Public Act 098-0354
 
HB0071 EnrolledLRB098 02586 KTG 32591 b


  
    AN ACT concerning public aid.
  
 
    Be it enacted by the People of the State of Illinois,
 
represented in the General Assembly:
  



 
 
    Section 5. The Illinois Public Aid Code is amended  by 
changing Sections 8A-2.5, 8A-13, and 8A-15 as follows:
 



    (305 ILCS 5/8A-2.5)



    Sec. 8A-2.5. Unauthorized use of medical assistance. 

    (a) Any person who knowingly uses, acquires, possesses, or 
transfers a
medical card in any manner not authorized by law or 
by rules and regulations of
the Illinois Department, or who 
knowingly alters a medical card, or who
knowingly uses, 
acquires, possesses, or transfers an altered medical card, is

guilty of a violation of this Article and shall be punished as 
provided in
Section 8A-6.

    (b) Any person who knowingly obtains unauthorized medical 
benefits or causes to be obtained unauthorized medical benefits 
with or
without use of a medical card is guilty of a violation 
of this Article and
shall be punished as provided in Section 
8A-6.

    (b-5) Any vendor that knowingly assists a person in 
committing a violation under subsection (a) or (b) of this 
Section is guilty of a violation of this Article and shall be 
punished as provided in Section 8A-6.
    (b-6) Any person (including a vendor, organization, 
agency, or other entity) that, in any matter related to the 
medical assistance program, knowingly or willfully falsifies, 
conceals, or omits by any trick, scheme, artifice, or device a 
material fact, or makes any false, fictitious, or fraudulent 
statement or representation, or makes or uses any false writing 
or document, knowing the same to contain any false, fictitious, 
or fraudulent statement or entry in connection with the 
provision of health care or related services, is guilty of a 
violation of this Article and shall be punished as provided in 
Section 8A-6. 
    (c) The Department may seek to recover any and all State 
and federal monies for which it has improperly and erroneously 
paid benefits as a result of a fraudulent action and any civil 
penalties authorized in this Section.  Pursuant to Section 
11-14.5 of this Code, the Department may determine the monetary 
value of benefits improperly and erroneously received.  The 
Department may recover the monies paid for such benefits and 
interest on that amount at the rate of 5% per annum for the 
period from which payment was made to the date upon which 
repayment is made to the State. Prior to the recovery of any 
amount paid for benefits allegedly obtained by fraudulent 
means, the recipient or payee of such benefits shall be 
afforded an opportunity for a hearing after reasonable notice. 
The notice shall be served personally or by certified or 
registered mail or as otherwise provided by law upon the 
parties or their agents appointed to receive service of process 
and shall include the following: 
        (1) A statement of the time, place and nature of the 
    hearing. 
        (2) A statement of the legal authority and jurisdiction 
    under which the hearing is to be held. 
        (3) A reference to the particular Sections of the 
    substantive and procedural statutes and rules involved. 
        (4) Except where a more detailed statement is otherwise 
    provided for by law, a short and plain statement of the 
    matters asserted, the consequences of a failure to respond, 
    and the official file or other reference number. 
        (5) A statement of the monetary value of the benefits 
    fraudulently received by the person accused. 
        (6) A statement that, in addition to any other 
    penalties provided by law, a  civil penalty in an amount not 
    to exceed $2,000 may be imposed for each fraudulent claim 
    for benefits or payments. 
        (7) A statement providing that the determination of the 
    monetary value may be contested by petitioning the 
    Department for an administrative hearing within 30 days 
    from the date of mailing the notice. 
        (8) The names and mailing addresses of the 
    administrative law judge, all parties, and all other 
    persons to whom the agency gives notice of the hearing 
    unless otherwise confidential by law. 
    An opportunity shall be afforded all parties to be 
represented by legal counsel and to respond and present 
evidence and argument. 
    Unless precluded by law, disposition may be made of any 
contested case by stipulation, agreed settlement, consent 
order, or default. 
    Any final order, decision, or other determination made, 
issued or executed by the Director under the provisions of this 
Article whereby any person is aggrieved shall be subject to 
review in accordance with the provisions of the Administrative 
Review Law, and the rules adopted pursuant thereto, which shall 
apply to and govern all proceedings for the judicial review of 
final administrative decisions of the Director. 
    Upon entry of a final administrative decision for repayment 
of any benefits obtained by fraudulent means, or for any civil 
penalties assessed, a lien shall attach to all property and 
assets of such person, firm, corporation, association, agency, 
institution, vendor, or other legal entity until the judgment 
is satisfied. 
    Within 18 months of the effective date of this amendatory 
Act of the 96th General Assembly, the Department of Healthcare 
and Family Services will report to the General Assembly on the 
number of fraud cases identified and pursued, and the fines 
assessed and collected. The report will also include the 
Department's analysis as to the use of private sector resources 
to bring action, investigate, and collect monies owed. 
    (d) In subsections (a),(b),(b-5) and (b-6), "knowledge" 
has the meaning ascribed to that term in Section 4-5 of the 
Criminal Code of 2012. For any administrative action brought 
under subsection (c) pursuant to a violation of this Section, 
the Department shall define "knowing" by rule. 
(Source: P.A. 96-1501, eff. 1-25-11; 97-23, eff. 1-1-12.)

