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1995 SESSION
LD0935828Patrons--Holland, C.A., Holland, E.M., Lambert, Schewel, Stolle, Walker and Woods; Delegates: Ball, Brickley, Connally, DeBoer, Forbes, Heilig, Melvin and Morgan
Be it enacted by the General Assembly of Virginia:
1. That § 18.2-213.23 of the Code of Virginia is amended and reenacted as follows:
§ 18.2-213.23. Health care fraud by insurer.
No person, insurer, insurance company, or health services plan as defined
in § 38.2-100 shall [ knowingly and willfully with the
intent to defraud ] make or cause to be made any false statement or
representation of a material fact in any communication or explanation of
benefits or payments due an insured pursuant to an insurance policy as
described in § 38.2-3400.
Any person, insurer, insurance company or health services plan that
violates this section shall be guilty of a Class 1 misdemeanor. However, if
the person, insurer, insurance company or health services plan violates this
section [ with such frequency as to indicate through
] a fraudulent scheme or business practice, it shall be guilty of a Class
5 felony. In addition to the penalty provided herein, the court may [
(i) order restitution to the insured or insureds in an amount equal to
the benefits and payments wrongfully withheld 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 and (ii) ] fashion an
appropriate equitable remedy for all parties adversely affected by a
violation of this section.