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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>54506</law_id><section_number>32.1-312</section_number><catch_line>Fraudulently obtaining excess or attempting to obtain excess benefits or payments; penalty</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>32.1-313</reference><reference>32.1-320</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="32.1">Health</unit><unit label="chapter" level="2" order_by="1" identifier="9">Regulation of Medical Assistance</unit><unit label="article" level="3" order_by="1" identifier="1">In General</unit></structure><text>
						<section id="A"><p><span class="prefix-number">A.</span> No <span class="dictionary">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 <span class="dictionary">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 &#xA7;&#xA0;<a class="law" title="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" href="/32.1-325/">32.1-325</a>, hereafter referred to as &#x201C;medical assistance&#x201D; in a greater amount than that to which entitled by: <a id="paragraph-200142" class="section-permalink" href="https://vacode.org/32.1-312/#A"><i class="fa fa-link"/></a></p></section>
						<section id="A1" class="indent-1"><p><span class="prefix-number">1.</span> Knowingly and willfully making or causing to be made any false statement or false representation of <span class="dictionary">material</span> <span class="dictionary">fact</span>; <a id="paragraph-200143" class="section-permalink" href="https://vacode.org/32.1-312/#A1"><i class="fa fa-link"/></a></p></section>
						<section id="A2" class="indent-1"><p><span class="prefix-number">2.</span> Knowingly and willfully concealing or causing to be concealed any <span class="dictionary">material</span> <span class="dictionary">facts</span>; or <a id="paragraph-200144" class="section-permalink" href="https://vacode.org/32.1-312/#A2"><i class="fa fa-link"/></a></p></section>
						<section id="A3" class="indent-1"><p><span class="prefix-number">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. <a id="paragraph-200145" class="section-permalink" href="https://vacode.org/32.1-312/#A3"><i class="fa fa-link"/></a></p></section>
						<section id="B"><p><span class="prefix-number">B.</span> Any <span class="dictionary">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 <span class="dictionary">law</span>, subject to civil penalties. The state <span class="dictionary">Attorney General</span> may <span class="dictionary">petition</span> the <span class="dictionary">circuit</span> <span class="dictionary">court</span> in the <span class="dictionary">jurisdiction</span> of the alleged <span class="dictionary">offense</span>, to seek an <span class="dictionary">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 <span class="dictionary">law</span>. <a id="paragraph-200146" class="section-permalink" href="https://vacode.org/32.1-312/#B"><i class="fa fa-link"/></a></p></section>
						<section id="C"><p><span class="prefix-number">C.</span> A criminal action need not be brought against a <span class="dictionary">person</span> for that <span class="dictionary">person</span> to be civilly liable under this section. <a id="paragraph-200147" class="section-permalink" href="https://vacode.org/32.1-312/#C"><i class="fa fa-link"/></a></p></section>
						<section id="D"><p><span class="prefix-number">D.</span> Civil penalties shall be deposited in the general fund of the state treasury upon their receipt. <a id="paragraph-200148" class="section-permalink" href="https://vacode.org/32.1-312/#D"><i class="fa fa-link"/></a></p></section>
						<section id="E"><p><span class="prefix-number">E.</span> A <span class="dictionary">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 <span class="dictionary">facts</span> <span class="dictionary">material</span> to the <span class="dictionary">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. <a id="paragraph-200149" class="section-permalink" href="https://vacode.org/32.1-312/#E"><i class="fa fa-link"/></a></p></section></text><history>1981, c. 255; 1984, c. 781; 2007, c. 569; 2010, c. 305.</history><metadata></metadata></law>
