• Illinois Creates Health Care Fraud Elimination Task Force
  • April 26, 2016 | Authors: Katherine S. Makielski; Heather M. O'Shea
  • Law Firm: Jones Day - Chicago Office
  • On April 5, 2016, Illinois Governor Bruce Rauner signed Executive Order 16-05, creating a new Health Care Fraud Elimination Task Force to address fraud, abuse, and waste in the state's health care programs. The Task Force will be led by Executive Inspector General Maggie Hickey and consist of 11 other designated officials, including the Director of the State Police Medicaid Fraud Control Unit. Unless further renewed by Executive Order, the Task Force is currently scheduled to continue until June 30, 2019.

    According to the Executive Order and associated press release from the Governor's Office, the Task Force is directed to take a "comprehensive," "holistic," and "cross-agency, data-driven" approach to preventing and eliminating health care fraud, waste, and abuse in taxpayer-funded programs (e.g., the Illinois Medicaid program, the State Employees Group Insurance Program, and the Workers' Compensation Program for Illinois agencies, boards, and commissions). The Executive Order highlights Illinois's FY 2015 expenditure of more than $19 billion on state health care programs (Medicaid and group insurance) and notes the innovative and successful anti-fraud efforts being taken by the federal government, other states, the private sector, and various Illinois state agencies. The Task Force will reportedly draw on these approaches and other information gathered to recommend strategies for improving Illinois's fraud prevention and enforcement efforts.

    Specifically, the Task Force has been charged with gathering information on areas such as:
    • The forms of fraud currently present in state-administered health care programs, including patterns of systemwide fraud and abuse.
    • State agencies and resources currently involved in health care fraud prevention and enforcement.
    • Best practices for fraud prevention and enforcement used by the private sector, the federal government, and other states.
    • The use of data analysis, predictive analysis, trend evaluation, and modeling approaches.
    Additionally, the Executive Order directs the Task Force to, among other things:
    • Develop, in tandem with industry experts, a multifaceted strategy for reducing exposure to fraud and recovering taxpayer funds.
    • Recommend improved internal controls for state agencies.
    • Identify, if applicable, additional agencies and resources that should be involved in health care fraud prevention and enforcement.
    • Assess how the observed best practices can be applied in Illinois.
    • Prioritize prevention and enforcement areas to optimize taxpayer investment.
    The Task Force is required to conduct at least one public meeting per quarter and, by October 2016, submit an initial report to Governor Rauner on the initial identification efforts. Following the October report, periodic reports will be made to the governor and public on the Task Force's progress.