99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
SB3330

 

Introduced 2/19/2016, by Sen. Wm. Sam McCann

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/8A-2.5

    Amends the Public Assistance Fraud Article of the Illinois Public Aid Code. In a provision concerning the recovery of the monetary value of medical benefits improperly and erroneously received, provides that the records of the Department of Healthcare and Family Services regarding the improper payment of benefits are self-authenticating and presumed to be true and correct absent evidence to the contrary.


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A BILL FOR

 

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1    AN ACT concerning public aid.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Public Aid Code is amended by
5changing Section 8A-2.5 as follows:
 
6    (305 ILCS 5/8A-2.5)
7    Sec. 8A-2.5. Unauthorized use of medical assistance.
8    (a) Any person who knowingly uses, acquires, possesses, or
9transfers a medical card in any manner not authorized by law or
10by rules and regulations of the Illinois Department, or who
11knowingly alters a medical card, or who knowingly uses,
12acquires, possesses, or transfers an altered medical card, is
13guilty of a violation of this Article and shall be punished as
14provided in Section 8A-6.
15    (b) Any person who knowingly obtains unauthorized medical
16benefits or causes to be obtained unauthorized medical benefits
17with or without use of a medical card is guilty of a violation
18of this Article and shall be punished as provided in Section
198A-6.
20    (b-5) Any vendor that knowingly assists a person in
21committing a violation under subsection (a) or (b) of this
22Section is guilty of a violation of this Article and shall be
23punished as provided in Section 8A-6.

 

 

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1    (b-6) Any person (including a vendor, organization,
2agency, or other entity) that, in any matter related to the
3medical assistance program, knowingly or willfully falsifies,
4conceals, or omits by any trick, scheme, artifice, or device a
5material fact, or makes any false, fictitious, or fraudulent
6statement or representation, or makes or uses any false writing
7or document, knowing the same to contain any false, fictitious,
8or fraudulent statement or entry in connection with the
9provision of health care or related services, is guilty of a
10violation of this Article and shall be punished as provided in
11Section 8A-6.
12    (c) The Department may seek to recover any and all State
13and federal monies for which it has improperly and erroneously
14paid benefits as a result of a fraudulent action and any civil
15penalties authorized in this Section. Pursuant to Section
1611-14.5 of this Code, the Department may determine the monetary
17value of benefits improperly and erroneously received. The
18records of the Department regarding the improper payment of
19benefits shall be self-authenticating and shall be presumed to
20be true and correct absent evidence to the contrary. The
21Department may recover the monies paid for such benefits and
22interest on that amount at the rate of 5% per annum for the
23period from which payment was made to the date upon which
24repayment is made to the State. Prior to the recovery of any
25amount paid for benefits allegedly obtained by fraudulent
26means, the recipient or payee of such benefits shall be

 

 

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1afforded an opportunity for a hearing after reasonable notice.
2The notice shall be served personally or by certified or
3registered mail or as otherwise provided by law upon the
4parties or their agents appointed to receive service of process
5and shall include the following:
6        (1) A statement of the time, place and nature of the
7    hearing.
8        (2) A statement of the legal authority and jurisdiction
9    under which the hearing is to be held.
10        (3) A reference to the particular Sections of the
11    substantive and procedural statutes and rules involved.
12        (4) Except where a more detailed statement is otherwise
13    provided for by law, a short and plain statement of the
14    matters asserted, the consequences of a failure to respond,
15    and the official file or other reference number.
16        (5) A statement of the monetary value of the benefits
17    fraudulently received by the person accused.
18        (6) A statement that, in addition to any other
19    penalties provided by law, a civil penalty in an amount not
20    to exceed $2,000 may be imposed for each fraudulent claim
21    for benefits or payments.
22        (7) A statement providing that the determination of the
23    monetary value may be contested by petitioning the
24    Department for an administrative hearing within 30 days
25    from the date of mailing the notice.
26        (8) The names and mailing addresses of the

 

 

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1    administrative law judge, all parties, and all other
2    persons to whom the agency gives notice of the hearing
3    unless otherwise confidential by law.
4    An opportunity shall be afforded all parties to be
5represented by legal counsel and to respond and present
6evidence and argument.
7    Unless precluded by law, disposition may be made of any
8contested case by stipulation, agreed settlement, consent
9order, or default.
10    Any final order, decision, or other determination made,
11issued or executed by the Director under the provisions of this
12Article whereby any person is aggrieved shall be subject to
13review in accordance with the provisions of the Administrative
14Review Law, and the rules adopted pursuant thereto, which shall
15apply to and govern all proceedings for the judicial review of
16final administrative decisions of the Director.
17    Upon entry of a final administrative decision for repayment
18of any benefits obtained by fraudulent means, or for any civil
19penalties assessed, a lien shall attach to all property and
20assets of such person, firm, corporation, association, agency,
21institution, vendor, or other legal entity until the judgment
22is satisfied.
23    Within 18 months of the effective date of this amendatory
24Act of the 96th General Assembly, the Department of Healthcare
25and Family Services will report to the General Assembly on the
26number of fraud cases identified and pursued, and the fines

 

 

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1assessed and collected. The report will also include the
2Department's analysis as to the use of private sector resources
3to bring action, investigate, and collect monies owed.
4    (d) In subsections (a), (b), (b-5) and (b-6), "knowledge"
5has the meaning ascribed to that term in Section 4-5 of the
6Criminal Code of 2012. For any administrative action brought
7under subsection (c) pursuant to a violation of this Section,
8the Department shall define "knowing" by rule.
9(Source: P.A. 97-23, eff. 1-1-12; 98-354, eff. 8-16-13.)