{"formats":[{"name":"JSON","format":"json","url":"\/downloads\/2025\/code-json\/38.2-3445.05.json"},{"name":"Plain Text","format":"text","url":"\/downloads\/2025\/code-text\/38.2-3445.05.txt"},{"name":"XML","format":"xml","url":"\/downloads\/2025\/code-xml\/38.2-3445.05.xml"},{"name":"HTML","format":"html","url":"\/downloads\/2025\/code-html\/38.2-3445.05.html"}],"law_id":67926,"edition_id":1,"section_id":67926,"structure_id":13819,"section_number":"38.2-3445.05","catch_line":"Enforcement","history":"2020, cc. 1080, 1081.","full_text":"A\n\nIf the Commission has cause to believe that any health care provider has engaged in a pattern of potential violations of &#xA7; 38.2-3445.01 with no corrective action, the Commission may submit information to the Board of Medicine or the Commissioner of Health for action. Prior to such submission, the Commission may provide the provider with an opportunity to cure the alleged violations or provide an explanation as to why the actions in question were not violations of &#xA7; 38.2-3445.01.B\n\nIf any health care provider has engaged in a pattern of potential violations of &#xA7; 38.2-3445.01 with no corrective action, the Board of Medicine or the Commissioner of Health may levy a fine or cost recovery upon the health care provider and take other action as permitted under the authority of the Board of Medicine or Commissioner of Health. Upon completion of its review of any potential violation submitted by the Commission or initiated directly by an enrollee, the Board of Medicine or Commissioner of Health shall notify the Commission of the results of the review, including whether the violation was substantiated and any enforcement action taken as a result of a finding of a substantiated violation.C\n\nIf a carrier has engaged in a pattern of substantiated violations of any provision of &#xA7; 38.2-3445.01, the Commission may levy a fine or apply remedies authorized pursuant to Chapter 2 (&#xA7; 38.2-200 et seq.).D\n\nNo carrier or provider shall initiate arbitration pursuant to &#xA7; 38.2-3445.02 with such frequency as to indicate a general business practice.","order_by":null,"text":{"0":{"id":246018,"text":"If the Commission has cause to believe that any health care provider has engaged in a pattern of potential violations of &#xA7; 38.2-3445.01 with no corrective action, the Commission may submit information to the Board of Medicine or the Commissioner of Health for action. Prior to such submission, the Commission may provide the provider with an opportunity to cure the alleged violations or provide an explanation as to why the actions in question were not violations of &#xA7; 38.2-3445.01.","type":"section","prefixes":["A"],"prefix":"A","entire_prefix":"A","prefix_anchor":"A","level":1,"next_prefix":"B"},"1":{"id":246019,"text":"If any health care provider has engaged in a pattern of potential violations of &#xA7; 38.2-3445.01 with no corrective action, the Board of Medicine or the Commissioner of Health may levy a fine or cost recovery upon the health care provider and take other action as permitted under the authority of the Board of Medicine or Commissioner of Health. Upon completion of its review of any potential violation submitted by the Commission or initiated directly by an enrollee, the Board of Medicine or Commissioner of Health shall notify the Commission of the results of the review, including whether the violation was substantiated and any enforcement action taken as a result of a finding of a substantiated violation.","type":"section","prefixes":["B"],"prefix":"B","entire_prefix":"B","prefix_anchor":"B","level":1,"prior_prefix":"A","next_prefix":"C"},"2":{"id":246020,"text":"If a carrier has engaged in a pattern of substantiated violations of any provision of &#xA7; 38.2-3445.01, the Commission may levy a fine or apply remedies authorized pursuant to Chapter 2 (&#xA7; 38.2-200 et seq.).","type":"section","prefixes":["C"],"prefix":"C","entire_prefix":"C","prefix_anchor":"C","level":1,"prior_prefix":"B","next_prefix":"D"},"3":{"id":246021,"text":"No carrier or provider shall initiate arbitration pursuant to &#xA7; 38.2-3445.02 with such frequency as to indicate a general business practice.","type":"section","prefixes":["D"],"prefix":"D","entire_prefix":"D","prefix_anchor":"D","level":1,"prior_prefix":"C"}},"ancestry":[{"id":13819,"edition_id":1,"name":"Federal Market Reforms","identifier":"6","label":"article","depth":3,"order_by":1,"parent_id":12993,"metadata":{},"date_created":"2026-06-26 