(740 ILCS 92/1)
Sec. 1.
Short title.
This Act may be cited as the Insurance Claims Fraud
Prevention
Act.
(Source: P.A. 92-233, eff. 1-1-02.)
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(740 ILCS 92/5)
Sec. 5. Patient and client procurement.
(a) Except as otherwise permitted or authorized by law, it
is unlawful to knowingly offer or pay any remuneration
directly or
indirectly, in cash or in kind, to induce any person to procure clients or
patients to obtain services
or benefits under a contract of insurance or that will be the basis for a claim
against an insured
person or the person's
insurer. Nothing in this Act shall be construed to affect any contracts or
arrangements between or among insuring entities including health maintenance
organizations, health care professionals, or health care facilities which are
hereby excluded.
(b) A person who violates any provision of this Act, Section 17-8.5 or Section 17-10.5 of the Criminal Code of 1961 or the Criminal Code of 2012, or Article 46 of the
Criminal Code of
1961 shall be subject, in addition to any other penalties that may be
prescribed by law, to a civil
penalty of not less than $5,000 nor more than $10,000, plus an assessment of
not more than 3
times the amount of each claim for compensation under a contract of insurance.
The court shall
have the power to grant other equitable relief, including temporary injunctive
relief, as is
necessary to prevent the transfer, concealment, or dissipation of illegal
proceeds, or to protect the
public. The penalty prescribed in this subsection shall be assessed for each
fraudulent claim upon
a person in which the defendant participated.
(c) The penalties set forth in subsection (b) are intended to be remedial
rather than
punitive, and shall not preclude, nor be precluded by, a criminal prosecution
for the same
conduct. If the court finds, after considering the goals of disgorging unlawful
profit, restitution,
compensating the State for the costs of investigation and prosecution, and
alleviating the social
costs of increased insurance rates due to fraud, that such a penalty would be
punitive and would
preclude, or be precluded by, a criminal prosecution, the court shall reduce
that penalty
appropriately.
(Source: P.A. 97-1150, eff. 1-25-13.)
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(740 ILCS 92/10)
Sec. 10.
Action by State's Attorney or Attorney General.
The State's
Attorney of the
county in which the conduct occurred or Attorney General may bring a civil
action under this
Act. Before the Attorney General may bring the action, the Attorney General
shall present the
evidence obtained to the appropriate State's Attorney for possible criminal or
civil filing. If the
State's Attorney elects not to pursue the matter, then the Attorney General may
proceed with the
action.
(Source: P.A. 92-233, eff. 1-1-02.)
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(740 ILCS 92/15)
Sec. 15.
Action by interested person.
(a) An interested person, including an insurer, may bring a civil action for
a
violation of
this Act for the person and for the State of Illinois. The action shall be
brought in the name of the
State. The action may be dismissed only if the court and the State's Attorney
or the Attorney
General, whichever is participating, gives written consent to the dismissal
stating their reasons
for consenting.
(b) A copy of the complaint and a written disclosure of substantially all
material evidence
and information the person possesses shall be served on the State's Attorney
and Attorney
General. The complaint shall be filed in camera, shall remain under seal for at
least 60 days, and
shall not be served on the defendant until the court so orders. The State's
Attorney or Attorney
General may elect to intervene and proceed with the action within 60 days after
he or she
receives both the complaint and the material evidence and information. If more
than one
governmental entity elects to intervene, the State's Attorney shall have
precedence.
(c) The State's Attorney or Attorney General may, for good cause shown, move
the court
for extensions of the time during which the complaint shall remain under seal
under subsection
(b). The motions may be supported by affidavits or other submissions in camera.
The defendant
shall not be required to respond to any complaint filed under this Section
until 20 days after the
complaint is unsealed and served upon the defendant.
(d) Before the expiration of the 60-day period or any extensions obtained
under subsection (c), the State's Attorney or Attorney General shall either:
(1) proceed with the action, in which case the action | ||
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(2) notify the court that it declines to take over | ||
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(e) When a person or governmental agency brings an action under this Act, no
person
other than the State's Attorney or Attorney General may intervene or bring a
related action based
on the facts underlying the pending action unless another statute or common law
authorizes that
action.
(Source: P.A. 92-233, eff. 1-1-02.)
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(740 ILCS 92/20)
Sec. 20.
Role of State's Attorney or Attorney General.
(a) If the State's Attorney or Attorney General proceeds with the action, he
or
she shall
have the primary responsibility for prosecuting the action, and shall not be
bound by an act of the
person bringing the action. That person shall have the right to continue as a
party to the action,
subject to the limitations set forth in subsection (b).
(b) The State's Attorney or Attorney General may dismiss the action
notwithstanding the
objections of the person initiating the action if the person has been notified
by the State's
Attorney or Attorney General of the filing of the motion, and the court has
provided the person
with an opportunity for a hearing on the motion.
The State's Attorney or Attorney General may settle the action with the
defendant
notwithstanding the objections of the person initiating the action if the court
determines, after a
hearing, that the proposed settlement is fair, adequate, and reasonable under
all the
circumstances.
