[ Search ] [ Legislation ] [ Bill Summary ]
[ Home ] [ Back ] [ Bottom ]
| [ Introduced ] | [ Enrolled ] | [ Senate Amendment 001 ] |
90_SB1711eng
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
SB1711 Engrossed 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
SB1711 Engrossed -2- LRB9008936DJgc
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 person
32 found guilty of a first violation of this Article or of any
33 law of the United States or of any state which is
34 substantially similar to Sections 8A-2 through 8A-5 for
SB1711 Engrossed -3- LRB9008936DJgc
1 violations related to public assistance or medical assistance
2 programs of the kind provided under this Code may be
3 suspended from eligibility for public aid under this Code.
4 Any person found guilty of a second or subsequent violation
5 of this Article or of any law of the United States or of any
6 state which is substantially similar to Sections 8A-2 through
7 8A-5 for violations related to public assistance or medical
8 assistance programs of the kind provided under this Code
9 shall be ineligible for public aid under this Code.
10 (c) In no instance shall this Section adversely affect
11 the eligibility of children who are in need of public aid
12 under this Code, or the amount of the grant received by such
13 children. If a child's caretaker relative is adversely
14 affected by this Section, a substitute payee may be appointed
15 until the Illinois Department can determine, by rule, that
16 the caretaker relative can manage the public aid in the best
17 interest of the child.
18 (d) Any person, firm, corporation, association, agency,
19 institution or other legal entity that has been convicted of
20 a violation of this Article shall be prohibited from
21 participating as a vendor of goods or services to recipients
22 of public aid under this Code. Such prohibition shall extend
23 to any person with management responsibility in a firm,
24 corporation, association, agency, institution, or other legal
25 entity that has been convicted of any such violation and to
26 an officer or person owning, either directly or indirectly,
27 5% or more of the shares of stock or other evidences of
28 ownership in a corporation.
29 (e) Any employee of the Illinois Department, county
30 department or local governmental unit who has been found
31 guilty of a violation of this Article shall be terminated
32 from employment.
33 (Source: P.A. 89-489, eff. 1-1-97.)
SB1711 Engrossed -4- LRB9008936DJgc
1 (305 ILCS 5/12-4.25) (from Ch. 23, par. 12-4.25)
2 Sec. 12-4.25. Medical assistance program; vendor
3 participation.
4 (A) The Illinois Department may deny, suspend or
5 terminate the eligibility of any person, firm, corporation,
6 association, agency, institution or other legal entity to
7 participate as a vendor of goods or services to recipients
8 under the medical assistance program under Article V, if
9 after reasonable notice and opportunity for a hearing the
10 Illinois Department finds:
11 (a) Such vendor is not complying with the
12 Department's policy or rules and regulations, or with the
13 terms and conditions prescribed by the Illinois
14 Department in its vendor agreement, which document shall
15 be developed by the Department as a result of
16 negotiations with each vendor category, including
17 physicians, hospitals, long term care facilities,
18 pharmacists, optometrists, podiatrists and dentists
19 setting forth the terms and conditions applicable to the
20 participation of each vendor group in the program; or
21 (b) Such vendor has failed to keep or make
22 available for inspection, audit or copying, after
23 receiving a written request from the Illinois Department,
24 such records regarding payments claimed for providing
25 services. This section does not require vendors to make
26 available patient records of patients for whom services
27 are not reimbursed under this Code; or
28 (c) Such vendor has failed to furnish any
29 information requested by the Department regarding
30 payments for providing goods or services; or
31 (d) Such vendor has knowingly made, or caused to be
32 made, any false statement or representation of a material
33 fact in connection with the administration of the medical
34 assistance program; or
SB1711 Engrossed -5- LRB9008936DJgc
1 (e) Such vendor has furnished goods or services to
2 a recipient which are (1) in excess of his or her needs,
3 (2) harmful to the recipient, or (3) of grossly inferior
4 quality, all of such determinations to be based upon
5 competent medical judgment and evaluations; or
6 (f) The vendor; a person with management
7 responsibility for a vendor; an officer or person owning,
8 either directly or indirectly, 5% or more of the shares