 



    (305 ILCS 5/8A-13)



    Sec. 8A-13. Managed health care fraud. 

    (a) As used in this Section, "health plan" means any of the 
following:


        (1) Any health care reimbursement plan sponsored 
    wholly or
partially by the State.


        (2) Any private insurance carrier, health care 
    cooperative or
alliance, health maintenance organization, 
    insurer, organization,
entity, association, affiliation, 
    or person that contracts to provide or
provides goods or 
    services that are reimbursed by or are a required
benefit 
    of a health benefits program funded wholly or partially by 
    the
State.


        (3) Anyone who provides or contracts to provide goods 
    and services to an
entity described in paragraph (1) or (2) 
    of this subsection.

    For purposes of item (2) in subsection (b), 
"representation" and "statement"
include, but are not limited 
to, reports, claims, certifications,
acknowledgments and 
ratifications of financial information, enrollment claims,

demographic statistics, encounter data, health services 
available or rendered,
and the qualifications of person 
rendering health care and ancillary services.

    (b) Any person, firm, corporation, association, agency, 
institution, or
other legal entity that, with the intent to 
obtain benefits or payments under
this Code to which the person 
or entity is not entitled or in a greater amount
than that to 
which the person or entity is entitled, knowingly or willfully: 
executes or
conspires to execute a scheme or artifice


        (1) executes or conspires to execute a scheme or 
    artifice to defraud any State or federally funded or 
    mandated health plan in
connection with the delivery of or 
    payment for health care benefits, items, or
services; , or


        (2) executes or conspires to execute a scheme or 
    artifice to obtain by means of false or fraudulent 
    pretense, representation,
statement, or promise money or 
    anything of value in connection with the
delivery of or 
    payment for health care benefits, items, or services that 
    are in
whole or in part paid for, reimbursed, or subsidized 
    by, or are a required
benefit of, a State or federally 
    funded or mandated health plan; 
        (3) falsifies, conceals, or covers up by any trick, 
    scheme, or device a material fact in connection with the 
    delivery of or payment for health care benefits, items, or 
    services that are in whole or in part paid for or 
    reimbursed by a State or federal health plan;
        (4) makes any materially false, fictitious, or 
    fraudulent statements or representations, or makes or uses 
    any materially false writing or document knowing the same 
    to contain any materially false, fictitious, or fraudulent 
    statement or entry, in connection with the delivery of or 
    payment for health care benefits, items, or services that 
    are in whole or in part paid for or reimbursed by a State 
    or federal health plan; or
        (5) makes or uses any false writing or document knowing 
    the same to contain any materially false, fictitious, or 
    fraudulent statement or entry in connection with the 
    delivery of or payment for health care benefits, items, or 
    services that are in whole or in part paid for or 
    reimbursed by a State or federal health plan; 

is guilty of a
violation of this Article and shall be punished 
as provided in Section 8A-6.

(Source: P.A. 90-538, eff. 12-1-97.)

 



    (305 ILCS 5/8A-15)



    Sec. 8A-15. False statements relating to health care 
delivery. Any
person, firm, corporation, association, agency, 
institution, or other legal
entity that, in any matter related 
to a State or federally funded or mandated
health plan, 
knowingly and wilfully falsifies, conceals, or omits by any 
trick,
scheme, artifice, or device a material fact, or makes 
any false, fictitious, or
fraudulent statement or 
representation, or makes or uses any false writing or
document, 
knowing the same to contain any false, fictitious, or 
fraudulent
statement or entry in connection with the provision 
of health care or related
services, is guilty of a Class 4 
felony A misdemeanor.

(Source: P.A. 90-538, eff. 12-1-97.)

 
 
    Section 99. Effective date. This Act takes effect upon 
becoming law.