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90_SB1711
305 ILCS 5/8A-8 from Ch. 23, par. 8A-8
305 ILCS 5/12-4.25 from Ch. 23, par. 12-4.25
305 ILCS 5/12-13.1
Amends the "Public Assistance Fraud" and "Administration"
Articles of the Public Aid Code. Replaces provisions
concerning penalty for a second offense of public assistance
fraud. Provides that for a first offense of fraud related to
Medicaid or the provision of health care services, a person
may be suspended from eligibility to participate in the
Medicaid program for a period not to exceed one year. For a
second or subsequent offense of fraud related to Medicaid or
the provision of health care services, a person shall be
suspended from eligibility to participate in the Medicaid
program for a period not to exceed one year. Replaces
provisions concerning withholding of payments to vendors
under the Medicaid program. Provides that the Department of
Public Aid may temporarily withhold payments to a vendor if
there has been fraud on the part of the vendor or if an
officer or owner of the vendor has been charged with a
felony offense related to fraud under the Medicaid or
Medicare program or in connection with the provision of
health care services. Requires the Inspector General within
the Department of Public Aid to make annual (now, quarterly)
reports to the General Assembly and the Governor concerning
investigations into reports of fraud and other misconduct.
Effective immediately.
LRB9008936DJgc
LRB9008936DJgc
1 AN ACT to amend the Illinois Public Aid Code by changing
2 Sections 8A-8, 12-4.25, and 12-13.1.
3 Be it enacted by the People of the State of Illinois,
4 represented in the General Assembly:
5 Section 5. The Illinois Public Aid Code is amended by
6 changing Sections 8A-8, 12-4.25, and 12-13.1 as follows:
7 (305 ILCS 5/8A-8) (from Ch. 23, par. 8A-8)
8 Sec. 8A-8. Future Participation in the Public Assistance
9 Program.
10 (a) Any person applying for public assistance under this
11 Code who has been found guilty of a violation of this Article
12 or of any law of the United States or of any state which is
13 substantially similar to Sections 8A-2 through 8A-5 for
14 violations related to public assistance or medical assistance
15 programs of the kind provided under this Code and who has not
16 been previously convicted for a violation of this Article or
17 of any law of the United States or of any state which is
18 substantially similar to Sections 8A-2 through 8A-5 for
19 violations related to public assistance or medical assistance
20 programs of the kind provided under this Code shall have
21 applications for public assistance under this Code reviewed
22 by an administrative review board to determine the person's
23 eligibility and the need for administrative safeguards to
24 prevent any such further violations. The administrative
25 review board shall be composed of not less than two persons
26 who are selected in accordance with regulations of the
27 Illinois Department or the local governmental unit. Hearings
28 conducted by the board shall:
29 (1) be of an informal nature, permitting the
30 applicant to attend at his option;
31 (2) be open to the public, unless the applicant and
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1 the administrative review board determine otherwise;
2 (3) be subject to reasonable time and notification
3 requirements as determined by regulations of the Illinois
4 Department or local governmental units; and
5 (4) be held at a location convenient to the
6 applicant.
7 At the hearing, the administrative review board may deny
8 the application based on an investigation of the person's
9 eligibility, or the board may appoint a substitute payee,
10 require more frequent visits or consultations, more frequent
11 financial reports or require any other action to the extent
12 permitted by State and federal law and regulations. A
13 decision by the administrative review board to deny a
14 person's application shall only be based on the person's
15 failure to qualify under the eligibility criteria applicable
16 to all applicants for the public assistance program in
17 question. Any decision by the administrative review board may
18 be appealed pursuant to the provisions of this Code. In no
19 instance shall the administrative review board delay the
20 hearing or its decision beyond the time allowed under State
21 or federal law and regulations for determining an applicant's
22 eligibility for public assistance.