9 of stock or other evidences of ownership in a corporate
10 vendor; an owner of a sole proprietorship which is a
11 vendor; or a partner in a partnership which is a vendor,
12 either:
13 (1) was previously terminated from
14 participation in the medical assistance program; or
15 (2) was a person with management
16 responsibility for a previously terminated vendor
17 during the time of conduct which was the basis for
18 that vendor's termination from participation in the
19 medical assistance program; or
20 (3) was an officer, or person owning, either
21 directly or indirectly, 5% or more of the shares of
22 stock or other evidences of ownership in a
23 previously terminated corporate vendor during the
24 time of conduct which was the basis for that
25 vendor's termination from participation in the
26 medical assistance program; or
27 (4) was an owner of a sole proprietorship or
28 partner of a partnership which was previously
29 terminated during the time of conduct which was the
30 basis for that vendor's termination from
31 participation in the medical assistance program; or
32 (g) The vendor; a person with management
33 responsibility for a vendor; an officer or person owning,
34 either directly or indirectly, 5% or more of the shares
SB1711 Engrossed -6- LRB9008936DJgc
1 of stock or other evidences of ownership in a corporate
2 vendor; an owner of a sole proprietorship which is a
3 vendor; or a partner in a partnership which is a vendor,
4 either:
5 (1) has engaged in practices prohibited by
6 applicable federal or State law or regulation
7 relating to the medical assistance program; or
8 (2) was a person with management
9 responsibility for a vendor at the time that such
10 vendor engaged in practices prohibited by applicable
11 federal or State law or regulation relating to the
12 medical assistance program; or
13 (3) was an officer, or person owning, either
14 directly or indirectly, 5% or more of the shares of
15 stock or other evidences of ownership in a vendor at
16 the time such vendor engaged in practices prohibited
17 by applicable federal or State law or regulation
18 relating to the medical assistance program; or
19 (4) was an owner of a sole proprietorship or
20 partner of a partnership which was a vendor at the
21 time such vendor engaged in practices prohibited by
22 applicable federal or State law or regulation
23 relating to the medical assistance program.
24 (h) The direct or indirect ownership of the vendor
25 (including the ownership of a vendor that is a sole
26 proprietorship, a partner's interest in a vendor that is
27 a partnership, or ownership of 5% or more of the shares
28 of stock or other evidences of ownership in a corporate
29 vendor) has been transferred by an individual who is
30 terminated or barred from participating as a vendor to
31 the individual's spouse, child, brother, sister, parent,
32 grandparent, grandchild, uncle, aunt, niece, nephew,
33 cousin, or relative by marriage.
34 (B) The Illinois Department shall deny, suspend or
SB1711 Engrossed -7- LRB9008936DJgc
1 terminate the eligibility of any person, firm, corporation,
2 association, agency, institution or other legal entity to
3 participate as a vendor of goods or services to recipients
4 under the medical assistance program under Article V:
5 (1) if such vendor is not properly licensed;
6 (2) within 30 days of the date when such vendor's
7 professional license, certification or other authorization
8 has been refused renewal or has been revoked, suspended or
9 otherwise terminated; or
10 (3) if such vendor has been convicted of a
11 violation of this Code, as provided in Article VIIIA.
12 (C) Upon termination of a vendor of goods or services
13 from participation in the medical assistance program
14 authorized by this Article, a person with management
15 responsibility for such vendor during the time of any conduct
16 which served as the basis for that vendor's termination is
17 barred from participation in the medical assistance program.
18 Upon termination of a corporate vendor, the officers and
19 persons owning, directly or indirectly, 5% or more of the
20 shares of stock or other evidences of ownership in the vendor
21 during the time of any conduct which served as the basis for
22 that vendor's termination are barred from participation in
23 the medical assistance program. A person who owns, directly
24 or indirectly, 5% or more of the shares of stock or other
25 evidences of ownership in a terminated corporate vendor may
26 not transfer his or her ownership interest in that vendor to
27 his or her spouse, child, brother, sister, parent,
28 grandparent, grandchild, uncle, aunt, niece, nephew, cousin,
29 or relative by marriage.
