HR1104 100TH GENERAL ASSEMBLY

HR1104 LRB100 22076 KTG 40319 r

HOUSE RESOLUTION

WHEREAS, Over 3 million low-income children, pregnant women, adults, seniors, and people with disabilities are currently enrolled in the Illinois Medical Assistance Program (Medicaid) administered by the Department of Healthcare and Family Services; and

WHEREAS, In Fiscal Year 2016, State spending on Medicaid services reached over $19 billion; and

WHEREAS, It is estimated that 10% of all Medicaid claims made to the Department of Healthcare and Family Services are fraudulent accounting for an annual loss of $2 billion in State moneys; and

WHEREAS, Most Medicaid fraud is committed by doctors, nurses, pharmacists, and other medical providers who submit false claims or employ fraudulent schemes to obtain Medicaid funds, including billing for services not rendered, billing duplicate times for one service, falsifying a diagnosis, billing for a more costly service than performed, accepting kickbacks for patient referrals, billing for a covered service when a noncovered service was provided, ordering excessive or inappropriate tests, prescribing medicines that are not medically necessary or for use by people other than the patient, or billing related tests or procedures as individual visits to drive up the total cost; and

WHEREAS, Medicaid fraud and abuse divert State and federal funding from legitimate health care services, increase State health care costs, and expose persons eligible for Medicaid services to unnecessary and potentially harmful medical procedures; and

WHEREAS, Illinois has a vested interest in preventing Medicaid provider fraud in order to safeguard the integrity of the Illinois Medical Assistance Program, contain health care costs, and ensure that persons eligible for medical assistance have access to high quality health care; therefore, be it

RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE ONE HUNDREDTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that we urge the Department of Healthcare and Family Services to take a more aggressive approach to preventing and detecting provider fraud and abuse under the Illinois Medical Assistance Program by identifying and eliminating program deficiencies that enable Medicaid providers to overbill and falsify Medicaid claims, including billing for services not rendered, charging more than the fair-market value for covered services, and admitting Medicaid beneficiaries for inappropriate hospital stays; and be it further

RESOLVED, That a suitable copy of this resolution be delivered to the Director of the Department of Healthcare and Family Services.