23 If the person has been determined eligible, the Illinois
24 Department or the local governmental unit may recoup prior
25 payments obtained in violation of this Article from the
26 current cash assistance grants, unless such payments have
27 previously been repaid. The Illinois Department or the local
28 governmental unit, on a case by case basis, shall limit the
29 amount deducted from the current cash assistance grant so as
30 not to cause undue hardship to the person.
31 (b) To the extent permitted under federal law, any
32 person found guilty of a first offense of fraud related to
33 the medical assistance program under this Code or to the
34 provision of health care services under any other
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1 circumstances may be suspended from eligibility for
2 participation in the medical assistance program under this
3 Code for a period not to exceed one year. Any person found
4 guilty of a second or subsequent offense of fraud related to
5 the medical assistance program under this Code or to the
6 provision of health care services under any other
7 circumstances shall be suspended from eligibility for
8 participation in the medical assistance program under this
9 Code for a period not to exceed one year. second violation of
10 this Article or of any law of the United States or of any
11 state which is substantially similar to Sections 8A-2 through
12 8A-5 for violations related to public assistance or medical
13 assistance programs of the kind provided under this Code
14 shall be ineligible for public aid under this Code.
15 (c) In no instance shall this Section adversely affect
16 the eligibility of children who are in need of public aid
17 under this Code, or the amount of the grant received by such
18 children. If a child's caretaker relative is adversely
19 affected by this Section, a substitute payee may be appointed
20 until the Illinois Department can determine, by rule, that
21 the caretaker relative can manage the public aid in the best
22 interest of the child.
23 (d) Any person, firm, corporation, association, agency,
24 institution or other legal entity that has been convicted of
25 a violation of this Article shall be prohibited from
26 participating as a vendor of goods or services to recipients
27 of public aid under this Code. Such prohibition shall extend
28 to any person with management responsibility in a firm,
29 corporation, association, agency, institution, or other legal
30 entity that has been convicted of any such violation and to
31 an officer or person owning, either directly or indirectly,
32 5% or more of the shares of stock or other evidences of
33 ownership in a corporation.
34 (e) Any employee of the Illinois Department, county
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1 department or local governmental unit who has been found
2 guilty of a violation of this Article shall be terminated
3 from employment.
4 (Source: P.A. 89-489, eff. 1-1-97.)
5 (305 ILCS 5/12-4.25) (from Ch. 23, par. 12-4.25)
6 Sec. 12-4.25. Medical assistance program; vendor
7 participation.
8 (A) The Illinois Department may deny, suspend or
9 terminate the eligibility of any person, firm, corporation,
10 association, agency, institution or other legal entity to
11 participate as a vendor of goods or services to recipients
12 under the medical assistance program under Article V, if
13 after reasonable notice and opportunity for a hearing the
14 Illinois Department finds:
15 (a) Such vendor is not complying with the
16 Department's policy or rules and regulations, or with the
17 terms and conditions prescribed by the Illinois
18 Department in its vendor agreement, which document shall
19 be developed by the Department as a result of
20 negotiations with each vendor category, including
21 physicians, hospitals, long term care facilities,
22 pharmacists, optometrists, podiatrists and dentists
23 setting forth the terms and conditions applicable to the
24 participation of each vendor group in the program; or
25 (b) Such vendor has failed to keep or make
26 available for inspection, audit or copying, after
27 receiving a written request from the Illinois Department,
28 such records regarding payments claimed for providing
29 services. This section does not require vendors to make
30 available patient records of patients for whom services
31 are not reimbursed under this Code; or
32 (c) Such vendor has failed to furnish any
33 information requested by the Department regarding
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1 payments for providing goods or services; or
2 (d) Such vendor has knowingly made, or caused to be
3 made, any false statement or representation of a material
4 fact in connection with the administration of the medical
5 assistance program; or
6 (e) Such vendor has furnished goods or services to
7 a recipient which are (1) in excess of his or her needs,
8 (2) harmful to the recipient, or (3) of grossly inferior
