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<law><site_title>Virginia Decoded</site_title><site_url>https://vacode.org</site_url><law_id>67926</law_id><section_number>38.2-3445.05</section_number><catch_line>Enforcement</catch_line><edition url="https://vacode.org/2025/" slug="2025" current="TRUE" last_updated="">2025</edition><referred_to_by><reference>38.2-3445.06</reference></referred_to_by><structure><unit label="title" level="1" order_by="1" identifier="38.2">Insurance</unit><unit label="chapter" level="2" order_by="1" identifier="34">Provisions Relating to Accident and Sickness Insurance</unit><unit label="article" level="3" order_by="1" identifier="6">Federal Market Reforms</unit></structure><text>
						<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"/></a></p></section>
						<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"/></a></p></section>
						<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"/></a></p></section>
						<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"/></a></p></section></text><history>2020, cc. 1080, 1081.</history><metadata></metadata></law>
