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| | 101ST GENERAL ASSEMBLY
State of Illinois
2019 and 2020
HB3272 Introduced , by Rep. Jim Durkin SYNOPSIS AS INTRODUCED:
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| 305 ILCS 5/8A-2.5 | | 305 ILCS 5/8A-6 | from Ch. 23, par. 8A-6 | 305 ILCS 5/8A-7 | from Ch. 23, par. 8A-7 | 305 ILCS 5/8A-11 | from Ch. 23, par. 8A-11 | 305 ILCS 5/8A-16 | | 305 ILCS 5/8A-17 | |
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Amends the Public Assistance Fraud Article of the Illinois Public Aid Code. Increases the criminal and civil penalties for medical assistance fraud committed by individuals and corporations.
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| | | CORRECTIONAL BUDGET AND IMPACT NOTE ACT MAY APPLY | | FISCAL NOTE ACT MAY APPLY |
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| 1 | | AN ACT concerning public aid.
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| 2 | | Be it enacted by the People of the State of Illinois,
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| 3 | | represented in the General Assembly:
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| 4 | | Section 5. The Illinois Public Aid Code is amended by |
| 5 | | changing Sections 8A-2.5, 8A-6, 8A-7, 8A-11, 8A-16, and 8A-17 |
| 6 | | as follows:
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| 7 | | (305 ILCS 5/8A-2.5)
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| 8 | | Sec. 8A-2.5. Unauthorized use of medical assistance.
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| 9 | | (a) Any person who knowingly uses, acquires, possesses, or |
| 10 | | transfers a
medical card in any manner not authorized by law or |
| 11 | | by rules and regulations of
the Illinois Department, or who |
| 12 | | knowingly alters a medical card, or who
knowingly uses, |
| 13 | | acquires, possesses, or transfers an altered medical card, is
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| 14 | | guilty of a violation of this Article and shall be punished as |
| 15 | | provided in
Section 8A-6.
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| 16 | | (b) Any person who knowingly obtains unauthorized medical |
| 17 | | benefits or causes to be obtained unauthorized medical benefits |
| 18 | | with or
without use of a medical card is guilty of a violation |
| 19 | | of this Article and
shall be punished as provided in Section |
| 20 | | 8A-6.
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| 21 | | (b-5) Any vendor that knowingly assists a person in |
| 22 | | committing a violation under subsection (a) or (b) of this |
| 23 | | Section is guilty of a violation of this Article and shall be |
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| 1 | | punished as provided in Section 8A-6. |
| 2 | | (b-6) Any person (including a vendor, organization, |
| 3 | | agency, or other entity) that, in any matter related to the |
| 4 | | medical assistance program, knowingly or willfully falsifies, |
| 5 | | conceals, or omits by any trick, scheme, artifice, or device a |
| 6 | | material fact, or makes any false, fictitious, or fraudulent |
| 7 | | statement or representation, or makes or uses any false writing |
| 8 | | or document, knowing the same to contain any false, fictitious, |
| 9 | | or fraudulent statement or entry in connection with the |
| 10 | | provision of health care or related services, is guilty of a |
| 11 | | violation of this Article and shall be punished as provided in |
| 12 | | Section 8A-6. |
| 13 | | (c) The Department may seek to recover any and all State |
| 14 | | and federal monies for which it has improperly and erroneously |
| 15 | | paid benefits as a result of a fraudulent action and any civil |
| 16 | | penalties authorized in this Section. Pursuant to Section |
| 17 | | 11-14.5 of this Code, the Department may determine the monetary |
| 18 | | value of benefits improperly and erroneously received. The |
| 19 | | Department may recover the monies paid for such benefits and |
| 20 | | interest on that amount at the rate of 5% per annum for the |
| 21 | | period from which payment was made to the date upon which |
| 22 | | repayment is made to the State. Prior to the recovery of any |
| 23 | | amount paid for benefits allegedly obtained by fraudulent |
