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90_HB1633
305 ILCS 5/8A-6 from Ch. 23, par. 8A-6
305 ILCS 5/8A-13 new
305 ILCS 5/8A-14 new
305 ILCS 5/8A-15 new
305 ILCS 5/8A-16 new
305 ILCS 5/8A-17 new
Amends the "Public Assistance Fraud" Article of the
Public Aid Code. Makes it unlawful to do any of the
following: defraud any State or federally funded or mandated
health plan in connection with the delivery of or payment for
health care benefits; directly or indirectly give or offer
anything of value to a health care official with the intent
to influence or reward any act or decision of a health care
official; falsify or conceal a material fact or make a false
statement or representation in connection with the provision
of health care; or engage in any unfair or deceptive
marketing practice in connection with providing any health
care service or health plan. Provides for enhanced penalties
for violators other than individuals.
LRB9003208DJcdA
LRB9003208DJcdA
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Section 8A-6 and adding Sections 8A-13, 8A-14, 8A-15, 8A-16,
3 and 8A-17.
4 Be it enacted by the People of the State of Illinois,
5 represented in the General Assembly:
6 Section 5. The Illinois Public Aid Code is amended by
7 changing Section 8A-6 and adding Sections 8A-13, 8A-14,
8 8A-15, 8A-16, and 8A-17 as follows:
9 (305 ILCS 5/8A-6) (from Ch. 23, par. 8A-6)
10 Sec. 8A-6. Classification of violations.
11 (a) Any person, firm, corporation, association, agency,
12 institution or other legal entity that has been found by a
13 court to have engaged in an act, practice or course of
14 conduct declared unlawful under Sections 8A-2 through 8A-5 or
15 Section 8A-13 or 8A-14 where:
16 (1) the total amount of money involved in the violation,
17 including the monetary value of federal food stamps and the
18 value of commodities, is less than $150, shall be guilty of a
19 Class A misdemeanor;
20 (2) the total amount of money involved in the violation,
21 including the monetary value of federal food stamps and the
22 value of commodities, is $150 or more but less than $1,000,
23 shall be guilty of a Class 4 felony;
24 (3) the total amount of money involved in the violation,
25 including the monetary value of federal food stamps and the
26 value of commodities, is $1,000 or more but less than $5,000,
27 shall be guilty of a Class 3 felony;
28 (4) the total amount of money involved in the violation,
29 including the monetary value of federal food stamps and the
30 value of commodities, is $5,000 or more but less than
31 $10,000, shall be guilty of a Class 2 felony; or
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1 (5) the total amount of money involved in the violation,
2 including the monetary value of federal food stamps and the
3 value of commodities, is $10,000 or more, shall be guilty of
4 a Class 1 felony and, notwithstanding the provisions of
5 Section 8A-8 except for Subsection (c) of Section 8A-8, shall
6 be ineligible for financial aid under this Article for a
7 period of two years following conviction or until the total
8 amount of money, including the value of federal food stamps,
9 is repaid, whichever first occurs.
10 (b) Any person, firm, corporation, association, agency,
11 institution or other legal entity that commits a subsequent
12 violation of any of the provisions of Sections 8A-2 through
13 8A-5 and:
14 (1) the total amount of money involved in the subsequent
15 violation, including the monetary value of federal food
16 stamps and the value of commodities, is less than $150, shall
17 be guilty of a Class 4 felony;
18 (2) the total amount of money involved in the subsequent
19 violation, including the monetary value of federal food
20 stamps and the value of commodities, is $150 or more but less
21 than $1,000, shall be guilty of a Class 3 felony;
22 (3) the total amount of money involved in the subsequent
23 violation, including the monetary value of federal food
24 stamps and the value of commodities, is $1,000 or more but
25 less than $5,000, shall be guilty of a Class 2 felony;
26 (4) the total amount of money involved in the subsequent
27 violation, including the monetary value of federal food
28 stamps and the value of commodities, is $5,000 or more but
29 less than $10,000, shall be guilty of a Class 1 felony.
30 (c) For purposes of determining the classification of
31 offense under this Section, all of the money received as a
32 result of the unlawful act, practice or course of conduct can
33 be accumulated.
34 (Source: P.A. 85-1209.)
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1 (305 ILCS 5/8A-13 new)
2 Sec. 8A-13. Managed health care fraud.
3 (a) As used in this Section, "health plan" means any of
4 the following:
5 (1) Any government-sponsored health care
6 reimbursement plan.
7 (2) Any private insurance carrier, health care
8 cooperative or alliance, health maintenance organization,
9 insurer, organization, entity, association, affiliation,
10 or person that contracts to provide or provides goods or
11 services that are reimbursed by or are a required benefit
12 of a State or federally funded health benefits program.
13 (3) Anyone who provides or contracts to provide
14 goods and services to an entity described in paragraph
15 (1) or (2) of this subsection.
16 For purposes of item (2) in subsection (b),
17 "representation" and "statement" include, but are not limited
18 to, reports, claims, certifications, acknowledgments and
19 ratifications of financial information, enrollment claims,
20 demographic statistics, encounter data, health services
21 available or rendered, and the qualifications of person
22 rendering health care and ancillary services.
