SIU Today Fall 2021 - 18

all, not every insurer wants to make the proverbial " federal case "
out of having fallen prey to an organized ring.
The Illinois statute is similar to many other state statutes and
is also quite straightforward. Under the statute:
1. A person commits 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 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.
2. A person commits health care benefits fraud against a
provider, other than a governmental unit or agency, when he
or she knowingly obtains or attempts to obtain, by deception,
health care benefits and that obtaining or attempt to obtain
health care benefits does not involve control over property
of the provider.
mail fraud, a plaintiff must establish: (i) the existence of a
scheme to defraud; (ii) the defendant's knowing or intentional
participation in the scheme; and (iii) the use of interstate mails
in furtherance of a scheme.
Success at trial on a civil RICO claim entitles a plaintiff to triple
damages, reasonable costs associated with prosecuting the case
and reasonable attorney's fees. The statute of limitations for filing
a civil RICO case is four years from the date the claim accrued.
It is important to understand that all statutes of limitations
have some elasticity but can also expire sooner than we might
think they do. It is not unexpected that parties to insurance
fraud cases might spend considerable time litigating the statute
of limitations. This issue could easily occupy its own treatise,
let alone its own article. Suffice to say, it is crucial that every
investigator on the trail of an organized activity ring keep an
eye on the calendar.
Some states, including Illinois,
The statute of limitations under this statute is five years. If a
defendant is found guilty of civil insurance fraud in Illinois, he
or she will be liable for three times the value of the property
wrongfully obtained, or if no property was wrongfully obtained,
two times the value of the property attempted to be obtained,
whichever amount is greater, plus reasonable attorney's fees.
In other words, Illinois outlaws the mere attempt to commit
fraud, and does not penalize an insurer that scrutinizes well
and thus does not fall prey to fraudulent billing. An insurer
still can pursue recovery of twice the amount of the unpaid
fraudulent bill.
target insurance fraud
specifically by statute. These statutes can be very helpful
because they provide remedies similar to those available under
RICO, but do not necessitate suit filing in federal court. After
18 SIU TODAY | FALL 2021
The elements of common law fraud generally are the same
just about everywhere. To prevail on allegations of common
law fraud an entity must prove that: (1) a defendant made a
false statement of material fact; (2) the defendant knew that
the statement was false; (3) the defendant intended that the
statement would induce the plaintiff to act; (4) the plaintiff
relied upon that statement; and (5) the plaintiff suffered
damages resulting from reliance on the statement. In Illinois
the statute of limitations for a common law fraud case is five
years. A plaintiff alleging fraud may seek recovery of any sums
it lost to the fraud, as well as punitive damages and costs.
Common law fraud demands a high standard of pleading.
A plaintiff must allege the supposed fraud with sufficient
specificity, particularity and certainty to apprise the defendant

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