Health insurance fraud in Illinois is a serious offense.
Insurance fraud occurs when people deceive an insurance company or a government insurance provider so that they can collect money from a false claim. Many people can commit insurance fraud. Private persons, insurance agents, physicians and healthcare providers can all engage in health insurance fraud. Illinois has several laws that regulate and punish those persons who make false insurance claims. The federal government also has laws that control healthcare fraud in Illinois.
Illinois Criminal Law
The main law that regulates health insurance fraud in Illinois is the Insurance Claims For Excessive Charges Act. This act makes it illegal for doctors or healthcare providers to inflate the costs of their services in order to defraud health insurance providers. This law protects public health insurance providers, such as Medicare, as well as private insurers. The act also makes it illegal for patients to collude with physicians to inflate the seriousness of their injuries on health insurance forms. Violation of this act is a misdemeanor in Illinois. A person who violates this act can be punished by serving up to a year in jail and by paying back the fraudulently gained money.
Illinois Civil Law
Along with criminal penalties, Illinois also has civil penalties and civil protections that regulate health insurance fraud. An Illinois health insurance company that has been defrauded by a group health plan has the right to cancel or refuse to renew health insurance coverage offered to that group. This applies even if an individual in the plan has not defrauded the insurer. As long as the plan sponsor has performed a fraudulent act or made an intentional misrepresentation to the insurer, the insurer is allowed to drop every person in that group. The state of Illinois can also refuse to provide medicare or Medicaid services to a person who has committed healthcare fraud in the past.
Federal Law
The federal Health Insurance Portability and Accountability Act is the main federal law that regulates fraudulent health insurance claims made against Medicare or Medicaid. For first-time offenders who fraudulently misrepresent an insurance claim, the punishment is a year in jail with a fine of $10,000. For repeat offenders, or for people involved in a conspiracy to defraud the government, the penalties are even more serious. Sophisticated parties like physicians and healthcare providers who repeatedly defraud the government can be sentenced to as much as five years in federal prison and charged a fine of $25,000. These parties will also have to pay back the money that they fraudulently earned as restitution for their crimes.
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