Healthcare Regulatory & Qui Tam Defense Insurance in Virginia

Virginia at a glance

State false claims statute

Virginia Fraud Against Taxpayers Act

Authorizes private relator qui tam suits in circuit court, with its own award-percentage rules.

Civil audit authority

Department of Medical Assistance Services, Program Integrity division

Handles administrative billing audits and overpayment recovery, separate from criminal referral.

Fraud enforcement office

Attorney General's Medicaid Fraud Control Unit

Pursues criminal fraud and patient-abuse cases independent of DMAS recoupment.

Insurance regulator

Virginia State Corporation Commission, Bureau of Insurance

Confirm current licensing and filing guidance directly with the bureau.

The Fraud Against Taxpayers Act's relator standing

Virginia's Fraud Against Taxpayers Act authorizes a private relator to file a sealed qui tam complaint in circuit court, and the Attorney General's Office decides whether to intervene within a period defined by the statute. Virginia's relator award percentages and the specific circuit court venue rules differ from neighboring states, so counsel should confirm current figures rather than assume Virginia mirrors the federal statute's structure exactly.

DMAS Program Integrity and the Medicaid Fraud Control Unit operate on separate tracks

The Department of Medical Assistance Services runs a Program Integrity division that audits provider billing and recovers overpayments administratively, while the Attorney General's Medicaid Fraud Control Unit investigates and prosecutes criminal fraud and patient-abuse allegations. A Virginia provider negotiating a DMAS recoupment schedule should treat that as resolving the administrative claim only, since the Medicaid Fraud Control Unit can pursue a separate criminal referral on the same underlying conduct.

Diverse regional health systems across Northern Virginia, Richmond, and Hampton Roads

Virginia's healthcare enforcement activity spans three distinct regional clusters: the federal-contractor-adjacent systems of Northern Virginia, Richmond's academic and state-government-facing institutions, and Hampton Roads' military-health-adjacent providers, each of which brings a different referral-relationship profile to program-integrity review. Billing audits, exclusion-list screening, and documented review of referral and marketing arrangements remain the baseline controls across all three; restitution, fines, and knowing violations are not insurable regardless of region.

Confirm current relator-share rules and DMAS procedure with counsel

Virginia's qui tam relator-share percentages and DMAS Program Integrity referral thresholds are subject to periodic revision; confirm the current rules with counsel before relying on this page for an active matter.

Who we write this for in Virginia

Healthcare regulatory defense FAQs for Virginia