03:45:59","date_modified":"2026-06-26 03:45:59","permalink":{"id":215457,"object_type":"structure","relational_id":13819,"identifier":"6","token":"38.2\/34\/6","url":"\/38.2\/34\/6\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12993,"edition_id":1,"name":"Provisions Relating to Accident and Sickness Insurance","identifier":"34","label":"chapter","depth":2,"order_by":1,"parent_id":12698,"metadata":{},"date_created":"2026-06-26 03:44:07","date_modified":"2026-06-26 03:44:07","permalink":{"id":214887,"object_type":"structure","relational_id":12993,"identifier":"34","token":"38.2\/34","url":"\/38.2\/34\/","edition_id":1,"permalink":0,"preferred":1}},{"id":12698,"edition_id":1,"name":"Insurance","identifier":"38.2","label":"title","depth":1,"order_by":1,"parent_id":null,"metadata":{},"date_created":"2026-06-26 03:43:49","date_modified":"2026-06-26 03:43:49","permalink":{"id":210661,"object_type":"structure","relational_id":12698,"identifier":"38.2","token":"38.2","url":"\/38.2\/","edition_id":1,"permalink":0,"preferred":1}}],"structure_contents":[{"id":57210,"structure_id":13819,"section_number":"38.2-3438","catch_line":"Definitions","url":"\/38.2-3438\/","token":"38.2\/34\/6\/38.2-3438","metadata":false},{"id":55902,"structure_id":13819,"section_number":"38.2-3439","catch_line":"Dependent coverage for individuals to age 26","url":"\/38.2-3439\/","token":"38.2\/34\/6\/38.2-3439","metadata":false},{"id":59514,"structure_id":13819,"section_number":"38.2-3440","catch_line":"Lifetime and annual limits","url":"\/38.2-3440\/","token":"38.2\/34\/6\/38.2-3440","metadata":false},{"id":74720,"structure_id":13819,"section_number":"38.2-3441","catch_line":"Rescissions","url":"\/38.2-3441\/","token":"38.2\/34\/6\/38.2-3441","metadata":false},{"id":81548,"structure_id":13819,"section_number":"38.2-3442","catch_line":"Preventive services","url":"\/38.2-3442\/","token":"38.2\/34\/6\/38.2-3442","metadata":false},{"id":54833,"structure_id":13819,"section_number":"38.2-3443","catch_line":"Choice of a health care professional","url":"\/38.2-3443\/","token":"38.2\/34\/6\/38.2-3443","metadata":false},{"id":68187,"structure_id":13819,"section_number":"38.2-3444","catch_line":"Preexisting condition exclusions","url":"\/38.2-3444\/","token":"38.2\/34\/6\/38.2-3444","metadata":false},{"id":60836,"structure_id":13819,"section_number":"38.2-3445","catch_line":"Patient access to emergency services","url":"\/38.2-3445\/","token":"38.2\/34\/6\/38.2-3445","metadata":false},{"id":57195,"structure_id":13819,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","url":"\/38.2-3445.01\/","token":"38.2\/34\/6\/38.2-3445.01","metadata":false},{"id":74656,"structure_id":13819,"section_number":"38.2-3445.02","catch_line":"Arbitration","url":"\/38.2-3445.02\/","token":"38.2\/34\/6\/38.2-3445.02","metadata":false},{"id":57491,"structure_id":13819,"section_number":"38.2-3445.03","catch_line":"Data sets for determining commercially reasonable payments","url":"\/38.2-3445.03\/","token":"38.2\/34\/6\/38.2-3445.03","metadata":false},{"id":55717,"structure_id":13819,"section_number":"38.2-3445.04","catch_line":"Transparency","url":"\/38.2-3445.04\/","token":"38.2\/34\/6\/38.2-3445.04","metadata":false},{"id":67926,"structure_id":13819,"section_number":"38.2-3445.05","catch_line":"Enforcement","url":"\/38.2-3445.05\/","token":"38.2\/34\/6\/38.2-3445.05","metadata":false},{"id":66467,"structure_id":13819,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","url":"\/38.2-3445.06\/","token":"38.2\/34\/6\/38.2-3445.06","metadata":false},{"id":72898,"structure_id":13819,"section_number":"38.2-3445.07","catch_line":"Rules and regulations","url":"\/38.2-3445.07\/","token":"38.2\/34\/6\/38.2-3445.07","metadata":false},{"id":68114,"structure_id":13819,"section_number":"38.2-3445.1","catch_line":"Repealed","url":"\/38.2-3445.1\/","token":"38.2\/34\/6\/38.2-3445.1","metadata":false},{"id":63588,"structure_id":13819,"section_number":"38.2-3445.2","catch_line":"Out-of-network claims; reporting requirements","url":"\/38.2-3445.2\/","token":"38.2\/34\/6\/38.2-3445.2","metadata":false},{"id":86937,"structure_id":13819,"section_number":"38.2-3446","catch_line":"Applicability of federal law","url":"\/38.2-3446\/","token":"38.2\/34\/6\/38.2-3446","metadata":false},{"id":66501,"structure_id":13819,"section_number":"38.2-3447","catch_line":"(Effective January 1, 2026) Restrictions relating to premium