Article Summary

The Illinois Insurance Claims Fraud Prevention Act expands healthcare fraud laws to prohibit fraud against private insurers and empowers whistleblowers with a FCA-style qui tam provision.

This article by TELG managing principal R. Scott Oswald was published by Health Care Law on September 1, 2014. The full article is .

Excerpted from:

Illinois Insurance Claims Fraud Prevention Act: What whistleblowers and providers should know

Illinois has a peculiar statute that many healthcare
providers and their employees may not
know about: the Illinois Claims Fraud Prevention
Act (ICFPA). This article discusses the options
available for interested persons bringing actions
under the ICFPA and potential liabilities for health
care providers that have violated this Act. Finally,
it includes exemplar cases and lessons learned.

Billions of dollars in recoveries to the federal
government for False Claims Act violations have
made Medicare and Medicaid violations well
known throughout the medical community.
Healthcare entities train their employees about
the need to avoid liability for such violations.
Most employees know to be vigilant in billings
to Medicare and Medicaid. But providers and
employees in Illinois should be aware of qui tam
provisions that apply to private insurance claims
as well under the Illinois Insurance Claims Fraud
Prevention Act (ICFPA). In Illinois, interested
persons may bring claims on behalf of private
insurance companies and the state government
college argued that submitting the form to
its insurer or third-party administrator burdened
its free exercise of religion in violation
of the Religious Freedom Restoration Act of
1993 (RFRA). In particular, the college contended
that filing the self-certification form
would make it complicit in providing contraceptives
services by triggering the obligation
of the insurer or TPA to do so without cost.
In taking up the issue, the Supreme Court
noted that the circuit courts have been divided
on whether to enjoin the requirement
that religious non-profit organizations use
the self-certifying form. Aptly, the Supreme
Court Justices also found themselves split on
the issue.