Emma Gallimore May 23, 2016, 3:27pm

SPRINGFIELD - A new task force assembled by Illinois Gov. Bruce Rauner has been empaneled to root out some fraud in Medicaid and some other Illinois state health care reimbursement programs, in the hope of mitigating some of the budget issues facing the state. And health care providers should be ready to take a closer look at their billing practices to make sure they are not committing unforced errors, lawyers advised.

This spring, Rauner's office announced the governor had signed an executive order creating the state's Health Care Fraud Elimination Task Force.

Attorneys Dayna LaPlante and Matt Murer of Polsinelli PC in Chicago told the Cook County Record the task force could potentially help the state government "make a lot of money."

“Efforts to recoup improper reimbursements are big business for the government,” LaPlante said. 

According to the state press release announcing the executive order, Illinois spends more than $19 billion on state-state administered Medicaid programs and the State Employee Group Health Insurance Programs. The Health Care Fraud Elimination Task Force is tasked with investigating these and other taxpayer-funded programs.

Executive Inspector General Maggie Hickey will chair the Task Force, which will include the state's Deputy Governor, the Chief Compliance Officer and nine other government officials, including the Director of the Department on Aging, the Secretary of the Department of Innovation and Technology, and the Director of the Department of Insurance.

“The task force will take a holistic and comprehensive approach in the prevention and elimination of health care fraud, waste, and abuse in taxpayer-funded programs,” the release said.

“Whenever the government does a task force, the idea of going after fraud in government is always a politically positive or popular idea,” Murer said.

However, Murer said, most likely, the task force will spend more time on identifying and rectifying accidental errors than on rooting out intentional fraud.

“What happens is we say its fraud and abuse we’re going after and providers think: 'I’m a good provider, I don’t have anything to worry about,' but what happens is there’s so much scrutiny on billing errors, that really are errors. We’re talking about fraud in quotes,” Murer said. “The government is really looking to bring in revenue and they’re going to do that whether it’s an innocent mistake or whether its criminal fraud.”

With that in mind, LaPlante says that providers should see this as an opportunity to reexamine their billing processes to ensure that they are in compliance.

“They can say, let's make sure that we’re doing it correctly know so in the event that an audit comes out later, you’re kind of covering your bases,” LaPlante said. “Looking at your compliance and determining that you’re billing appropriately as a provider, that can only help you should the government come knocking.”

The executive order included a requirement for the task force to provide a report within six months. It is likely that this report will include recommendations for legislative changes and additional enforcement activities or enhanced investigations.

“The executive order really focuses on efficiency and really encouraging the task force to find the most efficient ways,” LaPlante said. “As the task force becomes even more efficient we’ll see increased actions related to it.”

Efficiency is even more important during a budget crisis. No provision has yet been made for additional funding to support the activities of the task force.

“It doesn’t appear that there’s a lot of money to throw at new initiatives,” Murer said. “Given the budget situation, I don’t see that happening.”

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Polsinelli PC
161 N Clark St
Chicago, IL 60601

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