23 (b) Any person, firm, corporation, association, agency,
24 institution, or other legal entity that, with the intent to
25 obtain benefits or payments under this Code to which the
26 person or entity is not entitled or in a greater amount than
27 that to which the person or entity is entitled, knowingly
28 executes or conspires to execute a scheme or artifice
29 (1) to defraud any State or federally funded or
30 mandated health plan in connection with the delivery of
31 or payment for health care benefits, items, or services,
32 or
33 (2) to obtain by means of false or fraudulent
34 pretense, representation, statement, or promise money or
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1 anything of value in connection with the delivery of or
2 payment for health care benefits, items, or services that
3 are in whole or in part paid for, reimbursed, or
4 subsidized by, or are a required benefit of, a State or
5 federally funded or mandated health plan
6 is guilty of a violation of this Article and shall be
7 punished as provided in Section 8A-6.
8 (305 ILCS 5/8A-14 new)
9 Sec. 8A-14. Bribery and graft in connection with health
10 care.
11 (a) As used in this Section:
12 "Health care official" means any of the following:
13 (1) An administrator, officer, trustee, fiduciary,
14 custodian, counsel, agent, or employee of any health
15 plan.
16 (2) An officer, counsel, agent, or employee of an
17 organization that provides, proposes to provide, or
18 contracts to provide services to any health plan.
19 (3) An official, employee, or agent of a State or
20 federal agency having regulatory or administrative
21 authority over any health plan.
22 "Health plan" has the meaning attributed to that term in
23 Section 8A-13.
24 (b) Any person, firm, corporation, association, agency,
25 institution, or other legal entity that
26 (1) directly or indirectly gives, offers, or
27 promises anything of value to a health care official, or
28 offers or promises to a health care official to give
29 anything of value to another person, with the intent
30 (A) to influence or reward any act or decision
31 of any health care official exercising any authority
32 in any State or federally funded or mandated health
33 plan, or
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1 (B) to influence the official to commit, aid
2 in the commission of, or conspire to allow any fraud
3 in a State or federally funded or mandated health
4 plan, or
5 (C) to induce the official to engage in any
6 conduct in violation of the official's lawful duty,
7 or
8 (2) being a health care official, directly or
9 indirectly demands, solicits, receives, accepts, or
10 agrees to accept anything of value personally or for any
11 other person or entity, the giving of which would violate
12 paragraph (1) of this subsection,
13 is guilty of a violation of this Article and shall be
14 punished as provided in Section 8A-6.
15 (305 ILCS 5/8A-15 new)
16 Sec. 8A-15. False statements relating to health care
17 delivery. Any person, firm, corporation, association,
18 agency, institution, or other legal entity that, in any
19 matter related to a State or federally funded or mandated
20 health plan, knowingly and wilfully falsifies, conceals, or
21 omits by any trick, scheme, artifice, or device a material
22 fact, or makes any false, fictitious, or fraudulent statement
23 or representation, or makes or uses any false writing or
24 document, knowing the same to contain any false, fictitious,
25 or fraudulent statement or entry in connection with the
26 provision of health care or related services, is guilty of a
27 Class A misdemeanor.
28 (305 ILCS 5/8A-16 new)
29 Sec. 8A-16. Unfair or deceptive marketing practices.
30 (a) As used in this Section, "health plan" has the
31 meaning attributed to that term in Section 8A-13.
32 (b) It is unlawful to engage in any unfair or deceptive
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1 marketing practice in connection with proposing, offering,
2 selling, soliciting, or providing any health care service or
3 any health plan. Unfair or deceptive marketing practices
4 include the following:
5 (1) Making a false and misleading oral or written
6 statement, visual description, advertisement, or other
7 representation of any kind that has the capacity,
8 tendency, or effect of deceiving or misleading health
9 care consumers with respect to any health care service,
10 health plan, or health care provider.
11 (2) Making a representation that a health care plan
12 or a health care provider offers any service, benefit,
13 access to care, or choice that it does not in fact offer.
14 (3) Making a representation that a health plan or
15 health care provider has any status, certification,
16 qualification, sponsorship, affiliation, or licensure
17 that it does not have.
18 (4) A failure to state a material fact if the
19 failure deceives or tends to deceive.
20 (5) Offering any kickback, bribe, reward, or
21 benefit to any person as an inducement to select or to
22 refrain from selecting any health care service, health
23 plan, or health care provider, unless the benefit offered
24 is medically necessary health care.
25 (6) The use of health care consumer or other
26 information that is confidential or privileged or that
27 cannot be disclosed to or obtained by the user without
28 violating a State or federal confidentiality law,
29 including:
30 (A) medical records information; and
31 (B) information that identifies the health
32 care consumer or any member of his or her group as a
33 recipient of any government sponsored or mandated
34 welfare program.
-7- LRB9003208DJcdA
1 (7) The use of any device or artifice in
2 advertising a health plan or soliciting a health care
3 consumer that misrepresents the solicitor's profession,
4 status, affiliation, or mission.
5 (c) Any person who commits a first violation of this
6 Section is guilty of a Class A misdemeanor and is subject to
7 a fine of not more than $5,000. Any person who commits a
8 second or subsequent violation of this Section is guilty of a
9 Class 4 felony and is subject to a fine of not more than
10 $25,000.
11 (305 ILCS 5/8A-17 new)
12 Sec. 8A-17. Penalties enhanced for persons other than
13 individuals. If a person who violates Section 8A-13, 8A-14,
14 8A-15, or 8A-16 is any person other than an individual, then
15 that person is subject to a fine of not more than $50,000 if
16 the violation is a misdemeanor and a fine of not more than
17 $250,000 if the violation is a felony.