| 24 | | means, the recipient or payee of such benefits shall be |
| 25 | | afforded an opportunity for a hearing after reasonable notice. |
| 26 | | The notice shall be served personally or by certified or |
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| 1 | | registered mail or as otherwise provided by law upon the |
| 2 | | parties or their agents appointed to receive service of process |
| 3 | | and shall include the following: |
| 4 | | (1) A statement of the time, place and nature of the |
| 5 | | hearing. |
| 6 | | (2) A statement of the legal authority and jurisdiction |
| 7 | | under which the hearing is to be held. |
| 8 | | (3) A reference to the particular Sections of the |
| 9 | | substantive and procedural statutes and rules involved. |
| 10 | | (4) Except where a more detailed statement is otherwise |
| 11 | | provided for by law, a short and plain statement of the |
| 12 | | matters asserted, the consequences of a failure to respond, |
| 13 | | and the official file or other reference number. |
| 14 | | (5) A statement of the monetary value of the benefits |
| 15 | | fraudulently received by the person accused. |
| 16 | | (6) A statement that, in addition to any other |
| 17 | | penalties provided by law, a civil penalty in an amount not |
| 18 | | to exceed $4,000 $2,000 may be imposed for each fraudulent |
| 19 | | claim for benefits or payments. |
| 20 | | (7) A statement providing that the determination of the |
| 21 | | monetary value may be contested by petitioning the |
| 22 | | Department for an administrative hearing within 30 days |
| 23 | | from the date of mailing the notice. |
| 24 | | (8) The names and mailing addresses of the |
| 25 | | administrative law judge, all parties, and all other |
| 26 | | persons to whom the agency gives notice of the hearing |
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| 1 | | unless otherwise confidential by law. |
| 2 | | An opportunity shall be afforded all parties to be |
| 3 | | represented by legal counsel and to respond and present |
| 4 | | evidence and argument. |
| 5 | | Unless precluded by law, disposition may be made of any |
| 6 | | contested case by stipulation, agreed settlement, consent |
| 7 | | order, or default. |
| 8 | | Any final order, decision, or other determination made, |
| 9 | | issued or executed by the Director under the provisions of this |
| 10 | | Article whereby any person is aggrieved shall be subject to |
| 11 | | review in accordance with the provisions of the Administrative |
| 12 | | Review Law, and the rules adopted pursuant thereto, which shall |
| 13 | | apply to and govern all proceedings for the judicial review of |
| 14 | | final administrative decisions of the Director. |
| 15 | | Upon entry of a final administrative decision for repayment |
| 16 | | of any benefits obtained by fraudulent means, or for any civil |
| 17 | | penalties assessed, a lien shall attach to all property and |
| 18 | | assets of such person, firm, corporation, association, agency, |
| 19 | | institution, vendor, or other legal entity until the judgment |
| 20 | | is satisfied. |
| 21 | | Within 18 months of the effective date of this amendatory |
| 22 | | Act of the 96th General Assembly, the Department of Healthcare |
| 23 | | and Family Services will report to the General Assembly on the |
| 24 | | number of fraud cases identified and pursued, and the fines |
| 25 | | assessed and collected. The report will also include the |
| 26 | | Department's analysis as to the use of private sector resources |
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| 1 | | to bring action, investigate, and collect monies owed. |
| 2 | | (d) In subsections (a), (b), (b-5) and (b-6), "knowledge" |
| 3 | | has the meaning ascribed to that term in Section 4-5 of the |
| 4 | | Criminal Code of 2012. For any administrative action brought |
| 5 | | under subsection (c) pursuant to a violation of this Section, |
| 6 | | the Department shall define "knowing" by rule. |
| 7 | | (Source: P.A. 97-23, eff. 1-1-12; 98-354, eff. 8-16-13.)
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| 8 | | (305 ILCS 5/8A-6) (from Ch. 23, par. 8A-6)
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| 9 | | Sec. 8A-6. Classification of violations.
