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1995 SESSION

LD8124828
SENATE BILL NO. 333
Offered January 25, 1994
A BILL to amend the Code of Virginia by adding a section numbered 18.2-213.2, relating to health care fraud; penalty.
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Patrons--Holland, E.M., Andrews, Holland, C.A., Lambert, Schewel, Walker and Woods; Delegates: Ball, Brickley, Connally, DeBoer, Heilig, Melvin and Morgan
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Referred to the Committee for Courts of Justice
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Be it enacted by the General Assembly of Virginia:

1. That the Code of Virginia is amended by adding a section numbered 18.2-213.2 as follows:

§ 18.2-213.2. Health care fraud.

A. No person on behalf of himself or another person or legal entity shall:

1. Knowingly and willfully make or cause to be made any false statement or representation of a material fact in any application for any payment from an insurer pursuant to an insurance policy as described in § 38.2-3400 or from a governmental entity pursuant to any local, state or federal government program which makes payments for health care services, or to knowingly and willfully falsify, conceal or cover up any trick, scheme or device employed in connection with such application;

2. Knowingly and willfully make or cause to be made any false statement or representation of a material fact for use by the insurer or governmental entity in determining rights to such payment or to knowingly and willfully falsify, conceal or cover up any trick, scheme or device employed in connection with determination of such rights by the insurer or governmental entity; or

3. When having knowledge of the occurrence of any event or circumstance materially affecting the initial or continued right to any payment or payments, willfully conceal or fail to disclose such event or circumstance with an intent to fraudulently procure such payment either in a greater amount or frequency than it is due or when no payment is due whatsoever.

B. Any person who violates any provisions of this section, irrespective of whether he receives any benefits or payments, shall be guilty of a Class 1 misdemeanor. However, if such person receives benefits or payments valued at $200 or more in a six-month period, he shall be guilty of a Class 5 felony. In addition, the court may order restitution to the insurer or government program in an amount equal to the benefits and payments fraudulently obtained plus reasonable attorney's fees, investigative costs and interest from the date of the order at the rate of interest set forth in § 6.1-330.54. The amount of benefits and payments fraudulently obtained shall be determined by an audit of all pertinent records.

2. That the provisions of this act may result in a net increase in periods of imprisonment in state correctional facilities. Pursuant to § 30-19.1:4, the estimated amount of the necessary appropriation is $ 250,000.