9 quality, all of such determinations to be based upon
10 competent medical judgment and evaluations; or
11 (f) The vendor; a person with management
12 responsibility for a vendor; an officer or person owning,
13 either directly or indirectly, 5% or more of the shares
14 of stock or other evidences of ownership in a corporate
15 vendor; an owner of a sole proprietorship which is a
16 vendor; or a partner in a partnership which is a vendor,
17 either:
18 (1) was previously terminated from
19 participation in the medical assistance program; or
20 (2) was a person with management
21 responsibility for a previously terminated vendor
22 during the time of conduct which was the basis for
23 that vendor's termination from participation in the
24 medical assistance program; or
25 (3) was an officer, or person owning, either
26 directly or indirectly, 5% or more of the shares of
27 stock or other evidences of ownership in a
28 previously terminated corporate vendor during the
29 time of conduct which was the basis for that
30 vendor's termination from participation in the
31 medical assistance program; or
32 (4) was an owner of a sole proprietorship or
33 partner of a partnership which was previously
34 terminated during the time of conduct which was the
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1 basis for that vendor's termination from
2 participation in the medical assistance program; or
3 (g) The vendor; a person with management
4 responsibility for a vendor; an officer or person owning,
5 either directly or indirectly, 5% or more of the shares
6 of stock or other evidences of ownership in a corporate
7 vendor; an owner of a sole proprietorship which is a
8 vendor; or a partner in a partnership which is a vendor,
9 either:
10 (1) has engaged in practices prohibited by
11 applicable federal or State law or regulation
12 relating to the medical assistance program; or
13 (2) was a person with management
14 responsibility for a vendor at the time that such
15 vendor engaged in practices prohibited by applicable
16 federal or State law or regulation relating to the
17 medical assistance program; or
18 (3) was an officer, or person owning, either
19 directly or indirectly, 5% or more of the shares of
20 stock or other evidences of ownership in a vendor at
21 the time such vendor engaged in practices prohibited
22 by applicable federal or State law or regulation
23 relating to the medical assistance program; or
24 (4) was an owner of a sole proprietorship or
25 partner of a partnership which was a vendor at the
26 time such vendor engaged in practices prohibited by
27 applicable federal or State law or regulation
28 relating to the medical assistance program.
29 (h) The direct or indirect ownership of the vendor
30 (including the ownership of a vendor that is a sole
31 proprietorship, a partner's interest in a vendor that is
32 a partnership, or ownership of 5% or more of the shares
33 of stock or other evidences of ownership in a corporate
34 vendor) has been transferred by an individual who is
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1 terminated or barred from participating as a vendor to
2 the individual's spouse, child, brother, sister, parent,
3 grandparent, grandchild, uncle, aunt, niece, nephew,
4 cousin, or relative by marriage.
5 (B) The Illinois Department shall deny, suspend or
6 terminate the eligibility of any person, firm, corporation,
7 association, agency, institution or other legal entity to
8 participate as a vendor of goods or services to recipients
9 under the medical assistance program under Article V:
10 (1) if such vendor is not properly licensed;
11 (2) within 30 days of the date when such vendor's
12 professional license, certification or other authorization
13 has been refused renewal or has been revoked, suspended or
14 otherwise terminated; or
15 (3) if such vendor has been convicted of a
16 violation of this Code, as provided in Article VIIIA.
17 (C) Upon termination of a vendor of goods or services
18 from participation in the medical assistance program
19 authorized by this Article, a person with management
20 responsibility for such vendor during the time of any conduct
21 which served as the basis for that vendor's termination is
22 barred from participation in the medical assistance program.
23 Upon termination of a corporate vendor, the officers and
24 persons owning, directly or indirectly, 5% or more of the
25 shares of stock or other evidences of ownership in the vendor
26 during the time of any conduct which served as the basis for
27 that vendor's termination are barred from participation in
28 the medical assistance program. A person who owns, directly
29 or indirectly, 5% or more of the shares of stock or other
30 evidences of ownership in a terminated corporate vendor may
31 not transfer his or her ownership interest in that vendor to
32 his or her spouse, child, brother, sister, parent,
33 grandparent, grandchild, uncle, aunt, niece, nephew, cousin,
34 or relative by marriage.
