Is Your Illinois Employer Or Medical Provider Submitting False Or Fraudulent Claims To Medicaid?
Illinois spends over $19 billion on Illinois Medicaid and State Employee Group Health Insurance programs. False billing and fraudulent schemes account for up to 10% of Medicaid claims each year, meaning nearly $2 billion in taxpayer dollars end up in the pockets of fraudsters every year – dollars meant to provide quality health care to low income individuals, families, the elderly and foster children. Illegal use of Illinois Medicaid funds results in an increase in health care for all of us.
The Illinois State Health Care Fraud Elimination Task Force is in place to investigate errors in Illinois Medicaid billing and intentional fraud and recover improper reimbursements for the State, but resources are limited. Discovery is largely dependent on health care professionals – nurses, physicians, bookkeepers, EMT’s, pharmacists and sales representatives – who have first-hand knowledge of the inner workings of billing policies and practices, patient admission and discharge requirements, and products and services rendered.
State and Federal False Claims Acts provide Illinois whistleblowers with substantial financial incentives and powerful protections for choosing to come forward and report fraud, waste and abuse of Illinois Medicaid funds. If you suspect Medicaid Fraud is occurring within your place of business or other Illinois health care facility, you may be entitled to a significant cash award. Call today for a free, immediate and confidential case evaluation.
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Reporting Illinois Medicaid Fraud
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What Are The Illinois Laws Covering Medicaid Fraud Reporting?
The Illinois False Claims Act (IFCA), 740 ILCS 175/1 et seq., allows private citizens to file a whistleblower, or ‘qui tam,’ lawsuit on behalf of the State of Illinois and share in a percentage of any government recovery.
The IFCA makes it a crime to:
- knowingly present, or cause to be presented, a false or fraudulent claim for payment or approval;
- knowingly make, use, or cause to be made or used, a false record or statement material to a false or fraudulent claim;
- conspire to commit a violation of the IFCA
- have possession, custody, or control of property or money used, or to be used, by the State and knowingly deliver, or cause to be delivered, less than all the money or property;
- make or deliver a document certifying receipt of property used, or to be used, by the State and, intending to defraud the State, make or deliver the receipt without completely knowing that the information on the receipt is true;
- knowingly buy, or receive as a pledge of an obligation or debt, public property from an officer or employee of the State, or a member of the Guard, who lawfully may not sell or pledge property; or knowingly make, use, or cause to be made or used, a false record or statement material to an obligation to pay or transmit money or property to the State, or knowingly conceal or knowingly and improperly avoid or decrease an obligation to pay or transmit money or property to the State.
“Knowingly” means the person has actual knowledge of the information relating to the false claim and acts in deliberate ignorance of the truth or falsity of the information or acts in reckless disregard of the truth or falsity of the information.
No proof of specific intent to defraud Illinois Medicaid is required to violate the IFCA.
Individuals or entities who violate the IFCA are liable to the State of Illinois for civil penalties of between $5,500 and $11,000, plus three times the amount of damages the State suffers due to the violation and the costs of the civil action brought to recover any penalty and/or damages, including reasonable attorneys’ fees and costs.
Putting a stop to Medicaid fraud is vital to the future of our nation’s health care programs. Medicaid fraud puts patient care at risk and raises the cost of health care for everyone. If you have knowledge of inappropriate billing, medically unnecessary service provision, ineligible patient coverage, document falsification, physician kickbacks or other fraudulent activity that results in false claims being submitted to Illinois Medicaid, you are protected by federal and state law and may be entitled to a substantial cash award for your information. Contact the Medicaid Fraud Hotline Today.
Does Illinois Law Protect Those Who Report Medicaid Fraud?
Whistleblower Protections under the Illinois False Claims Act
Under the Illinois False Claims Act (IFCA), 740 ILCS 175/1 et seq., any employee, contractor, or agent shall be entitled to all relief necessary to make that employee, contractor, or agent whole, if that employee, contractor, or agent is discharged, demoted, suspended, threatened, harassed, or in any other manner discriminated against because of lawful acts done by in furtherance of an IFCA action or other efforts to stop one or more violations of this Act.
