The report by the Illinois comptroller highlights the practice of delaying payments on billions of dollars in Medicaid bills. That makes the budget appear balanced when it's actually deep in the red.
For instance, the fiscal 2005 budget showed a small surplus. But when Medicaid bills are factored in, there was a deficit of more than $3 billion.
Comptroller Dan Hynes calls this a serious problem that hurts doctors, pharmacists and other medical providers who must wait months to be paid.
But Gov. Rod Blagojevich's office says the situation is improving.
Budget director John Filan says the amount of unpaid bills is declining while the state is putting put more money into schools, health care and other services.