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| 10 | | (a) Any person, firm, corporation,
association, agency, |
| 11 | | institution or other legal entity that has been found
by a |
| 12 | | court to have engaged in an act, practice or course of conduct |
| 13 | | declared
unlawful under Sections 8A-2 through 8A-5 or Section |
| 14 | | 8A-13 or 8A-14 where:
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| 15 | | (1) the total amount of money involved in the |
| 16 | | violation, including the
monetary value of federal food |
| 17 | | stamps and the value of commodities, is less
than $150, |
| 18 | | shall be guilty of a Class 4 felony Class A misdemeanor;
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| 19 | | (2) the total amount of money involved in the |
| 20 | | violation, including the
monetary value of federal food |
| 21 | | stamps and the value of commodities, is $150
or more but |
| 22 | | less than $1,000, shall be guilty of a Class 3 Class 4 |
| 23 | | felony;
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| 24 | | (3) the total amount of money involved in the |
| 25 | | violation, including the
monetary value of federal food |
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| 1 | | stamps and the value of commodities, is
$1,000 or more but |
| 2 | | less than $5,000, shall be guilty of a Class 2 Class 3 |
| 3 | | felony;
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| 4 | | (4) the total amount of money involved in the |
| 5 | | violation, including the
monetary value of federal food |
| 6 | | stamps and the value of commodities, is
$5,000 or more but |
| 7 | | less than $10,000, shall be guilty of a Class 1 Class 2 |
| 8 | | felony; or
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| 9 | | (5) the total amount of money involved in the |
| 10 | | violation, including the
monetary value of federal food |
| 11 | | stamps and the value of commodities, is
$10,000 or more, |
| 12 | | shall be guilty of a Class X Class 1 felony and, |
| 13 | | notwithstanding
the provisions of Section 8A-8 except for |
| 14 | | Subsection (c) of Section 8A-8,
shall be ineligible for |
| 15 | | financial aid under this Article for a period of
two years |
| 16 | | following conviction or until the total amount of money,
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| 17 | | including the value of federal food stamps, is repaid, |
| 18 | | whichever first occurs.
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| 19 | | (b) Any person, firm, corporation, association, agency, |
| 20 | | institution
or other legal entity that commits a subsequent |
| 21 | | violation of any of the
provisions of Sections 8A-2 through |
| 22 | | 8A-5 and:
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| 23 | | (1) the total amount of money involved in the |
| 24 | | subsequent violation,
including the monetary value of |
| 25 | | federal food stamps and the value of
commodities, is less |
| 26 | | than $150,
shall be guilty of a Class 3 Class 4 felony;
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| 1 | | (2) the total amount of money involved in the |
| 2 | | subsequent violation,
including the monetary value of |
| 3 | | federal food stamps and the value of
commodities, is $150 |
| 4 | | or more but
less than $1,000, shall be guilty of a Class 2 |
| 5 | | Class 3 felony;
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| 6 | | (3) the total amount of money involved in the |
| 7 | | subsequent violation,
including the monetary value of |
| 8 | | federal food stamps and the value of
commodities, is $1,000 |
| 9 | | or more
but less than $5,000, shall be guilty of a Class 1 |
| 10 | | Class 2 felony;
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| 11 | | (4) the total amount of money involved in the |
| 12 | | subsequent violation,
including the monetary value of |
| 13 | | federal food stamps and the value of
commodities, is $5,000 |
| 14 | | or more but
less than $10,000, shall be guilty of a Class X |
| 15 | | Class 1 felony.
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| 16 | | (c) For purposes of determining the classification of |
| 17 | | offense under
this Section, all of the money received as a |
| 18 | | result of the unlawful act,
practice or course of conduct can |
| 19 | | be accumulated.
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| 20 | | (Source: P.A. 90-538, eff. 12-1-97.)
