HB0071 EnrolledLRB098 02586 KTG 32591 b

1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Sections 8A-2.5, 8A-13, and 8A-15 as follows:
 
6    (305 ILCS 5/8A-2.5)
7    Sec. 8A-2.5. Unauthorized use of medical assistance.
8    (a) Any person who knowingly uses, acquires, possesses, or
9transfers a medical card in any manner not authorized by law or
10by rules and regulations of the Illinois Department, or who
11knowingly alters a medical card, or who knowingly uses,
12acquires, possesses, or transfers an altered medical card, is
13guilty of a violation of this Article and shall be punished as
14provided in Section 8A-6.
15    (b) Any person who knowingly obtains unauthorized medical
16benefits or causes to be obtained unauthorized medical benefits
17with or without use of a medical card is guilty of a violation
18of this Article and shall be punished as provided in Section
198A-6.
20    (b-5) Any vendor that knowingly assists a person in
21committing a violation under subsection (a) or (b) of this
22Section is guilty of a violation of this Article and shall be
23punished as provided in Section 8A-6.

 

 

HB0071 Enrolled- 2 -LRB098 02586 KTG 32591 b

1    (b-6) Any person (including a vendor, organization,
2agency, or other entity) that, in any matter related to the
3medical assistance program, knowingly or willfully falsifies,
4conceals, or omits by any trick, scheme, artifice, or device a
5material fact, or makes any false, fictitious, or fraudulent
6statement or representation, or makes or uses any false writing
7or document, knowing the same to contain any false, fictitious,
8or fraudulent statement or entry in connection with the
9provision of health care or related services, is guilty of a
10violation of this Article and shall be punished as provided in
11Section 8A-6.
12    (c) The Department may seek to recover any and all State
13and federal monies for which it has improperly and erroneously
14paid benefits as a result of a fraudulent action and any civil
15penalties authorized in this Section. Pursuant to Section
1611-14.5 of this Code, the Department may determine the monetary
17value of benefits improperly and erroneously received. The
18Department may recover the monies paid for such benefits and
19interest on that amount at the rate of 5% per annum for the
20period from which payment was made to the date upon which
21repayment is made to the State. Prior to the recovery of any
22amount paid for benefits allegedly obtained by fraudulent
23means, the recipient or payee of such benefits shall be
24afforded an opportunity for a hearing after reasonable notice.
25The notice shall be served personally or by certified or
26registered mail or as otherwise provided by law upon the

 

 

HB0071 Enrolled- 3 -LRB098 02586 KTG 32591 b

1parties or their agents appointed to receive service of process
2and shall include the following:
3        (1) A statement of the time, place and nature of the
4    hearing.
5        (2) A statement of the legal authority and jurisdiction
6    under which the hearing is to be held.
7        (3) A reference to the particular Sections of the
8    substantive and procedural statutes and rules involved.
9        (4) Except where a more detailed statement is otherwise
10    provided for by law, a short and plain statement of the
11    matters asserted, the consequences of a failure to respond,
12    and the official file or other reference number.
13        (5) A statement of the monetary value of the benefits
14    fraudulently received by the person accused.
15        (6) A statement that, in addition to any other
16    penalties provided by law, a civil penalty in an amount not
17    to exceed $2,000 may be imposed for each fraudulent claim
18    for benefits or payments.
19        (7) A statement providing that the determination of the
20    monetary value may be contested by petitioning the
21    Department for an administrative hearing within 30 days
22    from the date of mailing the notice.
23        (8) The names and mailing addresses of the
24    administrative law judge, all parties, and all other
25    persons to whom the agency gives notice of the hearing
26    unless otherwise confidential by law.

 

 

HB0071 Enrolled- 4 -LRB098 02586 KTG 32591 b

1    An opportunity shall be afforded all parties to be
2represented by legal counsel and to respond and present
3evidence and argument.
4    Unless precluded by law, disposition may be made of any
5contested case by stipulation, agreed settlement, consent
6order, or default.
7    Any final order, decision, or other determination made,
8issued or executed by the Director under the provisions of this
9Article whereby any person is aggrieved shall be subject to
10review in accordance with the provisions of the Administrative
11Review Law, and the rules adopted pursuant thereto, which shall
12apply to and govern all proceedings for the judicial review of
13final administrative decisions of the Director.
14    Upon entry of a final administrative decision for repayment
15of any benefits obtained by fraudulent means, or for any civil
16penalties assessed, a lien shall attach to all property and
17assets of such person, firm, corporation, association, agency,
18institution, vendor, or other legal entity until the judgment
19is satisfied.
20    Within 18 months of the effective date of this amendatory
21Act of the 96th General Assembly, the Department of Healthcare
22and Family Services will report to the General Assembly on the
23number of fraud cases identified and pursued, and the fines
24assessed and collected. The report will also include the
25Department's analysis as to the use of private sector resources
26to bring action, investigate, and collect monies owed.

