720 ILCS 5/17-10.5(a)(2) – Health Care Benefits Fraud
This law makes it illegal to trick or lie to get health care benefits from a private provider.
This Illinois law says that a person commits insurance fraud when they knowingly use lies or deception to obtain health care benefits from a private provider. If caught, the person can face a Class A misdemeanor charge.
(a) Insurance fraud.
- A person commits health care benefits fraud against a provider that is not part of the government when they knowingly try to get or actually get health care benefits through lying or tricking the provider. This kind of fraud happens when the person’s actions do not involve taking control of the provider’s property.
(d) Sentence.
- Sentence: Breaking the rule in part (a)(2) is a Class A misdemeanor, which can include up to one year in jail and a fine.
- Anyone found guilty must repay the insurance company or other victims for financial losses, including court costs and attorney’s fees.
- A person can also be punished for both committing insurance fraud and plotting or organizing insurance fraud.
(e) Civil damages for insurance fraud.
- If someone lies to get money from an insurance company, they must pay back either three times the money wrongfully received or twice the value of what they tried to get–whichever is higher–plus attorney’s fees.
- However, if an insurance company sues someone in bad faith (without good reason), that company must pay the person twice the amount claimed, plus attorney’s fees.
(f) Determination of property value. If the exact dollar amount isn’t listed, the “value” means the fair market replacement value or the reasonable cost to replace or reimburse services.
(g) Actions by State licensing agencies.
- State police and licensing agencies must work together to enforce this law.
- If someone with a professional license in Illinois is convicted of insurance fraud, the Illinois State Police must tell all licensing agencies.
- Those agencies must report within 6 months on what actions were taken, such as suspending or revoking the person’s license.
(h) Definitions. Words like “obtain,” “deception,” and “property” have the same meanings as they do in Article 15 of the Illinois Criminal Code.
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