{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/32.1-312.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/32.1-312.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/32.1-312.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/32.1-312.html"}],"law_id":54506,"edition_id":1,"section_id":54506,"structure_id":13438,"section_number":"32.1-312","catch_line":"Fraudulently obtaining excess or attempting to obtain excess benefits or payments; penalty","history":"1981, c. 255; 1984, c. 781; 2007, c. 569; 2010, c. 305.","full_text":"A\n\nNo person, agency or institution, but not including an individual medical assistance recipient of health care, on behalf of himself or others, whether under a contract or otherwise, shall obtain or attempt to obtain benefits or payments where the Commonwealth directly or indirectly provides any portion of the benefits or payments pursuant to the Plan for Medical Assistance and any amendments thereto as provided for in \u00a7 32.1-325, hereafter referred to as “medical assistance” in a greater amount than that to which entitled by:1\n\nKnowingly and willfully making or causing to be made any false statement or false representation of material fact;2\n\nKnowingly and willfully concealing or causing to be concealed any material facts; or3\n\nKnowingly and willfully engaging in any fraudulent scheme or device, including, but not limited to, submitting a claim for services, drugs, supplies or equipment that were unfurnished or were of a lower quality, or a substitution or misrepresentation of items billed.B\n\nAny person, agency or institution knowingly and willfully violating any of the provisions of subsection A shall be (i) liable for repayment of any excess benefits or payments received, plus interest on the amount of the excess benefits or payments at the rate of 1.5 percent each month for the period from the date upon which payment was made to the date upon which repayment is made to the Commonwealth and (ii) in addition to any other penalties provided by law, subject to civil penalties. The state Attorney General may petition the circuit court in the jurisdiction of the alleged offense, to seek an order assessing civil penalties in an amount not to exceed three times the amount of such excess benefits or payments. Such civil penalties shall not apply to any acts or omissions occurring prior to the effective date of this law.C\n\nA criminal action need not be brought against a person for that person to be civilly liable under this section.D\n\nCivil penalties shall be deposited in the general fund of the state treasury upon their receipt.E\n\nA civil action under this section shall be brought (i) within six years of the date on which the violation was committed, or (ii) within three years of the date when an official of the Commonwealth charged with the responsibility to act in the circumstances discovered or reasonably should have discovered the facts material to the cause of action. However, in no event shall the limitations period extend more than 10 years from the date on which the violation was committed.","order_by":null,"text":{"0":{"id":200142,"text":"No person, agency or institution, but not including an individual medical assistance recipient of health care, on behalf of himself or others, whether under a contract or otherwise, shall obtain or attempt to obtain benefits or payments where the Commonwealth directly or indirectly provides any portion of the benefits or payments pursuant to the Plan for Medical Assistance and any amendments thereto as provided for in \u00a7 32.1-325, hereafter referred to as “medical assistance” in a greater amount than that to which entitled by:","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"A1"},"1":{"id":200143,"text":"Knowingly and willfully making or causing to be made any false statement or false representation of material fact;","type":"section","prefixes":["A","1"],"prefix":"1","entire_prefix":"A1","prefix_anchor":"A1","level":2,"prior_prefix":"A","next_prefix":"A2"},"2":{"id":200144,"text":"Knowingly and willfully concealing or causing to be concealed any material facts; or","type":"section","prefixes":["A","2"],"prefix":"2","entire_prefix":"A2","prefix_anchor":"A2","level":2,"prior_prefix":"A1","next_prefix":"A3"},"3":{"id":200145,"text":"Knowingly and willfully engaging in any fraudulent scheme or device, including, but not limited to, submitting a claim for services, drugs, supplies or equipment that were unfurnished or were of a lower quality, or a substitution or misrepresentation of items billed.","type":"section","prefixes":["A","3"],"prefix":"3","entire_prefix":"A3","prefix_anchor":"A3","level":2,"prior_prefix":"A2","next_prefix":"B"},"4":{"id":200146,"text":"Any person, agency or institution knowingly and willfully violating any of the provisions of subsection A shall be (i) liable for repayment of any excess benefits or payments received, plus interest on the amount of the excess benefits or payments at the rate of 1.5 percent each month for the period from the date upon which payment was made to the date upon which repayment is made to the Commonwealth and (ii) in addition to any other penalties provided by law, subject to civil penalties. The state Attorney General may petition the circuit court in the jurisdiction of the alleged offense, to seek an order assessing civil penalties in an amount not to exceed three times the amount of such excess benefits or payments. Such civil penalties shall not apply to any acts or omissions occurring prior to the effective date of this law.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A3","next_prefix":"C"},"5":{"id":200147,"text":"A criminal action need not be brought against a person for that person to be civilly liable under this section.","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"6":{"id":200148,"text":"Civil penalties shall be deposited in the general fund of the state treasury upon their receipt.