Whistleblower Protections under the Illinois Whistleblower Act
The Illinois Whistleblower Act (IWA), 740 ILCS 174/1 et seq., also protects employees from employer retaliation in response to reporting Illinois Medicaid fraud. Under the IWA, any employee who is employed full-time or part-time by an individual, sole proprietorship, partnership, firm, corporation, association, or any other entity that has one or more employees in the State of Illinois can file a claim for damages when the employer makes, adopts, or enforces any rule, regulation, or policy preventing an employee from disclosing information to a government or law enforcement agency if the employee has reasonable cause to believe that the information discloses a violation of a State or federal law, rule, or regulation.
Under the IWA, an employer may not retaliate against an employee who:
- discloses information in a court, an administrative hearing, or before a legislative commission or committee, or in any other proceeding, where the employee has reasonable cause to believe that the information discloses a violation of a State or federal law, rule, or regulation; or
- discloses information to a government or law enforcement agency, where the employee has reasonable cause to believe that the information discloses a violation of a State or federal law, rule, or regulation; or
- refuses to participate in an activity that would result in a violation of a State or federal law, rule, or regulation.
Under the IWA, employer retaliation is any act that would be materially adverse to a reasonable employee and is because of the employee disclosing or attempting to disclose public corruption or wrongdoing.
Whistleblowers Are Entitled To Remedies For Employer Retaliation
A whistleblower experiencing employer retaliation due to reporting Illinois Medicaid fraud is entitled to file a claim for damages under the Illinois False Claims Act, including:
- reinstatement with the same seniority status that the employee, contractor, or agent would have had but for the discrimination
- two times the amount of back pay
- interest on the back pay
- compensation for any special damages sustained as a result of the discrimination, including litigation costs and reasonable attorneys' fees
Violation of the Illinois Whistleblower Act is a Class A misdemeanor. An employee may bring a civil action against the employer for all relief necessary to make the employee whole, including but not limited to:
- reinstatement with the same seniority status that the employee would have had, but for the violation;
- back pay, with interest; and
- compensation for any damages sustained as a result of the violation, including litigation costs, expert witness fees, and reasonable attorney's fees.
What Cash Award Amount Is Paid To Illinois Medicaid Fraud Whistleblowers?
Under the Illinois False Claims Act (IFCA), 740 ILCS 175/1 et seq., after a whistleblower reports knowledge of Medicaid fraud, the State has 60 days to decide if they will intervene in the action or if the whistleblower will proceed with a personal legal team.
If the State opts to intervene, the whistleblower is entitled to a cash award of between 15% and 25% of the total government recovery. If the whistleblower proceeds with a personal legal team, the whistleblower cash award is increased to between 25% and 30% of the total government recovery.
In addition to the whistleblower cash award, the whistleblower is also awarded reasonable expenses which the court finds to have been necessarily incurred, plus reasonable attorneys' fees and costs.
Final award amounts are calculated based upon the significance of the information provided by the whistleblower and the extent of the role the whistleblower plays in the investigation and advancing the case to litigation.
Successful recovery of stolen Illinois Medicaid funds through False Claims Act prosecution is dependent on whistleblowers coming forward to report their information. In 2014, our nation’s whistleblowers received a collective $435 million in whistleblower cash awards for aiding in the recovery of $3 billion in stolen taxpayer dollars. Don’t wait to make your report. Learn your rights and secure your role as whistleblower. Call the Medicaid Fraud Hotline Now.
Are There Time Limits On Reporting Illinois Medicaid Fraud?
A whistleblower lawsuit under the Illinois False Claims Act (IFCA), 740 ILCS 175/1 et seq., must be brought:
- within 6 years after the date on which the violation is committed, or
- within 3 years after the date when facts material to the right of action are known or reasonably should have been known, and
- no longer than 10 years after the date on which the violation is committed, whichever occurs last.
Under the Illinois False Claims Act and the Illinois Whistleblower Act, a civil action for damages due to employer retaliation must be brought within 3 years after the date when the retaliation occurred.
3 Easy Steps to Help you Decide
Whether You Should Report Medicaid Fraud
Don’t put off your report any longer. If you have information relating to Illinois Medicaid Fraud, contact the Medicaid Fraud Hotline or fill out the online report form. Only the first to report a False Claims Act violation is eligible to collect a whistleblower cash award. Secure your eligibility now by calling the Medicaid Fraud Hotline and receive an immediate and confidential, no-obligation case evaluation.
Whistleblowers Paid Over $1 Million Cash for Tips Leading to Illinois Recovery