health coverage for low-income individuals and families. Medicaid is funded by a partnership between the federal government and state governments, primarily using taxpayer dollars. When asked about the effect of Medicaid fraud on the state of Utah, Kaye Lynn Wootton, Director of the Medicaid Fraud and Patient Abuse Division, stated, “Protecting the Medicaid program against fraud is critical given the limited resources available to provide care for this needy population. When fraudsters cause false claims to be paid by Medicaid, that reduces resources available to provide care to those who desperately need services. Often, as in this case, Medicaid fraud also means that although services were paid, the Medicaid patients who needed the services were neglected and went without the care they needed.”
Kaye Lynn Wootton and her team of investigators, auditors, nurses, attorneys, paralegals and support staff work diligently to hold those who commit Medicaid fraud accountable and to investigate and prosecute the abuse, neglect, and exploitation of vulnerable individuals. This mission would not be possible without the work of numerous state and federal partners. This case required support from policy experts at DHHS, federal agents from the U.S. Department of Health and Human Services – Office of Inspector General, investigators from DWS and the Assistant Attorneys General who support them, and ongoing support from the Utah Medicaid program (Division of Integrated Healthcare), and the Utah Office of Inspector General of Medicaid Services.
The Medicaid Fraud and Patient Abuse Division of the Office of the Utah Attorney General receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $3,925,631 for federal fiscal year 2025. The state of Utah funds the remaining 25 percent.
In March 2024, a Washington County licensed practical nurse pled guilty to Pattern of Unlawful Activity and Witness Tampering. The Defendant called in prescriptions using the name of a local doctor, giving the pharmacy the impression that medications had been lawfully prescribed. This created multiple instances of identity fraud. The defendant then approached a witness attempting to get him to sign a statement that was contrary to information previously submitted to law enforcement, leading to witness tampering.
In February 2024, a caregiver pled guilty to Abuse or Neglect of a Vulnerable Adult after admitting to lying about circumstances surrounding the disappearance of an autistic patient. In July 2023, the vulnerable individual went missing while under the care of Ms. Vahai. People searched diligently along the Jordan River Parkway after Ms. Vahai said that was where he was last seen. A MFCU investigation discovered, however, that Ms. Vahai had lied about where and how the vulnerable individual went missing, and that he had actually wandered off from the defendant’s home in Taylorsville. The disabled individual was found the following day, but the defendant’s actions had delayed this already dangerous, difficult situation.
In June 2023, a Beaver County woman was sentenced after pleading guilty to Exploitation of a Vulnerable Adult, a third-degree felony, for selling her grandfather’s home in California and then misusing the proceeds. MFCU agents found evidence that Ms. Ramirez used her grandfather’s money to buy a home in Beaver, did not put her grandfather’s name on the title, and eventually lost the home in foreclosure. Ms. Ramirez also transferred money out of her grandfather’s accounts and spent his money on herself. The grandfather ended up in a facility, dependent on Medicaid, with no retirement funds left. At sentencing, Judge Allen-McIff described the defendant’s actions as despicable.
In March 2023, a Salt Lake County eye surgeon pled guilty to Aggravated Assault and a Pattern of Unlawful Activity. Dr. Wyatt had previously been disciplined by DOPL for improper practices resulting in poor patient outcomes. After disciplinary actions in multiple states, Dr. Wyatt lost his surgical license. He continued, however, to perform operations which resulted in terrible outcomes. Some patients had to undergo additional procedures to solve problems, others experienced a partial loss of vision, and one even lost an eyeball. Dr. Wyatt pled guilty to two counts of third-degree unlawful/unprofessional conduct and two counts of third-degree aggravated assault and is currently serving his sentence in the Utah State Prison.
In March 2023, following an in-depth investigation conducted by MFCU and HHS-OIG agents, Summit Hospice agreed to pay over $1,000,000 to resolve allegations that they had violated the False Claims Act by submitting claims to Medicare and Medicaid for non-covered services. The allegations included claims of billing for services which were not medically necessary and failure to document terminal illnesses. Hospice is a special service intended to comfort terminally ill patients, but Medicaid and Medicare fraud occurs when hospice services seek reimbursement for patients who are not terminally ill.