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| 21 | | (305 ILCS 5/8A-7) (from Ch. 23, par. 8A-7)
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| 22 | | Sec. 8A-7. Civil Remedies. (a) A person who receives |
| 23 | | financial aid by
means of a false statement, willful |
| 24 | | misrepresentation or by his failure
to notify the county |
| 25 | | department or local governmental unit, as the case
may be, of a |
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| 1 | | change in his status as required by Sections 11-18 and 11-19,
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| 2 | | for the purpose of preventing the denial, cancellation or |
| 3 | | suspension of
his grant, or a variation in the amount thereof, |
| 4 | | or by other fraudulent
device, or a person who knowingly aids |
| 5 | | or abets any person in obtaining
financial aid for which he is |
| 6 | | not eligible, shall be answerable to the county
department or |
| 7 | | the local governmental unit, as the case may be, for refunding
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| 8 | | the entire amount of aid received. If the refund is not made, |
| 9 | | it shall be
recoverable in a civil action from the person who |
| 10 | | received the aid, or from
anyone who willfully aided such |
| 11 | | person to obtain the aid. If an act which
would be unlawful |
| 12 | | under Section 8A-2 is proven, the court may as a penalty
assess |
| 13 | | an additional sum of money, not to exceed the entire amount of |
| 14 | | aid
provided, against the recipient or against any person who |
| 15 | | willfully aided
the recipient. If assessed, the penalty shall |
| 16 | | be included in any judgment
entered for the aid received, and |
| 17 | | paid to the county department or the
local governmental unit, |
| 18 | | as the case may be. Upon entry of the judgment a
lien shall |
| 19 | | attach to all property and assets of such person until the
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| 20 | | judgment is satisfied.
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| 21 | | (b) Any person, firm, corporation, association, agency, |
| 22 | | institution or
other legal entity, other than an individual |
| 23 | | recipient, that willfully,
by means of a false statement or |
| 24 | | representation, or by concealment of any
material fact or by |
| 25 | | other fraudulent scheme or device on behalf of himself
or |
| 26 | | others, obtains or attempts to obtain benefits or payments |
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| 1 | | under this
Code to which he or it is not entitled, or in a |
| 2 | | greater amount than that
to which he or it is entitled, shall |
| 3 | | be liable for repayment of any excess
benefits or payments |
| 4 | | received and, in addition to any other penalties provided
by |
| 5 | | law, civil penalties consisting of (1) the interest on the |
| 6 | | amount of
excess benefits or payments at the maximum legal rate |
| 7 | | in effect on the date
the payment was made to such person, |
| 8 | | firm, corporation, association, agency,
institution or other |
| 9 | | legal entity for the period from the date upon which
payment |
| 10 | | was made to the date upon which repayment is made to the State,
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| 11 | | (2) an amount not to exceed 3 times the amount of such excess |
| 12 | | benefits or
payments, and (3) the sum of $4,000 $2,000 for each |
| 13 | | excessive claim for benefits
or payments. Upon entry of a |
| 14 | | judgment for repayment of any excess benefits
or payments, or |
| 15 | | for any civil penalties assessed by the court, a lien shall
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| 16 | | attach to all property and assets of such person, firm, |
| 17 | | corporation,
association, agency, institution or other legal |
| 18 | | entity until the judgment is satisfied.
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| 19 | | (c) Civil recoveries provided for in this Section may be |
| 20 | | recoverable in
court proceedings initiated by the Attorney |
| 21 | | General or, in actions
involving a local governmental unit, by |
| 22 | | the State's Attorney.
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| 23 | | (d) Any person who commits the offense of vendor fraud or |
| 24 | | recipient
fraud as defined in Section 8A-2 and Section 8A-3 of |
| 25 | | this Article shall
forfeit, according to the provisions
of this |
| 26 | | subsection, any monies, profits or proceeds, and any interest |
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| 1 | | or
property which the sentencing court determines he has |
| 2 | | acquired or maintained,
directly or indirectly, in whole or in |
| 3 | | part as a result of such offense.
