Consumer Fraud

Anti-insurance-fraud coalition objects to Illinois court’s ruling against whistleblower

whistleblower Anti insurance fraud coalition objects to Illinois court’s ruling against whistleblowerThe Coalition Against Insurance Fraud has filed an amicus brief in Illinois state appellate court following a lower court’s ruling that struck down a physical therapist’s whistleblower complaint.

According to the Property Casualty 360, the Coalition believes the Illinois court’s decision will weaken the state’s whistleblowing laws and diminish fraud-fighting efforts there.

The objectionable ruling centers on complaint brought by Jocelyn Zolna-Pitts against her former employer accusing the clinic of routinely overbilling insurers for patient services. Ms. Zolna-Pitts filed her whistleblower lawsuit in an Illinois Circuit Court under the state’s Insurance Claims Fraud Prevention Act.

The court dismissed the lawsuit, however, saying that the Act permitted individuals to sue only for violations of the anti-kickback provisions of the Illinois criminal code but not for other violations.

Property Casualty 360 notes that the wording of the state’s whistleblower law states that any private citizen can file a civil claim “when any of provision of the state’s criminal code is violated.”

“The Circuit Court failed to account for the purpose and legislative history of the Act – to encourage and empower private citizens to bring a civil suit against the perpetrators of all forms of insurance fraud,” the Coalition argued in its brief.

Property Casualty 360 says the Illinois Circuit Court’s interpretation of the law had “the exact opposite of the intent of the state’s whistleblower law, which encourages private citizens to come forward and expose wrongdoers.”

“This case implicates the Coalition’s core interests,” the group said in the amicus brief. “It involves the proper interpretation of the Insurance Claims Fraud Prevention Act – a law that the Illinois General Assembly enacted to impose civil penalties against perpetrators of all forms of insurance fraud directed at private payers, including kickback schemes and more classic forms of insurance fraud.”

“The Act achieves these goals,” the Coalition added, “by, among other things, authorizing private plaintiffs to bring qui tam actions on behalf of the State to expose, and recover civil penalties for, insurance fraud.”


The Coalition Against Insurance Fraud amicus brief
Property Casualty 360