Article 46: Illinois Fraud Law

Illinois Criminal Code of 1961 - Article 46

Sec. 46-1. Insurance fraud.
    (720 ILCS 5/46-1)

(a) A person commits the offense of insurance fraud when he or she knowingly obtains, attempts to obtain, or causes to be obtained, by deception, control over the property of an insurance company or self-insured entity by the making of a false claim or by causing a false claim to be made on any policy of insurance issued by an insurance company or by the making of a false claim to a self-insured entity, intending to deprive an insurance company or self-insured entity permanently of the use and benefit of that property.

(b) Sentence.

(1) A violation of this Section in which the value of the property obtained or attempted to be obtained is $300 or less is a Class A misdemeanor.

(2) A violation of the Section in which the value of the property obtained or attempted to be obtained is more than $300 but not more than $10,000 is a Class 3 felony.

(3) A violation of this Section in which the value of the property obtained or attempted to be obtained is more than $10,000 but not more than $100,000 is a Class 2 felony.

(4) A violation of this Section in which the value of the property obtained or attempted to be obtained is more than $100,000 is a Class 1 felony.

(5) A person convicted of insurance fraud, vendor fraud, or a federal criminal violation associated with defrauding the Medicaid program shall be ordered to pay monetary restitution to the insurance company or self-insured entity or any other person for any financial loss sustained as a result of a violation of this Section, including any court costs and attorney fees. An order of restitution also includes expenses incurred and paid by the State of Illinois or an insurance company or self-insured entity in connection with any medical evaluation or treatment services.

(c) For the purposes of this Article, where the exact value of property obtained or attempted to be obtained is either not alleged by the accused or not specifically set by the terms of a policy of insurance, the value of the property shall be the fair market replacement value of the property claimed to be lost, the reasonable costs of reimbursing a vendor or other claimant for services to be rendered, or both.

(d) Definitions. For the purposes of this Article:

(1) "Insurance company" means "company" as defined under Section 2 of the Illinois Insurance Code.

(2) "Self-insured entity" means any person, business, partnership, corporation, or organization that sets aside funds to meet his, her, or its losses or to absorb fluctuations in the amount of loss, the losses being charged against the funds set aside or accumulated.

(3) "Obtain", "obtains control", "deception",

"property" and "permanent deprivation" have the meanings ascribed to those terms in Article 15 of this Code.

(4) "Governmental entity" means each officer, board, commission, and agency created by the constitution, whether in the executive, legislative, or judicial branch of State government; each officer, department, board, commission, agency, institution, authority, university, and body politic and corporate of the State; each administrative unit or corporate outgrowth of State government that is created by or pursuant to statute, including units of local government and their officers, school districts, and boards of election commissioners; and each administrative unit or corporate outgrowth of the above and as may be created by executive order of the Governor.

(5) "False claim" means any statement made to any insurer, purported insurer, servicing corporation, insurance broker, or insurance agent, or any agent or employee of the entities, and made as part of, or in support of, a claim for payment or other benefit under a policy of insurance, or as part of, or in support of, an application for the issuance of, or the rating of, any insurance policy, when the statement contains any false, incomplete, or misleading information concerning any fact or thing material to the claim, or conceals the occurrence of an event that is material to any person's initial or continued right or entitlement to any insurance benefit or payment, or the amount of any benefit or payment to which the person is entitled.

(6) "Statement" means any assertion, oral, written, or otherwise, and includes, but is not limited to, any notice, letter, or memorandum; proof of loss; bill of lading; receipt for payment; invoice, account, or other financial statement; estimate of property damage; bill for services; diagnosis or prognosis; prescription; hospital, medical or dental chart or other record, x-ray, photograph, videotape, or movie film; test result; other evidence of loss, injury, or expense; computer-generated document; and data in any form. (Source: P.A. 94-577, eff. 1-1-06.)

