All health care providers must be aware of the Illinois Insurance Claims Fraud Prevention Act (“IFCPA”) adopted in 2002 which is aimed at prosecuting fraudulent insurance claims filed against private insurance companies or self-insured entities (740 ILCS 92/1 et seq.  Illinois is one of only two states which have a private insurance whistleblower statute.
     The IFCPA can be violated in two ways by:
     (1) knowingly making or causing to be made a false claim on an insurance policy (the insurance fraud provision); or
     (2) knowingly offering or paying remuneration directly or indirectly, in cash or in kind, to induce any person to procure clients or patients to obtain services or benefits under a contract of insurance except as permitted by law (the Anti-Kickback provision). 
     This law is analogous to two federal statutes: (1) the False Claims Act, under which  providers who submit false claims to federal health care programs can be prosecuted for false claim submission; and (2) the federal Anti-Kickback Statute, under which individuals can be prosecuted for paying or receiving kickbacks in order to induce referrals of Medicare or Medicaid beneficiaries.
     There are both criminal and civil penalties for violation of the IFPCA.  Civil penalties include: $5,000 to $10,000 per false claim submitted under an insurance contract, plus three times the amount of each false claim; equitable relief to prevent the dissipation of illegal proceeds or to protect the public; and payment of attorneys fees and costs.  The court has the power to grant a temporary injunction to prevent the transfer or dissipation of illegal proceeds.
     Under the whistleblower provisions of the IFCPA, any “interested person, referred to as a “relator,” may bring a civil action for violation of the IFCPA.  To encourage reporting of suspected fraud, the relator receives at least less than 30% of recovered proceeds if the State’s Attorney or Attorney General decide to intervene, or at least 40% if the State declines to intervene.  A relator must be the first to file and the information related must not have been subject of any prior public disclosures.