32.1-312 - Fraudulently obtaining excess or attempting to obtain excess benefits or payments; penalty. - Virginia Statutes

§ 32.1-312. Fraudulently obtaining excess or attempting to obtain excessbenefits or payments; penalty.

A. No person, agency or institution, but not including an individual medicalassistance recipient of health care, on behalf of himself or others, whetherunder a contract or otherwise, shall obtain or attempt to obtain benefits orpayments where the Commonwealth directly or indirectly provides any portionof the benefits or payments pursuant to the Plan for Medical Assistance andany amendments thereto as provided for in § 32.1-325, hereafter referred toas "medical assistance" in a greater amount than that to which entitled by:

1. Knowingly and willfully making or causing to be made any false statementor false representation of material fact;

2. Knowingly and willfully concealing or causing to be concealed any materialfacts; or

3. 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 asubstitution or misrepresentation of items billed.

B. Any person, agency or institution knowingly and willfully violating any ofthe provisions of subsection A shall be (i) liable for repayment of anyexcess benefits or payments received, plus interest on the amount of theexcess benefits or payments at the rate of 1.5 percent each month for theperiod from the date upon which payment was made to the date upon whichrepayment is made to the Commonwealth and (ii) in addition to any otherpenalties provided by law, subject to civil penalties. The state AttorneyGeneral may petition the circuit court in the jurisdiction of the allegedoffense, to seek an order assessing civil penalties in an amount not toexceed three times the amount of such excess benefits or payments. Such civilpenalties shall not apply to any acts or omissions occurring prior to theeffective date of this law.

C. A criminal action need not be brought against a person for that person tobe civilly liable under this section.

D. Civil penalties shall be deposited in the general fund of the statetreasury upon their receipt.

E. A civil action under this section shall be brought (i) within six years ofthe date on which the violation was committed, or (ii) within three years ofthe date when an official of the Commonwealth charged with the responsibilityto act in the circumstances discovered or reasonably should have discoveredthe facts material to the cause of action. However, in no event shall thelimitations period extend more than 10 years from the date on which theviolation was committed.

(1981, c. 255; 1984, c. 781; 2007, c. 569; 2010, c. 305.)