Such person shall also |
| 4 | | forfeit any interest in, securities of, claim against,
or |
| 5 | | contractual right of any kind which affords him a source of |
| 6 | | influence
over, any enterprise which he has established, |
| 7 | | operated, controlled, conducted,
or participated in |
| 8 | | conducting, where his relationship to or connection with
any |
| 9 | | such thing or activity directly or indirectly, in whole or in |
| 10 | | part,
is traceable to any thing or benefit which he has |
| 11 | | obtained or acquired through
vendor fraud or recipient fraud.
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| 12 | | Proceedings instituted pursuant to this subsection shall |
| 13 | | be subject to
and conducted in accordance with the following |
| 14 | | procedures:
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| 15 | | (1) The sentencing court shall, upon petition by the |
| 16 | | Attorney General
or State's Attorney at any time following |
| 17 | | sentencing, conduct a hearing
to determine whether any property |
| 18 | | or property interest is subject to forfeiture
under this |
| 19 | | subsection. At the forfeiture hearing the People shall have
the |
| 20 | | burden of establishing, by a preponderance of the evidence, |
| 21 | | that the
property or property interests are subject to such |
| 22 | | forfeiture.
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| 23 | | (2) In any action brought by the People of the State of |
| 24 | | Illinois under
this Section, in which any restraining order, |
| 25 | | injunction or prohibition or
any other action in connection |
| 26 | | with any property or interest subject to
forfeiture under this |
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| 1 | | subsection is sought, the circuit court presiding
over the |
| 2 | | trial of the person charged with recipient fraud or
vendor |
| 3 | | fraud as defined in Sections 8A-2 or 8A-3 of this Article shall
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| 4 | | first determine whether there is probable cause to believe that |
| 5 | | the person
so charged has committed the offense of recipient |
| 6 | | fraud or
vendor fraud and whether the property or interest is |
| 7 | | subject to forfeiture
under this subsection. To make such a |
| 8 | | determination, prior to
entering any such order, the court |
| 9 | | shall conduct a hearing without a jury,
at which the People |
| 10 | | shall establish that there is (i) probable cause that
the |
| 11 | | person so charged has committed the offense of recipient
fraud |
| 12 | | or vendor fraud and (ii) probable cause that any property or |
| 13 | | interest
may be subject to forfeiture pursuant to this |
| 14 | | subsection. Such hearing may
be conducted simultaneously with a |
| 15 | | preliminary hearing, if the prosecution
is commenced by |
| 16 | | information or complaint, or by motion of the People at any
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| 17 | | stage in the proceedings. The court may accept a finding of |
| 18 | | probable cause
at a preliminary hearing following the filing of |
| 19 | | an information charging
the offense of recipient fraud or |
| 20 | | vendor fraud as defined in Sections 8A-2
or 8A-3 or the return |
| 21 | | of an indictment by a grand jury charging the offense
of |
| 22 | | recipient fraud or vendor fraud as defined in Sections 8A-2 or |
| 23 | | 8A-3 of
this Article as sufficient evidence of probable cause |
| 24 | | as provided in item
(i) above. Upon such a finding, the circuit |
| 25 | | court shall enter such
restraining order, injunction or |
| 26 | | prohibition, or shall take such other
action in connection with |
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| 1 | | any such property or other interest subject to
forfeiture under |
| 2 | | this Act as is necessary to insure that such property is
not |
| 3 | | removed from the jurisdiction of the court, concealed, |
| 4 | | destroyed or
otherwise disposed of by the owner of that |
| 5 | | property or interest prior to a
forfeiture hearing under this |
| 6 | | subsection. The Attorney General or State's
Attorney shall file |
| 7 | | a certified copy of such restraining order, injunction
or other |
| 8 | | prohibition with the recorder of deeds or registrar of titles |
| 9 | | of
each county where any such property of the defendant may be |
| 10 | | located. No
such injunction, restraining order or other |
| 11 | | prohibition shall affect the
rights of any bonafide purchaser, |
| 12 | | mortgagee, judgement creditor or other
lien holder arising |
| 13 | | prior to the date of such filing. The court may, at
any time, |
| 14 | | upon verified petition by the defendant, conduct a hearing to
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| 15 | | determine whether all or portions of any such property or |
| 16 | | interest which
the court previously determined to be subject to |
| 17 | | forfeiture
or subject to any restraining order, injunction, or |
| 18 | | prohibition or other
action, should be released. The court may |
| 19 | | in its discretion release such
property to the defendant for |
| 20 | | good cause shown.
