Illinois Insurance Claims Fraud Prevention Act

The ICS has advised its members often: federal and state regulators have for some time prioritized the prevention and prosecution of health insurance fraud. The HHS Office of the Inspector General, in its Semiannual Report to Congress for the six-month period ending September 30, 2025 (“Report”) reported an improved return on investment to $12.70 in expected recoveries and receivables (money agreed to be repaid to HHS) for every $1 spent by the government.  To further bolster this program, laws have created incentives for private persons having knowledge of fraud – often referred to as “whistleblowers” – to assist the government by initiating litigation and sharing in money damages in successful cases.

As most doctors know, under federal law, any person or entity may be prosecuted for soliciting or receiving remuneration or “kickbacks” in exchange for referring patients for services under any federal health care program, including Medicare and Medicaid. And, under the federal False Claims Act, private individuals may assist the government in prosecuting these cases by bringing a lawsuit on behalf of the United States, where the private person has information that the named defendant has knowingly submitted false or fraudulent claims to the United States. The “whistleblower” (legally termed the “relator”) need not have been personally harmed by the defendant’s conduct in order to bring suit.