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C","next_prefix":"E"},"7":{"id":200149,"text":"A civil action under this section shall be brought (i) within six years of the date on which the violation was committed, or (ii) within three years of the date when an official of the Commonwealth charged with the responsibility to act in the circumstances discovered or reasonably should have discovered the facts material to the cause of action. However, in no event shall the limitations period extend more than 10 years from the date on which the violation was committed.","type":"section","prefixes":["E"],"prefix":"E","entire_prefix":"E","prefix_anchor":"E","level":1,"prior_prefix":"D"}},"ancestry":[{"id":13438,"edition_id":1,"name":"In General","identifier":"1","label":"article","depth":3,"order_by":1,"parent_id":13437,"metadata":{},"date_created":"2026-06-26 03:44:53","date_modified":"2026-06-26 03:44:53","permalink":{"id":204701,"object_type":"structure","relational_id":13438,"identifier":"1","token":"32.1\/9\/1","url":"\/32.1\/9\/1\/","edition_id":1,"permalink":0,"preferred":1}},{"id":13437,"edition_id":1,"name":"Regulation of Medical Assistance","identifier":"9","label":"chapter","depth":2,"order_by":1,"parent_id":12727,"metadata":{},"date_created":"2026-06-26 03:44:53","date_modified":"2026-06-26 03:44:53","permalink":{"id":204699,"object_type":"structure","relational_id":13437,"identifier":"9","token":"32.1\/9","url":"\/32.1\/9\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12727,"edition_id":1,"name":"Health","identifier":"32.1","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:50","date_modified":"2026-06-26 03:43:50","permalink":{"id":201099,"object_type":"structure","relational_id":12727,"identifier":"32.1","token":"32.1","url":"\/32.1\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":85954,"structure_id":13438,"section_number":"32.1-310","catch_line":"Declaration of purpose; authority to audit records; authority to review complaints of abuse or neglect","url":"\/32.1-310\/","token":"32.1\/9\/1\/32.1-310","metadata":false},{"id":70907,"structure_id":13438,"section_number":"32.1-311","catch_line":"Repealed","url":"\/32.1-311\/","token":"32.1\/9\/1\/32.1-311","metadata":false},{"id":54506,"structure_id":13438,"section_number":"32.1-312","catch_line":"Fraudulently obtaining excess or attempting to obtain excess benefits or payments; penalty","url":"\/32.1-312\/","token":"32.1\/9\/1\/32.1-312","metadata":false},{"id":78625,"structure_id":13438,"section_number":"32.1-313","catch_line":"Liability for excess benefits or payments obtained without intent to violate chapter","url":"\/32.1-313\/","token":"32.1\/9\/1\/32.1-313","metadata":false},{"id":63947,"structure_id":13438,"section_number":"32.1-314","catch_line":"False statement or representation in applications for payment or for use in determining rights to payment; concealment of facts; penalty","url":"\/32.1-314\/","token":"32.1\/9\/1\/32.1-314","metadata":false},{"id":70472,"structure_id":13438,"section_number":"32.1-315","catch_line":"Solicitation or receipt of remuneration for certain services; offer or payment of remuneration for inducement of such services; penalty","url":"\/32.1-315\/","token":"32.1\/9\/1\/32.1-315","metadata":false},{"id":65811,"structure_id":13438,"section_number":"32.1-316","catch_line":"False statement or representation as to conditions or operations of institution or facility; penalty","url":"\/32.1-316\/","token":"32.1\/9\/1\/32.1-316","metadata":false},{"id":63268,"structure_id":13438,"section_number":"32.1-317","catch_line":"Collecting excess payment for services; charging, soliciting, accepting or receiving certain consideration as precondition for admittance to facility or requirement for continued stay; penalty","url":"\/32.1-317\/","token":"32.1\/9\/1\/32.1-317","metadata":false},{"id":69423,"structure_id":13438,"section_number":"32.1-318","catch_line":"Knowing failure to deposit, transfer or maintain patient trust funds in separate account; penalty","url":"\/32.1-318\/","token":"32.1\/9\/1\/32.1-318","metadata":false},{"id":71136,"structure_id":13438,"section_number":"32.1-319","catch_line":"Written verification of application, statement or form; penalty for false or misleading information","url":"\/32.1-319\/","token":"32.1\/9\/1\/32.1-319","metadata":false},{"id":54400,"structure_id":13438,"section_number":"32.1-319.1","catch_line":"Department to establish pilot program to use data analytics to mitigate risk of improper payments","url":"\/32.1-319.1\/","token":"32.1\/9\/1\/32.1-319.1","metadata":false},{"id":73899,"structure_id":13438,"section_number":"32.1-320","catch_line":"Duties of Attorney General; medical services providers audit and investigation unit","url":"\/32.1-320\/","token":"32.1\/9\/1\/32.1-320","metadata":false},{"id":60362,"structure_id":13438,"section_number":"32.1-320.1","catch_line":"Powers and duties of sworn unit investigators","url":"\/32.1-320.1\/","token":"32.1\/9\/1\/32.1-320.1","metadata":false},{"id":81672,"structure_id":13438,"section_number":"32.1-321","catch_line":"Prosecution of cases","url":"\/32.1-321\/","token":"32.1\/9\/1\/32.1-321","metadata":false},{"id":72394,"structure_id":13438,"section_number":"32.1-321.01","catch_line":"Exemptions from disclosure","url":"\/32.1-321.01\/","token":"32.1\/9\/1\/32.1-321.01","metadata":false}],"previous_section":{"id":70907,"structure_id":13438,"section_number":"32.1-311","catch_line":"Repealed","url":"\/32.1-311\/","token":"32.1\/9\/1\/32.1-311","metadata":false},"next_section":{"id":78625,"structure_id":13438,"section_number":"32.1-313","catch_line":"Liability for excess benefits or payments obtained without intent to violate chapter","url":"\/32.1-313\/","token":"32.1\/9\/1\/32.1-313","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/32.1-312\/","history_text":"