Sec. 46-1.1. Fraud on a governmental entity.
    (720 ILCS 5/46-1.1)

(a) A person commits the offense of fraud on a governmental entity when he or she knowingly obtains, attempts to obtain, or causes to be obtained, by deception, control over the property of any governmental entity by the making of a false claim of bodily injury or of damage to or loss or theft of property or by causing a false claim of bodily injury or of damage to or loss or theft of property to be made against the governmental entity, intending to deprive the governmental entity permanently of the use and benefit of that property.

(b) Sentence.

(1) A violation of this Section in which the value of the property obtained or attempted to be obtained is $300 or less is a Class A misdemeanor.

(2) A violation of this Section in which the value of the property obtained or attempted to be obtained is more than $300 but not more than $10,000 is a Class 3 felony.

(3) A violation of this Section in which the value of the property obtained or attempted to be obtained is more than $10,000 but not more than $100,000 is a Class 2 felony.

(4) A violation of this Section in which the value of the property obtained or attempted to be obtained is more than $100,000 is a Class 1 felony. (Source: P.A. 90-333, eff. 1-1-98; 91-232, eff. 1-1-00.)

Sec. 46-2. Aggravated fraud.
    (720 ILCS 5/46-2)

(a) A person commits the offense of aggravated fraud when he or she, within an 18 month period, obtains, attempts to obtain, or causes to be obtained, by deception, control over the property of an insurance company or insurance companies, a self-insured entity or self-insured entities, or any governmental entity or governmental entities by the making of 3 or more false claims or by causing 3 or more false claims to be made arising out of separate incidents or transactions in violation of Section 46-1 or 46-1.1 of this Code.

(b) Sentence. A violation of this Section is a Class 1 felony, regardless of the value of the property obtained, attempted to be obtained, or caused to be obtained. (Source: P.A. 90-333, eff. 1-1-98; 91-232, eff. 1-1-00.)

Sec. 46-3. Conspiracy to commit fraud.
    (720 ILCS 5/46-3)

(a) A person commits conspiracy to commit fraud when, with the intent that a violation of Section 46-1, 46-1.1, or 46-2 of this Code be committed, he agrees with another to violate Section 46-1, 46-1.1, or 46-2. No person may be convicted of conspiracy to commit fraud unless an overt act or acts in furtherance of the agreement is alleged and proved to have been committed by him or by a co-conspirator and the accused is a part of a common scheme or plan to engage in the unlawful activity. Where the offense agreed to be committed is a violation of Section 46-2, the person or persons with whom the accused is alleged to have agreed to commit the 3 or more violations of Section 46-1 or 46-1.1 need not be the same person or persons for each violation, as long as the accused was a part of the common scheme or plan to engage in each of the 3 or more alleged violations.

(b) It is not a defense to conspiracy to commit fraud that the person or persons with whom the accused is alleged to have conspired:

(1) have not been prosecuted or convicted;

(2) have been convicted of a different offense;

(3) are not amenable to justice;

(4) have been acquitted; or

(5) lacked the capacity to commit an offense.

(c) Notwithstanding Section 8-5 of this Code, a person may be convicted and sentenced both for the offense of conspiracy to commit fraud and for any other offense that is the object of the conspiracy.

(d) Conspiracy to commit fraud involving a violation of Section 46-1 or 46-1.1 of this Code is a Class 2 felony. Insurance fraud conspiracy involving a violation of Section 46-2 of this Code is a Class 1 felony. (Source: P.A. 90-333, eff. 1-1-98.)

Sec. 46-4. Organizer of an aggravated fraud conspiracy.
    (720 ILCS 5/46-4)

(a) A person commits the offense of being an organizer of an aggravated fraud conspiracy when he:

(1) with the intent that a violation of Section 46-2 of this Code be committed, agrees with another to the commission of that offense; and

(2) with respect to other persons within the conspiracy, occupies a position of organizer, supervisor, financer, or other position of management.