Upon a showing of good cause, the hearing may be held in camera.
Upon a showing by the State's Attorney or Attorney General that unrestricted
participation during the course of the litigation by the person initiating the
action would interfere
with or unduly delay the State's Attorney's or Attorney General's prosecution
of the case, or
would be repetitious, irrelevant, or for purposes of harassment, the court may,
in its discretion,
impose limitations on the person's participation, including, but not limited
to, the following:
(1) limiting the number of witnesses the person may | ||
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(2) limiting the length of the testimony of those | ||
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(3) limiting the person's cross-examination of | ||
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(4) otherwise limiting the participation by the | ||
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Upon a showing by the defendant that unrestricted participation during the
course of the
litigation by the person initiating the action would be for purposes of
harassment or would cause
the defendant undue burden or unnecessary expense, the court may limit the
participation by the
person in the litigation.
(c) If the State's Attorney or Attorney General elects not to proceed with
the
action, the
person who initiated the action shall have the right to conduct the action. If
the State's Attorney
or Attorney General so requests, he or she shall be served with copies of all
pleadings filed in the
action and shall be supplied with copies of all deposition transcripts, at the
State's Attorney's or
Attorney General's expense. When a person proceeds with the action, the court,
without limiting
the status and rights of the person initiating the action, may nevertheless
permit the State's
Attorney or Attorney General to intervene at a later date upon a showing of
good cause.
(d) If at any time both a civil action for penalties and equitable relief
pursuant to this Act
and a criminal action are pending against a defendant for substantially the
same conduct, whether
brought by the government or a private party, the civil action shall be stayed
until the criminal
action has been concluded at the trial court level. The stay shall not preclude
the court from
granting or enforcing temporary equitable relief while the actions are pending.
Whether or not
the State's Attorney or Attorney General proceeds with the action, upon a
showing by the State's
Attorney or Attorney General that certain actions of discovery by the person
initiating the action
would interfere with a law enforcement or governmental agency investigation or
prosecution of a
criminal or civil matter arising out of the same facts, the court may stay discovery for a period of
not more than 180 days. A hearing on a request for the stay shall be conducted in camera. The
court may extend the 180-day period upon a further showing in camera that the agency has
pursued the criminal or civil investigation or proceedings with reasonable diligence and any
proposed discovery in the civil action will interfere with the ongoing criminal
or civil
investigation or proceedings.
(e) Notwithstanding Section 15, the State's Attorney or Attorney General may
elect to
pursue its claim through any alternate remedy available to the State's Attorney
or Attorney
General.
(Source: P.A. 92-233, eff. 1-1-02.)
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(740 ILCS 92/25)
Sec. 25. Costs and proceeds of action.
(a) If the State's Attorney or Attorney General proceeds with an action
brought
by a
person under Section 15, that person is entitled to receive an amount that the
court determines is
reasonable based upon the extent to which the person contributed to the
prosecution of the action.
Subject to subsection (d), the amount awarded to the person who brought the
action shall not be
less than 30% of the proceeds of the action or settlement of the claim, and
shall be paid from the
proceeds.
(b) If the State's Attorney or Attorney General does not proceed with an
action
brought
by a person under Section 15, that person shall receive an amount that the
court decides is
reasonable for collecting the civil penalty and damages. Subject to subsection
(d), the amount
shall not be less than 40% of the proceeds of the action or settlement, and
shall be paid from the
proceeds.
(c) If the person bringing the action as a result of a violation of this Act
has paid money
to the defendant or to an attorney acting on behalf of the defendant in the
underlying claim, then
he or she shall be entitled to up to double the amount paid to the defendant or
the attorney if that
amount is greater than 50% of the proceeds.
(d) Where the action is one that the court finds to be based primarily on
disclosures of
specific information, other than information provided by the person bringing
the action under
Section 15, relating to allegations or transactions in a criminal, civil, or
administrative hearing, in
a legislative or administrative report, hearing, audit, or investigation, or
from the news media, the
court may award those sums that it considers appropriate, but in no case more
than 10% of the
proceeds, taking into account the significance of the information and the role
of the person
bringing the action in advancing the case to litigation.
(e) Any payment to a person under subsection (a), (b), (c), or (d) shall be
made from the
proceeds. The person shall also receive an amount for reasonable expenses that
the court finds to
have been necessarily incurred, plus reasonable attorney's fees and costs. All
of those expenses,
fees, and costs shall be awarded against the defendant.
(f) If a local State's Attorney has proceeded with an action under this Act,
the Treasurer
of the County where the action was brought shall receive an amount for
reasonable expenses that
the court finds to have been necessarily incurred by the State's Attorney,
including reasonable
attorney's fees and costs, plus 50% of the funds not awarded to a private
party. Those amounts
shall be used to investigate and prosecute insurance fraud, augmenting existing
budgets rather
than replacing them. All remaining funds shall go to the State and be deposited
in the General
Revenue Fund and, when appropriated, shall be allocated to appropriate State
agencies for
enhanced insurance fraud investigation, prosecution, and prevention efforts.