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| 21 | | (3) Upon conviction of a person under this Article, the |
| 22 | | court shall
authorize the Director of the Illinois Department |
| 23 | | of State Police to seize
all property or other interest |
| 24 | | declared forfeited under this subsection upon
such terms and |
| 25 | | conditions as the court shall deem proper.
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| 26 | | (4) The Director of the Illinois Department of State Police |
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| 1 | | is
authorized to sell all property forfeited and seized |
| 2 | | pursuant to this
subsection, unless such property is
required |
| 3 | | by law to be destroyed or is harmful to the public.
After the |
| 4 | | deduction of all requisite expenses of administration and
sale, |
| 5 | | the court shall order the Director to distribute to the |
| 6 | | Illinois
Department an amount from the proceeds of the |
| 7 | | forfeited property, or monies
forfeited or seized, which will |
| 8 | | satisfy any unsatisfied court order of
restitution entered |
| 9 | | pursuant to a conviction under this Article. If the
proceeds |
| 10 | | are less than the amount necessary to satisfy the order of
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| 11 | | restitution, the Director shall distribute to the Illinois |
| 12 | | Department the
entire amount of the remaining proceeds. The |
| 13 | | Director shall distribute any
remaining proceeds of such sale, |
| 14 | | along with any monies forfeited or seized,
in accordance with |
| 15 | | the following schedules:
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| 16 | | (a) 25% shall be distributed to the unit of local |
| 17 | | government whose
officers or employees conducted the |
| 18 | | investigation into recipient fraud or
vendor fraud and caused |
| 19 | | the arrest or arrests and prosecution leading to
the |
| 20 | | forfeiture. Amounts distributed to units of local government |
| 21 | | shall be
used solely for enforcement matters relating to |
| 22 | | detection, investigation or
prosecution of recipient fraud or |
| 23 | | vendor fraud as defined in Section 8A-2
or 8A-3 of this |
| 24 | | Article. Where the investigation, arrest or arrests leading to
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| 25 | | the prosecution and forfeiture is undertaken solely by the |
| 26 | | Illinois
Department of State Police, the portion provided |
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| 1 | | hereunder shall be paid
into the Medicaid Fraud and Abuse |
| 2 | | Prevention Fund, which is hereby created
in the State treasury. |
| 3 | | Monies from this fund shall be used by the
Department of State |
| 4 | | Police for the furtherance of enforcement matters
relating to |
| 5 | | detection, investigation or prosecution of recipient fraud or
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| 6 | | vendor fraud. Monies directed to this fund shall be used in |
| 7 | | addition to,
and not as a substitute for, funds annually |
| 8 | | appropriated to the Department
of State Police for medicaid |
| 9 | | fraud enforcement.