No person may be convicted of the offense of being an organizer of an aggravated fraud conspiracy unless an overt act or acts in furtherance of the agreement is alleged and proved to have been committed by him or by a co-conspirator and the accused is part of a common scheme or plan to engage in the unlawful activity. For the purposes of this Section, the person or persons with whom the accused is alleged to have agreed to commit the 3 or more violations of Section 46-1 or 46-1.1 of this Code need not be the same person or persons for each violation, as long as the accused occupied a position of organizer, supervisor, financer, or other position of management in each of the 3 or more alleged violations.

(b) It is not a defense to the offense of being an organizer of an aggravated fraud conspiracy that the person or persons with whom the accused is alleged to have conspired:

(1) have not been prosecuted or convicted;

(2) have been convicted of a different offense;

(3) are not amenable to justice;

(4) have been acquitted; or

(5) lacked the capacity to commit an offense.

(c) Notwithstanding Section 8-5 of this Code, a person may be convicted and sentenced both for the offense of being an organizer of an aggravated fraud conspiracy and for any other offense that is the object of the conspiracy.

(d) The offense of being an organizer of an aggravated fraud conspiracy is a Class X felony. (Source: P.A. 90-333, eff. 1-1-98; 91-357, eff. 7-29-99.)

Sec. 46-5. Civil damages for insurance fraud or fraud on a governmental entity.
    (720 ILCS 5/46-5)

(a) A person who knowingly obtains, attempts to obtain, or causes to be obtained, by deception, control over the property of any insurance company by the making of a false claim or by causing a false claim to be made on a policy of insurance issued by an insurance company, or by the making of a false claim or by causing a false claim to be made to a self-insured entity intending to deprive an insurance company or self-insured entity permanently of the use and benefit of that property, shall be civilly liable to the insurance company or self-insured entity that paid the claim or against whom the claim was made or to the subrogee of that insurance company or self-insured entity in an amount equal to either 3 times the value of the property wrongfully obtained or, if no property was wrongfully obtained, twice the value of the property attempted to be obtained, whichever amount is greater, plus reasonable attorneys fees. A person who knowingly obtains, attempts to obtain, or causes to be obtained, by deception, control over the property of a governmental entity by the making of a false claim of bodily injury or of damage to or loss or theft of property, intending to deprive the governmental entity permanently of the use and benefit of that property, shall be civilly liable to the governmental entity that paid the claim or against whom the claim was made or to the subrogee of the governmental entity in an amount equal to either 3 times the value of the property wrongfully obtained or, if property was not wrongfully obtained, twice the value of the property attempted to be obtained, whichever amount is greater, plus reasonable attorneys fees.

(b) An insurance company or self-insured entity that brings an action against a person under subsection (a) of this Section in bad faith shall be liable to that person for twice the value of the property claimed, plus reasonable attorneys fees. In determining whether an insurance company or self-insured entity acted in bad faith, the court shall relax the rules of evidence to allow for the introduction of any facts or other information on which the insurance company or self-insured entity may have relied in bringing an action under subsection (a) of this Section.

(c) For the purposes of this Section, where the exact value of the property attempted to be obtained is either not alleged by the claimant or not specifically set by the terms of a policy of insurance, the value of the property shall be the fair market replacement value of the property claimed to be lost, the reasonable costs of reimbursing a vendor or other claimant for services to be rendered, or both. (Source: P.A. 90-333, eff. 1-1-98; 91-232, eff. 1-1-00.)

Sec. 46-6. Actions by State licensing agencies.
    (720 ILCS 5/46-6)

(a) All State licensing agencies, the Illinois State Police, and the Department of Financial and Professional Regulation shall coordinate enforcement efforts relating to acts of insurance fraud. (b) If a person who is licensed or registered under the laws of the State of Illinois to engage in a business or profession is convicted of or pleads guilty to engaging in an act of insurance fraud, the Illinois State Police must forward to each State agency by which the person is licensed or registered a copy of the conviction or plea and all supporting evidence. (c) Any agency that receives information under this Section shall, not later than 6 months after the date on which it receives the information, publicly report the final action taken against the convicted person, including but not limited to the revocation or suspension of the license or any other disciplinary action taken. (Source: P.A. 94-577, eff. 1-1-06.)