This law was first created in 1981. The record of its establishment is cataloged in chapter 255 of that year\u2019s edition of \u201cActs of Assembly,\u201d the annual state publication listing all changes made to the Code of Virginia in that year. Unfortunately, the 1981 \u201cActs\u201d aren\u2019t available online. It has been modified 3 times. Those modifications are cataloged by \u201cThe Acts of Assembly,\u201d a state publication, by year and chapter. Those modifications that can be read on the General Assembly\u2019s website will be linked accordingly. Those modifications are as follows: in 1984, chapter 781; in 2007, chapter 569<\/a>; in 2010, chapter 305<\/a>.<\/p>","references":[{"id":78625,"section_number":"32.1-313","catch_line":"Liability for excess benefits or payments obtained without intent to violate chapter","order_by":null,"url":"\/32.1-313\/"},{"id":73899,"section_number":"32.1-320","catch_line":"Duties of Attorney General; medical services providers audit and investigation unit","order_by":null,"url":"\/32.1-320\/"}],"refers_to":[{"id":77747,"section_number":"32.1-325","catch_line":"Board to submit plan for medical assistance services to U.S. Secretary of Health and Human Services pursuant to federal law; administration of plan; contracts with health care providers","order_by":null,"url":"\/32.1-325\/"}],"permalink":{"id":204711,"object_type":"law","relational_id":54506,"identifier":"32.1-312","token":"32.1\/9\/1\/32.1-312","url":"\/32.1-312\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/32.1-312\/","token":"32.1\/9\/1\/32.1-312","dublin_core":{"Title":"Fraudulently obtaining excess or attempting to obtain excess benefits or payments; penalty","Type":"Text","Format":"text\/html","Identifier":"\u00a7 32.1-312","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t