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| 10 | | (b) 25% shall be distributed to the county in which the |
| 11 | | prosecution and
petition for forfeiture resulting in the |
| 12 | | forfeiture was instituted,
and deposited in a special fund in |
| 13 | | the county treasury
and appropriated to the State's Attorney |
| 14 | | for use solely in enforcement
matters relating to detection, |
| 15 | | investigation or prosecution of recipient
fraud or vendor |
| 16 | | fraud; however, if the Attorney General brought the
prosecution |
| 17 | | resulting in the forfeiture, the portion provided hereunder
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| 18 | | shall be paid into the Medicaid Fraud and Abuse Prevention |
| 19 | | Fund, to be used
by the Medicaid Fraud Control Unit of the |
| 20 | | Illinois Department of State Police
for enforcement matters |
| 21 | | relating to detection, investigation or prosecution
of |
| 22 | | recipient fraud or vendor fraud. Where the Attorney General and |
| 23 | | a
State's Attorney have jointly participated in any portion of |
| 24 | | the
proceedings, 12.5% shall be distributed to the county in |
| 25 | | which the
prosecution resulting in the forfeiture was |
| 26 | | instituted, and used as
specified herein, and 12.5% shall be |
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| 1 | | paid into the Medicaid Fraud and Abuse
Prevention Fund, and |
| 2 | | used as specified herein.
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| 3 | | (c) 50% shall be transmitted to the State Treasurer for |
| 4 | | deposit in the
General Revenue Fund.
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| 5 | | (Source: P.A. 85-707.)
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| 6 | | (305 ILCS 5/8A-11) (from Ch. 23, par. 8A-11)
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| 7 | | Sec. 8A-11. (a) No person shall:
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| 8 | | (1) Knowingly charge a resident of a nursing home for |
| 9 | | any services
provided pursuant to Article V of the Illinois |
| 10 | | Public Aid Code, money or
other consideration at a rate in |
| 11 | | excess of the rates established for covered
services by the |
| 12 | | Illinois Department pursuant to Article V of the Illinois
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| 13 | | Public Aid Code; or
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| 14 | | (2) Knowingly charge, solicit, accept or receive, in |
| 15 | | addition to any
amount otherwise authorized or required to |
| 16 | | be paid pursuant to Article V of
the Illinois Public Aid |
| 17 | | Code, any gift, money, donation or other consideration:
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| 18 | | (i) As a precondition to admitting or expediting |
| 19 | | the admission of a
recipient or applicant, pursuant to |
| 20 | | Article V of the Illinois Public Aid Code,
to a |
| 21 | | long-term care facility as defined in Section 1-113 of |
| 22 | | the Nursing
Home Care Act or a facility as defined in |
| 23 | | Section 1-113 of the ID/DD Community Care Act, Section |
| 24 | | 1-113 of the MC/DD Act, or Section 1-102 of the |
| 25 | | Specialized Mental Health Rehabilitation Act of 2013; |
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| 1 | | and
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| 2 | | (ii) As a requirement for the recipient's or |
| 3 | | applicant's continued stay
in such facility when the |
| 4 | | cost of the services provided therein to the
recipient |
| 5 | | is paid for, in whole or in part, pursuant to Article V |
| 6 | | of the
Illinois Public Aid Code.
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| 7 | | (b) Nothing herein shall prohibit a person from making a |
| 8 | | voluntary
contribution, gift or donation to a long-term care |
| 9 | | facility.
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| 10 | | (c) This paragraph shall not apply to agreements to provide |
| 11 | | continuing
care or life care between a life care facility as |
| 12 | | defined by the Life
Care Facilities Act, and a person |
| 13 | | financially eligible for benefits pursuant to
Article V of the |
| 14 | | Illinois Public Aid Code.
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| 15 | | (d) Any person who violates this Section shall be guilty of |
| 16 | | a business
offense and fined not less than $10,000 $5,000 nor |
| 17 | | more than $50,000 $25,000.
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| 18 | | (e) "Person", as used in this Section, means an individual, |
| 19 | | corporation,
partnership, or unincorporated association.
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| 20 | | (f) The State's Attorney of the county in which the |
| 21 | | facility is located
and the Attorney General shall be notified |
| 22 | | by the Illinois Department of
any alleged violations of this |
| 23 | | Section known to the Department.
