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The Illinois Department of Healthcare and Family Services (HFS), formerly the Department of Public Aid, [1] is the code department [2] [3] of the Illinois state government that is responsible for providing healthcare coverage for adults and children who qualify for Medicaid, and for providing child support services to help ensure that Illinois children receive financial support from both parents.
Health care fraud includes "snake oil" marketing, health insurance fraud, drug fraud, and medical fraud. Health insurance fraud occurs when a company or an individual defrauds an insurer or government health care program, such as Medicare (United States) or equivalent State programs. The manner in which this is done varies, and persons engaging ...
Forms of fraud by health insurance companies include the wrongful denial of claims, wrongful cancellation of coverage, and underpayment of hospitals and physicians. [2] [3] When detected, health insurance fraud can result in civil liability as well as criminal penalties, and potential action against a healthcare provider's license. [35] [36]
Disability fraud can be harder to detect than other forms of fraud, as the majority of people receiving disability payments (at least 90%) do not use a wheelchair or walker, or uses a wheelchair but is able to walk limited distances sometimes, while at the same time, many people who need wheelchairs would not qualify for disability payments. [2]
Claims under the law have typically involved government health care programs (Medicare, Medicaid and TriCare), military, or other government spending programs. FCA actions dominate the list of largest pharmaceutical settlements. Between 1987 and 2019, the government recovered more than $62 billion under the False Claims Act. [5]
A case of Medicaid fraud was carried out in 2010 by an Armenian-American organized crime group called the Mirzoyan–Terdjanian organization. [1] [2] The scam involved a crime syndicate which created 118 fake clinics in 25 states and used stolen medical license numbers of real doctors and matched them to legitimate Medicare patients whose names and billing information were also stolen.
The Illinois Department of Human Services (IDHS) is the department [1] [2] of the Illinois state government responsible for providing a wide variety of safety net services to Illinois residents in poverty, who are facing other economic challenges, or who have any of a variety of disabilities. As of 2006, it was the largest administrative agency ...
Key insurance industries it regulates include health insurance, auto insurance, homeowners insurance, and life insurance. [1] The department is the umbrella agency that operates the Illinois Health Benefits Exchange (IHBE), a health insurance marketplace that serves as an intermediary between Illinois residents and the health-insurance mandate ...