A.<\/span> No person<\/span>, agency or institution, but not including an individual medical assistance recipient of health care, on behalf of himself or others, whether under a contract<\/span> or otherwise, shall obtain or attempt to obtain benefits or payments where the Commonwealth directly or indirectly provides any portion of the benefits or payments pursuant to the Plan for Medical Assistance and any amendments thereto as provided for in \u00a7 32.1-325<\/a>, hereafter referred to as “medical assistance” in a greater amount than that to which entitled by: <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

1.<\/span> Knowingly and willfully making or causing to be made any false statement or false representation of material<\/span> fact<\/span>; <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

2.<\/span> Knowingly and willfully concealing or causing to be concealed any material<\/span> facts<\/span>; or <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

3.<\/span> Knowingly and willfully engaging in any fraudulent scheme or device, including, but not limited to, submitting a claim for services, drugs, supplies or equipment that were unfurnished or were of a lower quality, or a substitution or misrepresentation of items billed. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

B.<\/span> Any person<\/span>, agency or institution knowingly and willfully violating any of the provisions of subsection A shall be (i) liable for repayment of any excess benefits or payments received, plus interest on the amount of the excess benefits or payments at the rate of 1.5 percent each month for the period from the date upon which payment was made to the date upon which repayment is made to the Commonwealth and (ii) in addition to any other penalties provided by law<\/span>, subject to civil penalties. The state Attorney General<\/span> may petition<\/span> the circuit<\/span> court<\/span> in the jurisdiction<\/span> of the alleged offense<\/span>, to seek an order<\/span> assessing civil penalties in an amount not to exceed three times the amount of such excess benefits or payments. Such civil penalties shall not apply to any acts or omissions occurring prior to the effective date of this law<\/span>. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

C.<\/span> A criminal action need not be brought against a person<\/span> for that person<\/span> to be civilly liable under this section. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

D.<\/span> Civil penalties shall be deposited in the general fund of the state treasury upon their receipt. <\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t

E.<\/span> A civil action<\/span> under this section shall be brought (i) within six years of the date on which the violation was committed, or (ii) within three years of the date when an official of the Commonwealth charged with the responsibility to act in the circumstances discovered or reasonably should have discovered the facts<\/span> material<\/span> to the cause of action<\/span>. However, in no event shall the limitations period extend more than 10 years from the date on which the violation was committed. <\/i><\/a><\/p><\/section>","plain_text":" CODE OF VIRGINIA\n\nFRAUDULENTLY OBTAINING EXCESS OR ATTEMPTING TO OBTAIN EXCESS BENEFITS OR\nPAYMENTS; PENALTY (\u00a7 32.1-312)\n\nA. No person, agency or institution, but not including an individual medical\nassistance recipient of health care, on behalf of himself or others, whether\nunder a contract or otherwise, shall obtain or attempt to obtain benefits or\npayments where the Commonwealth directly or indirectly provides any portion of\nthe benefits or payments pursuant to the Plan for Medical Assistance and any\namendments thereto as provided for in \u00a7 32.1-325, hereafter referred to as\n“medical assistance” in a greater amount than that to which entitled\nby:\n\n 1. Knowingly and willfully making or causing to be made any false statement or\n false representation of material fact;\n\n 2. Knowingly and willfully concealing or causing to be concealed any material\n facts; or\n\n 3. Knowingly and willfully engaging in any fraudulent scheme or device,\n including, but not limited to, submitting a claim for services, drugs,\n supplies or equipment that were unfurnished or were of a lower quality, or a\n substitution or misrepresentation of items billed.\n\nB. Any person, agency or institution knowingly and willfully violating any of\nthe provisions of subsection A shall be (i) liable for repayment of any excess\nbenefits or payments received, plus interest on the amount of the excess\nbenefits or payments at the rate of 1.5 percent each month for the period from\nthe date upon which payment was made to the date upon which repayment is made to\nthe Commonwealth and (ii) in addition to any other penalties provided by law,\nsubject to civil penalties. The state Attorney General may petition the circuit\ncourt in the jurisdiction of the alleged offense, to seek an order assessing\ncivil penalties in an amount not to exceed three times the amount of such excess\nbenefits or payments. Such civil penalties shall not apply to any acts or\nomissions occurring prior to the effective date of this law.\n\nC. A criminal action need not be brought against a person for that person to be\ncivilly liable under this section.\n\nD. Civil penalties shall be deposited in the general fund of the state treasury\nupon their receipt.\n\nE. A civil action under this section shall be brought (i) within six years of\nthe date on which the violation was committed, or (ii) within three years of the\ndate when an official of the Commonwealth charged with the responsibility to act\nin the circumstances discovered or reasonably should have discovered the facts\nmaterial to the cause of action. However, in no event shall the limitations\nperiod extend more than 10 years from the date on which the violation was\ncommitted.\n\nHISTORY: 1981, c. 255; 1984, c. 781; 2007, c. 569; 2010, c. 305.","edition":{"id":1,"name":"2025","slug":"2025","date_created":"2026-06-21 22:39:22","date_modified":"2026-06-21 22:39:22","current":1,"order_by":1,"last_import":null}}