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1 Upon termination of a sole proprietorship or partnership,
2 the owner or partners during the time of any conduct which
3 served as the basis for that vendor's termination are barred
4 from participation in the medical assistance program. The
5 owner of a terminated vendor that is a sole proprietorship,
6 and a partner in a terminated vendor that is a partnership,
7 may not transfer his or her ownership or partnership interest
8 in that vendor to his or her spouse, child, brother, sister,
9 parent, grandparent, grandchild, uncle, aunt, niece, nephew,
10 cousin, or relative by marriage.
11 Rules adopted by the Illinois Department to implement
12 these provisions shall specifically include a definition of
13 the term "management responsibility" as used in this Section.
14 Such definition shall include, but not be limited to, typical
15 job titles, and duties and descriptions which will be
16 considered as within the definition of individuals with
17 management responsibility for a provider.
18 (D) If a vendor has been suspended from the medical
19 assistance program under Article V of the Code, the Director
20 may require that such vendor correct any deficiencies which
21 served as the basis for the suspension. The Director shall
22 specify in the suspension order a specific period of time,
23 which shall not exceed one year from the date of the order,
24 during which a suspended vendor shall not be eligible to
25 participate. At the conclusion of the period of suspension
26 the Director shall reinstate such vendor, unless he finds
27 that such vendor has not corrected deficiencies upon which
28 the suspension was based.
29 If a vendor has been terminated from the medical
30 assistance program under Article V, such vendor shall be
31 barred from participation for at least one year. At the end
32 of one year a vendor who has been terminated may apply for
33 reinstatement to the program. Upon proper application to be
34 reinstated such vendor may be deemed eligible by the Director
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1 providing that such vendor meets the requirements for
2 eligibility under this Act. If such vendor is deemed not
3 eligible for reinstatement, he shall be barred from again
4 applying for reinstatement for one year from the date his
5 application for reinstatement is denied.
6 If a vendor has been terminated and reinstated to the
7 medical assistance program under Article V and the vendor is
8 terminated a second or subsequent time from the medical
9 assistance program, the vendor shall be barred from
10 participation for at least 2 years. At the end of 2 years, a
11 vendor who has been terminated may apply for reinstatement to
12 the program. Upon application to be reinstated, the vendor
13 may be deemed eligible if the vendor meets the requirements
14 for eligibility under this Code. If the vendor is deemed not
15 eligible for reinstatement, the vendor shall be barred from
16 again applying for reinstatement for 2 years from the date
17 the vendor's application for reinstatement is denied.
18 (E) The Illinois Department may recover money improperly
19 or erroneously paid, or overpayments, either by setoff,
20 crediting against future billings or by requiring direct
21 repayment to the Illinois Department.
22 (F) The Illinois Department may temporarily withhold
23 payments to a vendor when the Department has reliable
24 evidence of fraud on the part of the vendor or otherwise has
25 a reasonable basis for believing that there has been fraud
26 on the part of the vendor. Fraud on the part of the vendor
27 includes but is not limited to (i) submission of false
28 claims for reimbursement to the Illinois Department and (ii)
29 misrepresentation of any material fact related to
30 reimbursement or to the eligibility of a provider or
31 recipient to participate in the medical assistance program
32 under Article V of this Code. If the Illinois Department
33 withholds payments to a vendor under this subsection, the
34 Department or an authorized State or federal law enforcement
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1 agency shall immediately thereafter conduct an investigation
2 to determine whether there has in fact been fraud on the
3 part of the vendor. Upon completion of the investigation or
4 upon the passage of 180 days from the first withholding of a
5 payment to the vendor, whichever occurs first, the Illinois
6 Department shall either release to the vendor all withheld
7 payments or cause an appropriate criminal or civil
8 proceeding to be brought against the vendor based on the
9 vendor's alleged fraud.