rates","url":"\/38.2-3447\/","token":"38.2\/34\/6\/38.2-3447","metadata":false},{"id":79799,"structure_id":13819,"section_number":"38.2-3448","catch_line":"Guaranteed availability","url":"\/38.2-3448\/","token":"38.2\/34\/6\/38.2-3448","metadata":false},{"id":78815,"structure_id":13819,"section_number":"38.2-3449","catch_line":"Prohibiting discrimination based on health status","url":"\/38.2-3449\/","token":"38.2\/34\/6\/38.2-3449","metadata":false},{"id":67706,"structure_id":13819,"section_number":"38.2-3449.1","catch_line":"Prohibited discrimination based on gender identity or status as a transgender individual","url":"\/38.2-3449.1\/","token":"38.2\/34\/6\/38.2-3449.1","metadata":false},{"id":64622,"structure_id":13819,"section_number":"38.2-3450","catch_line":"Genetic information and testing","url":"\/38.2-3450\/","token":"38.2\/34\/6\/38.2-3450","metadata":false},{"id":83154,"structure_id":13819,"section_number":"38.2-3451","catch_line":"Essential health benefits","url":"\/38.2-3451\/","token":"38.2\/34\/6\/38.2-3451","metadata":false},{"id":76537,"structure_id":13819,"section_number":"38.2-3452","catch_line":"Waiting periods","url":"\/38.2-3452\/","token":"38.2\/34\/6\/38.2-3452","metadata":false},{"id":86395,"structure_id":13819,"section_number":"38.2-3453","catch_line":"Clinical trials","url":"\/38.2-3453\/","token":"38.2\/34\/6\/38.2-3453","metadata":false},{"id":81951,"structure_id":13819,"section_number":"38.2-3454","catch_line":"Wellness programs","url":"\/38.2-3454\/","token":"38.2\/34\/6\/38.2-3454","metadata":false},{"id":84250,"structure_id":13819,"section_number":"38.2-3454.1","catch_line":"Renewal of health benefit plans; special exception","url":"\/38.2-3454.1\/","token":"38.2\/34\/6\/38.2-3454.1","metadata":false}],"previous_section":{"id":55717,"structure_id":13819,"section_number":"38.2-3445.04","catch_line":"Transparency","url":"\/38.2-3445.04\/","token":"38.2\/34\/6\/38.2-3445.04","metadata":false},"next_section":{"id":66467,"structure_id":13819,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","url":"\/38.2-3445.06\/","token":"38.2\/34\/6\/38.2-3445.06","metadata":false},"metadata":false,"official_url":"https:\/\/law.lis.virginia.gov\/vacode\/38.2-3445.05\/","history_text":"<p>This law was first created in 2020. The record of its establishment is cataloged in chapters <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?201+ful+CHAP1080\">1080<\/a> and <a href=\"https:\/\/legacylis.virginia.gov\/cgi-bin\/legp604.exe?201+ful+CHAP1081\">1081<\/a> 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.<\/p>","references":[{"id":66467,"section_number":"38.2-3445.06","catch_line":"Applicability of certain sections","order_by":null,"url":"\/38.2-3445.06\/"}],"refers_to":[{"id":84875,"section_number":"38.2-200","catch_line":"General powers of the Commission relative to insurance","order_by":null,"url":"\/38.2-200\/"},{"id":57195,"section_number":"38.2-3445.01","catch_line":"Balance billing for certain services; prohibited","order_by":null,"url":"\/38.2-3445.01\/"},{"id":74656,"section_number":"38.2-3445.02","catch_line":"Arbitration","order_by":null,"url":"\/38.2-3445.02\/"}],"permalink":{"id":215507,"object_type":"law","relational_id":67926,"identifier":"38.2-3445.05","token":"38.2\/34\/6\/38.2-3445.05","url":"\/38.2-3445.05\/","edition_id":1,"permalink":0,"preferred":1},"url":"\/38.2-3445.05\/","token":"38.2\/34\/6\/38.2-3445.05","dublin_core":{"Title":"Enforcement","Type":"Text","Format":"text\/html","Identifier":"\u00a7 38.2-3445.05","Relation":"Code of Virginia"},"html":"\n\t\t\t\t\t\t<section id=\"A\"><p><span class=\"prefix-number\">A.<\/span> If the <span class=\"dictionary\">Commission<\/span> has cause to believe that any health care provider has engaged in a pattern of potential violations of &#xA7; <a class=\"law\" title=\"Balance billing for certain services; prohibited\" href=\"\/38.2-3445.01\/\">38.2-3445.01<\/a> with no corrective action, the <span class=\"dictionary\">Commission<\/span> may submit information to the Board of Medicine or the <span class=\"dictionary\">Commissioner<\/span> of Health for action. Prior to such submission, the <span class=\"dictionary\">Commission<\/span> may provide the provider with an opportunity to cure the alleged violations or provide an explanation as to why the actions in question were not violations of &#xA7; <a class=\"law\" title=\"Balance billing for certain services; prohibited\" href=\"\/38.2-3445.01\/\">38.2-3445.01<\/a>. <a id=\"paragraph-246018\" class=\"section-permalink\" href=\"https:\/\/vacode.org\/38.2-3445.05\/#A\"><i class=\"fa fa-link\"><\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t<section id=\"B\"><p><span class=\"prefix-number\">B.