(g) If the Attorney General has proceeded with an action under this Act, all
funds not
awarded to a private party, shall go to the State and be deposited in the
General Revenue Fund
and, when appropriated, shall be allocated to appropriate State agencies for
enhanced insurance
fraud investigation, prosecution, and prevention efforts.
(h) If neither a local State's Attorney or the Attorney General has
proceeded
with an
action under this Act, 50% of the funds not awarded to a private party shall be
deposited with the
Treasurer of the County where the action was brought and shall be disbursed to
the State's
Attorney of the County where the action was brought. Those funds shall be used
by the State's
Attorney solely to investigate, prosecute, and prevent crime,
augmenting existing
budgets rather than replacing them. All remaining funds shall go to the State
and be deposited in
the General Revenue Fund and, when appropriated, shall be allocated to
appropriate State
agencies for enhanced crime investigation, prosecution, and
prevention efforts.
(i) Whether or not the State's Attorney or Attorney General proceeds with
the
action, if
the court finds that the action was brought by a person who planned and
initiated the violation of
this Act, that person shall be dismissed from the civil action and shall not
receive any share of
the proceeds of the action. The dismissal shall not prejudice the right of the
State's Attorney or
Attorney General to continue the action on behalf of the State.
(j) If the State's Attorney or Attorney General does not proceed with the
action, and the
person bringing the action conducts the action, the court may award to the
defendant its
reasonable attorney's fees and expenses if the defendant prevails in the action
and the court finds
that the claim of the person bringing the action was clearly frivolous, clearly
vexatious, or
brought primarily for purposes of harassment.
(Source: P.A. 100-358, eff. 1-1-18.)
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(740 ILCS 92/30)
Sec. 30.
Limitation on bringing actions.
(a) In no event may a person bring an action under Section 15 that is based
upon
allegations or transactions that are the subject of a civil suit or an
administrative civil money
penalty proceeding in which the State's Attorney or Attorney General is already
a party.
(b) A court may not have jurisdiction over an action under this Act based
upon
the public
disclosure of allegations or transactions in a criminal, civil, or
administrative hearing, in a
legislative or administrative report, hearing, audit, or investigation, or from
the news media,
unless the action is brought by the State's Attorney, the Attorney General, or
a person who is an
original source of the information.
For purposes of this subsection, "original source" means an individual who has
direct and
independent knowledge of the information on which the allegations are based and
has voluntarily
provided the information to the State's Attorney or Attorney General before
filing an action
under this Act based on the information.
(Source: P.A. 92-233, eff. 1-1-02.)
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(740 ILCS 92/35)
Sec. 35.
Expenses and sanctions.
(a) Except as provided in subsection (b), the State's Attorney or Attorney
General is not
liable for expenses that a person incurs in bringing an action under this Act.
(b) In civil actions brought under this Act in which the Attorney General or
a
State's
Attorney is a party, the court shall retain discretion to impose sanctions
otherwise allowed by
law, including the ability to order a party to pay expenses as provided in the
Code of Civil
Procedure.
(Source: P.A. 92-233, eff. 1-1-02.)
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(740 ILCS 92/40)
Sec. 40.
Retaliatory discharge; remedy.
An employee who is discharged,
demoted,
suspended, threatened, harassed, or in any other manner discriminated against
in the terms and
conditions of employment by his or her employer because of lawful acts done by
the employee
on behalf of the employee or others in furtherance of an action under this Act,
including
investigation for, initiation of, testimony for, or assistance in an action
filed or to be filed under
this Act, shall be entitled to all relief necessary to make the employee whole.
That relief shall
include reinstatement with the same seniority status the employee would have
had but for the
discrimination, 2 times the amount of backpay, interest on the backpay, and
compensation for
any special damages sustained as a result of the discrimination, including
litigation costs and
reasonable attorney's fees. An employee may bring an action in the appropriate
court for the
relief provided in this Section. The remedies under this Section are
in addition to any other
remedies provided by existing law.
(Source: P.A. 92-233, eff. 1-1-02.)
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(740 ILCS 92/45)
Sec. 45. Time limitations.
(a) Except as provided in subsection (b), an action pursuant to this Act may
not be filed
more than 3 years after the discovery of the facts constituting the grounds for
commencing the
action.
(b) Notwithstanding subsection (a), an action may be filed pursuant to
this Act within not
more than 8 years after the commission of an act constituting a violation of
this Act, Section 17-8.5 or Section 17-10.5 of the Criminal Code of 1961 or the Criminal Code of 2012, or a violation
of Article 46 of the Criminal Code of 1961.
(Source: P.A. 97-1150, eff. 1-25-13.)
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(740 ILCS 92/90)
Sec. 90.
(Amendatory provisions; text omitted).
(Source: P.A. 92-233, eff. 1-1-02; text omitted.)
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