10 (F-5) The Illinois Department may temporarily withhold
11 payments to a vendor if any of the following individuals
12 have been indicted or otherwise charged under a law of the
13 United States or this or any other state with a felony
14 offense that is based on alleged fraud or willful
15 misrepresentation on the part of the individual related to
16 (i) the medical assistance program under Article V of this
17 Code, (ii) a medical assistance program provided in another
18 state which is of the kind provided under Article V of this
19 Code, (iii) the Medicare program under Title XVIII of the
20 Social Security Act, or (iv) the provision of health care
21 services:
22 (1) If the vendor is a corporation: an officer of
23 the corporation or an individual who owns, either
24 directly or indirectly, 5% or more of the shares of
25 stock or other evidence of ownership of the corporation.
26 (2) If the vendor is a sole proprietorship: the
27 owner of the sole proprietorship.
28 (3) If the vendor is a partnership: a partner in the
29 partnership.
30 (4) If the vendor is any other business entity
31 authorized by law to transact business in this State:
32 an officer of the entity or an individual who owns,
33 either directly or indirectly, 5% or more of the
34 evidences of ownership of the entity.
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1 If the Illinois Department withholds payments to a vendor
2 under this subsection, the Department shall not release
3 those payments to the vendor while any criminal proceeding
4 related to the indictment or charge is pending unless the
5 Department determines that there is good cause to release the
6 payments before completion of the proceeding. If the
7 indictment or charge results in the individual's conviction,
8 the Illinois Department shall retain all withheld payments,
9 which shall be considered forfeited to the Department. If
10 the indictment or charge does not result in the individual's
11 conviction, the Illinois Department shall release to the
12 vendor all withheld payments. The Illinois Department may
13 withhold payments to any vendor during the pendency of any
14 proceeding under this Section except that if a final
15 administrative decision has not been issued within 120 days
16 of the initiation of such proceedings, unless delay has been
17 caused by the vendor, payments can no longer be withheld,
18 provided, however, that the 120 day limit may be extended if
19 said extension is mutually agreed to by the Illinois
20 Department and the vendor. The Illinois Department shall
21 state by rule with as much specificity as practicable the
22 conditions under which payments will not be withheld during
23 the pendency of any proceeding under this Section. Payments
24 may be denied for bills submitted with service dates
25 occurring during the pendency of a proceeding where the final
26 administrative decision is to terminate eligibility to
27 participate in the medical assistance program. The Illinois
28 Department shall state by rule with as much specificity as
29 practicable the conditions under which payments will not be
30 denied for such bills.
31 (G) The provisions of the Administrative Review Law, as
32 now or hereafter amended, and the rules adopted pursuant
33 thereto, shall apply to and govern all proceedings for the
34 judicial review of final administrative decisions of the
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1 Illinois Department under this Section. The term
2 "administrative decision" is defined as in Section 3-101 of
3 the Code of Civil Procedure.
4 (H) Nothing contained in this Code shall in any way
5 limit or otherwise impair the authority or power of any State
6 agency responsible for licensing of vendors.
7 (I) Based on a finding of noncompliance on the part of a
8 nursing home with any requirement for certification under
9 Title XVIII or XIX of the Social Security Act (42 U.S.C. Sec.
10 1395 et seq. or 42 U.S.C. Sec. 1396 et seq.), the Illinois
11 Department may impose one or more of the following remedies
12 after notice to the facility:
13 (1) Termination of the provider agreement.
14 (2) Temporary management.
15 (3) Denial of payment for new admissions.
16 (4) Civil money penalties.
17 (5) Closure of the facility in emergency situations
18 or transfer of residents, or both.
19 (6) State monitoring.
20 (7) Denial of all payments when the Health Care
21 Finance Administration has imposed this sanction.
22 The Illinois Department shall by rule establish criteria
23 governing continued payments to a nursing facility subsequent
24 to termination of the facility's provider agreement if, in
25 the sole discretion of the Illinois Department, circumstances
26 affecting the health, safety, and welfare of the facility's
27 residents require those continued payments. The Illinois
28 Department may condition those continued payments on the
29 appointment of temporary management, sale of the facility to
30 new owners or operators, or other arrangements that the
31 Illinois Department determines best serve the needs of the
32 facility's residents.