<\/span> If any health care provider has engaged in a pattern of potential violations of &#xA7; <a class=\"law\" title=\"Balance billing for certain services; prohibited\" href=\"\/38.2-3445.01\/\">38.2-3445.01<\/a> with no corrective action, the Board of Medicine or the <span class=\"dictionary\">Commissioner<\/span> of Health may <span class=\"dictionary\">levy<\/span> a fine or cost recovery upon the health care provider and take other action as permitted under the authority of the Board of Medicine or <span class=\"dictionary\">Commissioner<\/span> of Health. Upon completion of its review of any potential violation submitted by the <span class=\"dictionary\">Commission<\/span> or initiated directly by an enrollee, the Board of Medicine or <span class=\"dictionary\">Commissioner<\/span> of Health shall notify the <span class=\"dictionary\">Commission<\/span> of the results of the review, including whether the violation was substantiated and any enforcement action taken as a result of a <span class=\"dictionary\">finding<\/span> of a substantiated violation. <a id=\"paragraph-246019\" class=\"section-permalink\" href=\"https:\/\/vacode.org\/38.2-3445.05\/#B\"><i class=\"fa fa-link\"><\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t<section id=\"C\"><p><span class=\"prefix-number\">C.<\/span> If a carrier has engaged in a pattern of substantiated violations of any provision of &#xA7; <a class=\"law\" title=\"Balance billing for certain services; prohibited\" href=\"\/38.2-3445.01\/\">38.2-3445.01<\/a>, the <span class=\"dictionary\">Commission<\/span> may <span class=\"dictionary\">levy<\/span> a fine or apply remedies authorized pursuant to Chapter 2 (&#xA7; <a class=\"law\" title=\"General powers of the Commission relative to insurance\" href=\"\/38.2-200\/\">38.2-200<\/a> et seq.). <a id=\"paragraph-246020\" class=\"section-permalink\" href=\"https:\/\/vacode.org\/38.2-3445.05\/#C\"><i class=\"fa fa-link\"><\/i><\/a><\/p><\/section>\n\t\t\t\t\t\t<section id=\"D\"><p><span class=\"prefix-number\">D.<\/span> No carrier or provider shall initiate arbitration pursuant to &#xA7; <a class=\"law\" title=\"Arbitration\" href=\"\/38.2-3445.02\/\">38.2-3445.02<\/a> with such frequency as to indicate a general business practice. <a id=\"paragraph-246021\" class=\"section-permalink\" href=\"https:\/\/vacode.org\/38.2-3445.05\/#D\"><i class=\"fa fa-link\"><\/i><\/a><\/p><\/section>","plain_text":"                                 CODE OF VIRGINIA\n\nENFORCEMENT (\u00a7 38.2-3445.05)\n\nA. If the Commission has cause to believe that any health care provider has\nengaged in a pattern of potential violations of &#xA7; 38.2-3445.01 with no\ncorrective action, the Commission may submit information to the Board of\nMedicine or the Commissioner of Health for action. Prior to such submission, the\nCommission may provide the provider with an opportunity to cure the alleged\nviolations or provide an explanation as to why the actions in question were not\nviolations of &#xA7; 38.2-3445.01.\n\nB. If any health care provider has engaged in a pattern of potential violations\nof &#xA7; 38.2-3445.01 with no corrective action, the Board of Medicine or the\nCommissioner of Health may levy a fine or cost recovery upon the health care\nprovider and take other action as permitted under the authority of the Board of\nMedicine or Commissioner of Health. Upon completion of its review of any\npotential violation submitted by the Commission or initiated directly by an\nenrollee, the Board of Medicine or Commissioner of Health shall notify the\nCommission of the results of the review, including whether the violation was\nsubstantiated and any enforcement action taken as a result of a finding of a\nsubstantiated violation.\n\nC. If a carrier has engaged in a pattern of substantiated violations of any\nprovision of &#xA7; 38.2-3445.01, the Commission may levy a fine or apply\nremedies authorized pursuant to Chapter 2 (&#xA7; 38.2-200 et seq.).\n\nD. No carrier or provider shall initiate arbitration pursuant to &#xA7;\n38.2-3445.02 with such frequency as to indicate a general business practice.\n\nHISTORY: 2020, cc. 1080, 1081.","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}}