 

 

HB0071 Enrolled- 5 -LRB098 02586 KTG 32591 b

1    (d) In subsections (a),(b),(b-5) and (b-6), "knowledge"
2has the meaning ascribed to that term in Section 4-5 of the
3Criminal Code of 2012. For any administrative action brought
4under subsection (c) pursuant to a violation of this Section,
5the Department shall define "knowing" by rule.
6(Source: P.A. 96-1501, eff. 1-25-11; 97-23, eff. 1-1-12.)
 
7    (305 ILCS 5/8A-13)
8    Sec. 8A-13. Managed health care fraud.
9    (a) As used in this Section, "health plan" means any of the
10following:
11        (1) Any health care reimbursement plan sponsored
12    wholly or partially by the State.
13        (2) Any private insurance carrier, health care
14    cooperative or alliance, health maintenance organization,
15    insurer, organization, entity, association, affiliation,
16    or person that contracts to provide or provides goods or
17    services that are reimbursed by or are a required benefit
18    of a health benefits program funded wholly or partially by
19    the State.
20        (3) Anyone who provides or contracts to provide goods
21    and services to an entity described in paragraph (1) or (2)
22    of this subsection.
23    For purposes of item (2) in subsection (b),
24"representation" and "statement" include, but are not limited
25to, reports, claims, certifications, acknowledgments and

 

 

HB0071 Enrolled- 6 -LRB098 02586 KTG 32591 b

1ratifications of financial information, enrollment claims,
2demographic statistics, encounter data, health services
3available or rendered, and the qualifications of person
4rendering health care and ancillary services.
5    (b) Any person, firm, corporation, association, agency,
6institution, or other legal entity that, with the intent to
7obtain benefits or payments under this Code to which the person
8or entity is not entitled or in a greater amount than that to
9which the person or entity is entitled, knowingly or willfully:
10executes or conspires to execute a scheme or artifice
11        (1) executes or conspires to execute a scheme or
12    artifice to defraud any State or federally funded or
13    mandated health plan in connection with the delivery of or
14    payment for health care benefits, items, or services; , or
15        (2) executes or conspires to execute a scheme or
16    artifice to obtain by means of false or fraudulent
17    pretense, representation, statement, or promise money or
18    anything of value in connection with the delivery of or
19    payment for health care benefits, items, or services that
20    are in whole or in part paid for, reimbursed, or subsidized
21    by, or are a required benefit of, a State or federally
22    funded or mandated health plan;
23        (3) falsifies, conceals, or covers up by any trick,
24    scheme, or device a material fact in connection with the
25    delivery of or payment for health care benefits, items, or
26    services that are in whole or in part paid for or

 

 

HB0071 Enrolled- 7 -LRB098 02586 KTG 32591 b

1    reimbursed by a State or federal health plan;
2        (4) makes any materially false, fictitious, or
3    fraudulent statements or representations, or makes or uses
4    any materially false writing or document knowing the same
5    to contain any materially false, fictitious, or fraudulent
6    statement or entry, in connection with the delivery of or
7    payment for health care benefits, items, or services that
8    are in whole or in part paid for or reimbursed by a State
9    or federal health plan; or
10        (5) makes or uses any false writing or document knowing
11    the same to contain any materially false, fictitious, or
12    fraudulent statement or entry in connection with the
13    delivery of or payment for health care benefits, items, or
14    services that are in whole or in part paid for or
15    reimbursed by a State or federal health plan;
16is guilty of a violation of this Article and shall be punished
17as provided in Section 8A-6.
18(Source: P.A. 90-538, eff. 12-1-97.)
 
19    (305 ILCS 5/8A-15)
20    Sec. 8A-15. False statements relating to health care
21delivery. Any person, firm, corporation, association, agency,
22institution, or other legal entity that, in any matter related
23to a State or federally funded or mandated health plan,
24knowingly and wilfully falsifies, conceals, or omits by any
25trick, scheme, artifice, or device a material fact, or makes

 

 

HB0071 Enrolled- 8 -LRB098 02586 KTG 32591 b

1any false, fictitious, or fraudulent statement or
2representation, or makes or uses any false writing or document,
3knowing the same to contain any false, fictitious, or
4fraudulent statement or entry in connection with the provision
5of health care or related services, is guilty of a Class 4
6felony A misdemeanor.
7(Source: P.A. 90-538, eff. 12-1-97.)
 
8    Section 99. Effective date. This Act takes effect upon
9becoming law.