33 Except in the case of a facility that has a right to a
34 hearing on the finding of noncompliance before an agency of
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1 the federal government, a facility may request a hearing
2 before a State agency on any finding of noncompliance within
3 60 days after the notice of the intent to impose a remedy.
4 Except in the case of civil money penalties, a request for a
5 hearing shall not delay imposition of the penalty. The
6 choice of remedies is not appealable at a hearing. The level
7 of noncompliance may be challenged only in the case of a
8 civil money penalty. The Illinois Department shall provide
9 by rule for the State agency that will conduct the
10 evidentiary hearings.
11 The Illinois Department may collect interest on unpaid
12 civil money penalties.
13 The Illinois Department may adopt all rules necessary to
14 implement this subsection (I).
15 (Source: P.A. 88-554, eff. 7-26-94; 89-21, eff. 1-1-96.)
16 (305 ILCS 5/12-13.1)
17 Sec. 12-13.1. Inspector General.
18 (a) The Governor shall appoint, and the Senate shall
19 confirm, an Inspector General who shall function within the
20 Illinois Department of Public Aid and report to the Governor.
21 The term of the Inspector General shall expire on the third
22 Monday of January, 1997 and every 4 years thereafter.
23 (b) In order to prevent, detect, and eliminate fraud,
24 waste, abuse, mismanagement, and misconduct, the Inspector
25 General shall oversee the Illinois Department of Public Aid's
26 integrity functions, which include, but are not limited to,
27 the following:
28 (1) Investigation of misconduct by employees,
29 vendors, contractors and medical providers.
30 (2) Audits of medical providers related to ensuring
31 that appropriate payments are made for services rendered
32 and to the recovery of overpayments.
33 (3) Monitoring of quality assurance programs
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1 generally related to the medical assistance program and
2 specifically related to any managed care program.
3 (4) Quality control measurements of the programs
4 administered by the Illinois Department of Public Aid.
5 (5) Investigations of fraud or intentional program
6 violations committed by clients of the Illinois
7 Department of Public Aid.
8 (6) Actions initiated against contractors or
9 medical providers for any of the following reasons:
10 (A) Violations of the medical assistance
11 program.
12 (B) Sanctions against providers brought in
13 conjunction with the Department of Public Health or
14 the Department of Human Services (as successor to
15 the Department of Mental Health and Developmental
16 Disabilities).
17 (C) Recoveries of assessments against
18 hospitals and long-term care facilities.
19 (D) Sanctions mandated by the United States
20 Department of Health and Human Services against
21 medical providers.
22 (E) Violations of contracts related to any
23 managed care programs.
24 (7) Representation of the Illinois Department of
25 Public Aid at hearings with the Illinois Department of
26 Professional Regulation in actions taken against
27 professional licenses held by persons who are in
28 violation of orders for child support payments.
29 (b-5) At the request of the Secretary of Human Services,
30 the Inspector General shall, in relation to any function
31 performed by the Department of Human Services as successor to
32 the Department of Public Aid, exercise one or more of the
33 powers provided under this Section as if those powers related
34 to the Department of Human Services; in such matters, the
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1 Inspector General shall report his or her findings to the
2 Secretary of Human Services.
3 (c) The Inspector General shall have access to all
4 information, personnel and facilities of the Illinois
5 Department of Public Aid and the Department of Human Services
6 (as successor to the Department of Public Aid), their
7 employees, vendors, contractors and medical providers and any
8 federal, State or local governmental agency that are
9 necessary to perform the duties of the Office as directly
10 related to public assistance programs administered by those
11 departments. No medical provider shall be compelled,
12 however, to provide individual medical records of patients
13 who are not clients of the Medical Assistance Program. State
14 and local governmental agencies are authorized and directed
15 to provide the requested information, assistance or
16 cooperation.