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| 24 | | (g) The Illinois Department shall adopt rules and |
| 25 | | regulations to carry
out the provisions of this Section.
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| 26 | | (Source: P.A. 98-104, eff. 7-22-13; 99-180, eff. 7-29-15.)
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| 1 | | (305 ILCS 5/8A-16)
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| 2 | | Sec. 8A-16. Unfair or deceptive marketing practices.
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| 3 | | (a) As used in this Section, "health plan" has the meaning |
| 4 | | attributed to
that term in Section 8A-13.
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| 5 | | (b) It is unlawful to knowingly and willfully engage in any |
| 6 | | unfair or
deceptive marketing practice
in connection with |
| 7 | | proposing, offering, selling, soliciting, or providing any
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| 8 | | health care service or any health plan. Unfair or deceptive |
| 9 | | marketing
practices include the following:
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| 10 | | (1) Making a false and misleading oral or written |
| 11 | | statement, visual
description, advertisement, or other |
| 12 | | representation of any kind that has the
capacity, tendency, |
| 13 | | or effect of deceiving or misleading health care consumers
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| 14 | | with respect to any health care service, health plan, or |
| 15 | | health care provider.
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| 16 | | (2) Making a representation that a health care plan or |
| 17 | | a health care
provider offers any service, benefit, access |
| 18 | | to care, or choice that it does
not in fact offer.
|
| 19 | | (3) Making a representation that a health plan or |
| 20 | | health care provider has
any status, certification, |
| 21 | | qualification, sponsorship, affiliation, or
licensure that |
| 22 | | it does not have.
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| 23 | | (4) A failure to state a material fact if the failure |
| 24 | | deceives or tends to
deceive.
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| 25 | | (5) Offering any kickback, bribe, reward, or benefit to |
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| 1 | | any person as an
inducement to select or to refrain from |
| 2 | | selecting any health care service,
health plan, or health |
| 3 | | care provider, unless the benefit offered is medically
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| 4 | | necessary health care or is permitted by the Illinois |
| 5 | | Department.
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| 6 | | (6) The use of health care consumer or other |
| 7 | | information that is
confidential or privileged or that |
| 8 | | cannot be disclosed to or obtained by the
user without |
| 9 | | violating a State or federal confidentiality law, |
| 10 | | including:
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| 11 | | (A) medical records information; and
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| 12 | | (B) information that identifies the health care |
| 13 | | consumer or any member
of his or her group as a |
| 14 | | recipient of any government sponsored or mandated
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| 15 | | welfare program.
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| 16 | | (7) The use of any device or artifice in advertising a |
| 17 | | health plan or
soliciting a health care consumer that |
| 18 | | misrepresents the solicitor's
profession, status, |
| 19 | | affiliation, or mission.
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| 20 | | (c) Any person who commits a first violation of this |
| 21 | | Section is guilty of a
Class
4
felony A misdemeanor and is |
| 22 | | subject to a fine of not more than $10,000 $5,000. Any person |
| 23 | | who
commits a second or subsequent violation of this Section is |
| 24 | | guilty of a Class 3 4
felony and is subject to a fine of not |
| 25 | | more than $50,000 $25,000.
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| 26 | | (Source: P.A. 90-538, eff. 12-1-97.)
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| 1 | | (305 ILCS 5/8A-17)
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| 2 | | Sec. 8A-17. Penalties enhanced for persons other than |
| 3 | | individuals. If a
person who violates Section 8A-13, 8A-14, |
| 4 | | 8A-15, or 8A-16 is any person other
than an individual, then |
| 5 | | that person is subject to a fine of not more than
$100,000 |
| 6 | | $50,000 if the violation is a Class 1, 2, 3, or 4 felony |
| 7 | | misdemeanor and a fine of not more than $500,000 $250,000
if |
| 8 | | the violation is a Class X felony a felony.
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| 9 | | (Source: P.A. 90-538, eff. 12-1-97.)
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