Cornell University defines healthcare fraud as any submission of data to a healthcare system with the intention of turning a profit. Despite this definition, healthcare fraud can take place in a number of ways. Practitioners can acquire subsidized drugs and then sell them on the black market for a profit. They can also file forms for imaginary clients or duplicate claims for the same client in order to be paid for the same service twice. Practitioners can also benefit from kickbacks from drug companies for erroneous diagnosis of a condition to benefit from it by sale of a particular medicine, or by prescribing unnecessary treatment regimens for diseases.
Recent statistics estimate as much as one tenth of all money paid into the health system goes towards fraudulent health payments. In order to ensure the system’s efficiency, health care insurance is required to be paid within thirty (30) days of the claim being filed. Because of this limitation, it is usually many years before health care fraud is detected and pursued. Illinois law has a handful of legal precedents in place to deal with situations like this when they arise. In the case of discovery, the False Claims Act deals with this as a matter of when the evidence to prosecute the matter was discovered, although it still takes into account a statute of limitations of ten(10 years before the validity of charges wane.
Illinois Laws And Penalties
There are quite a number of Illinois health insurance laws. They are designed to protect the local policyholders against any discrimination based on the type of illness they have. Illinois also defers to federal healthcare laws such as HIPAA and COBRA. Laws within the state of Illinois cover misbehavior from medical professionals in a number of ways not limited to self-referrals, running illegal pharmacies online, fraudulent billing under Medicare/Medicaid, Illegal importation of drugs controlled by the FDA and bribery of medical boards.
The health insurance laws were recently updated to reflect the changing face of healthcare fraud in the state. Penalties were increased to match the seriousness of the offenses.
Illinois Healthcare Fraud Penalties
Penalties for healthcare fraud in Illinois have been updated recently, with the signing into legislation in September 2013 of updated penalties for healthcare related fraudulent practices. The new updates to the penalties class healthcare fraud as a class 4 felony, and grants fines of up to $25,000 for individuals and up to $50,000 for corporations. Medicaid fraud also counts as a felony charge and can be prosecuted under federal law. The new legislation delineates a civil money penalty on people who submit fraudulent Medicaid information ranging from $10,000 to $50,000. These are supplementary to the Illinois False Claims Act, which provides for damages between $5,500 and $11,000. In addition, a number of anti-kickback statutes were enacted, allowing for a minimum of twenty (20) years imprisonment, with an option for life imprisonment present.
Statute Of Limitations on Illinois
The Statute of Limitations on fraudulent concealment within Illinois is five (5) years. When it comes to the False Claims Act, however, the statute of limitations varies. Charges can be pressed within six (6) years of the date at which the violation was committed. However, the circumstance arises where the facts for the case are not known to the governmental agency that has the right to press charges. As such, if evidence is found within ten (10) years of the violation, charges can be pressed no more than three years after evidence first comes to light.
Key Illinois Healthcare Fraud Cases
- Hospice Executive Charged for Fraud – An Illinois hospice executive was charged for fraud, relating to the submission of claims for procedures that were never performed. Some patients were enrolled for services that did not match the severity of their illness and Medicare and Medicaid was paid out to the hospice for procedures that were never actually done.
- Chicago Hospital Charged with Healthcare Fraud – A major Chicago hospital was charged with claiming for unnecessary procedures in an attempt to defraud Medicare and Medicaid. They were further charged with delivering kickbacks for doctors for referrals to the hospital.
- Doctor in Anton Pleads Guilty to Health Care Fraud and Illegal Dispensation of Controlled Drugs – The doctor of Anton, Illinois provided controlled substances such as Xanax and Hydrocodone outside the realm of professional conduct. Dispensation of these drugs (both of which are controlled substances under the FDA), can lead to a maximum of 10 years in prison per charge. He is also charged with trying to defraud the Medicare and Medicaid programs by including these controlled substances on the claim forms.
- Couple pleads Guilty to Health Care Fraud – A couple, man and woman, of Cahokia, Illinois pleaded guilty to charges of defrauding and attempting to defraud Medicare and Medicaid by submitting false claims.