17 (d) The Inspector General shall serve as the Illinois
18 Department of Public Aid's primary liaison with law
19 enforcement, investigatory and prosecutorial agencies,
20 including but not limited to the following:
21 (1) The Department of State Police.
22 (2) The Federal Bureau of Investigation and other
23 federal law enforcement agencies.
24 (3) The various Inspectors General of federal
25 agencies overseeing the programs administered by the
26 Illinois Department of Public Aid.
27 (4) The various Inspectors General of any other
28 State agencies with responsibilities for portions of
29 programs primarily administered by the Illinois
30 Department of Public Aid.
31 (5) The Offices of the several United States
32 Attorneys in Illinois.
33 (6) The several State's Attorneys.
34 The Inspector General shall meet on a regular basis with
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1 these entities to share information regarding possible
2 misconduct by any persons or entities involved with the
3 public aid programs administered by the Illinois Department
4 of Public Aid.
5 (e) All investigations conducted by the Inspector
6 General shall be conducted in a manner that ensures the
7 preservation of evidence for use in criminal prosecutions.
8 If the Inspector General determines that a possible criminal
9 act relating to fraud in the provision or administration of
10 the medical assistance program has been committed, the
11 Inspector General shall immediately notify the Medicaid Fraud
12 Control Unit. If the Inspector General determines that a
13 possible criminal act has been committed within the
14 jurisdiction of the Office, the Inspector General may request
15 the special expertise of the Department of State Police. The
16 Inspector General may present for prosecution the findings of
17 any criminal investigation to the Office of the Attorney
18 General, the Offices of the several United State Attorneys in
19 Illinois or the several State's Attorneys.
20 (f) To carry out his or her duties as described in this
21 Section, the Inspector General and his or her designees shall
22 have the power to compel by subpoena the attendance and
23 testimony of witnesses and the production of books,
24 electronic records and papers as directly related to public
25 assistance programs administered by the Illinois Department
26 of Public Aid or the Department of Human Services (as
27 successor to the Department of Public Aid). No medical
28 provider shall be compelled, however, to provide individual
29 medical records of patients who are not clients of the
30 Medical Assistance Program.
31 (g) The Inspector General shall report all convictions,
32 terminations, and suspensions taken against vendors,
33 contractors and medical providers to the Illinois Department
34 of Public Aid and to any agency responsible for licensing or
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1 regulating those persons or entities.
2 (h) The Inspector General shall make annual quarterly
3 reports, findings, and recommendations regarding the Office's
4 investigations into reports of fraud, waste, abuse,
5 mismanagement, or misconduct relating to any public aid
6 programs administered by the Illinois Department of Public
7 Aid or the Department of Human Services (as successor to the
8 Department of Public Aid) to the General Assembly and the
9 Governor. These reports shall include, but not be limited
10 to, the following information:
11 (1) Aggregate provider billing and payment
12 information, including the number of providers at various
13 Medicaid earning levels.
14 (2) The number of audits of the medical assistance
15 program and the dollar savings resulting from those
16 audits.
17 (3) The number of prescriptions rejected annually
18 under the Illinois Department of Public Aid's Refill Too
19 Soon program and the dollar savings resulting from that
20 program.
21 (4) Provider sanctions, in the aggregate, including
22 terminations and suspensions.
23 (5) A detailed summary of the investigations
24 undertaken in the previous fiscal year. These summaries
25 shall comply with all laws and rules regarding
26 maintaining confidentiality in the public aid programs.
27 (i) Nothing in this Section shall limit investigations
28 by the Illinois Department of Public Aid or the Department of
29 Human Services that may otherwise be required by law or that
30 may be necessary in their capacity as the central
31 administrative authorities responsible for administration of
32 public aid programs in this State.
33 (Source: P.A. 88-554, eff. 7-26-94; 89-507, eff. 7-1-97.)
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1 Section 99. Effective date. This Act takes effect upon
2 becoming law.