30 Upon termination of a sole proprietorship or partnership,
31 the owner or partners during the time of any conduct which
32 served as the basis for that vendor's termination are barred
33 from participation in the medical assistance program. The
34 owner of a terminated vendor that is a sole proprietorship,
SB1711 Engrossed -8- LRB9008936DJgc
1 and a partner in a terminated vendor that is a partnership,
2 may not transfer his or her ownership or partnership interest
3 in that vendor to his or her spouse, child, brother, sister,
4 parent, grandparent, grandchild, uncle, aunt, niece, nephew,
5 cousin, or relative by marriage.
6 Rules adopted by the Illinois Department to implement
7 these provisions shall specifically include a definition of
8 the term "management responsibility" as used in this Section.
9 Such definition shall include, but not be limited to, typical
10 job titles, and duties and descriptions which will be
11 considered as within the definition of individuals with
12 management responsibility for a provider.
13 (D) If a vendor has been suspended from the medical
14 assistance program under Article V of the Code, the Director
15 may require that such vendor correct any deficiencies which
16 served as the basis for the suspension. The Director shall
17 specify in the suspension order a specific period of time,
18 which shall not exceed one year from the date of the order,
19 during which a suspended vendor shall not be eligible to
20 participate. At the conclusion of the period of suspension
21 the Director shall reinstate such vendor, unless he finds
22 that such vendor has not corrected deficiencies upon which
23 the suspension was based.
24 If a vendor has been terminated from the medical
25 assistance program under Article V, such vendor shall be
26 barred from participation for at least one year. At the end
27 of one year a vendor who has been terminated may apply for
28 reinstatement to the program. Upon proper application to be
29 reinstated such vendor may be deemed eligible by the Director
30 providing that such vendor meets the requirements for
31 eligibility under this Act. If such vendor is deemed not
32 eligible for reinstatement, he shall be barred from again
33 applying for reinstatement for one year from the date his
34 application for reinstatement is denied.
SB1711 Engrossed -9- LRB9008936DJgc
1 If a vendor has been terminated and reinstated to the
2 medical assistance program under Article V and the vendor is
3 terminated a second or subsequent time from the medical
4 assistance program, the vendor shall be barred from
5 participation for at least 2 years. At the end of 2 years, a
6 vendor who has been terminated may apply for reinstatement to
7 the program. Upon application to be reinstated, the vendor
8 may be deemed eligible if the vendor meets the requirements
9 for eligibility under this Code. If the vendor is deemed not
10 eligible for reinstatement, the vendor shall be barred from
11 again applying for reinstatement for 2 years from the date
12 the vendor's application for reinstatement is denied.
13 (E) The Illinois Department may recover money improperly
14 or erroneously paid, or overpayments, either by setoff,
15 crediting against future billings or by requiring direct
16 repayment to the Illinois Department.
17 (F) The Illinois Department may withhold payments to any
18 vendor during the pendency of any proceeding under this
19 Section except that if a final administrative decision has
20 not been issued within 120 days of the initiation of such
21 proceedings, unless delay has been caused by the vendor,
22 payments can no longer be withheld, provided, however, that
23 the 120 day limit may be extended if said extension is
24 mutually agreed to by the Illinois Department and the vendor.
25 The Illinois Department shall state by rule with as much
26 specificity as practicable the conditions under which
27 payments will not be withheld during the pendency of any
28 proceeding under this Section. Payments may be denied for
29 bills submitted with service dates occurring during the
30 pendency of a proceeding where the final administrative
31 decision is to terminate eligibility to participate in the
32 medical assistance program. The Illinois Department shall
33 state by rule with as much specificity as practicable the
34 conditions under which payments will not be denied for such
SB1711 Engrossed -10- LRB9008936DJgc
1 bills.
2 (F-5) The Illinois Department may temporarily withhold
3 payments to a vendor if any of the following individuals
4 have been indicted or otherwise charged under a law of the
5 United States or this or any other state with a felony
6 offense that is based on alleged fraud or willful
7 misrepresentation on the part of the individual related to
8 (i) the medical assistance program under Article V of this
9 Code, (ii) a medical assistance program provided in another
10 state which is of the kind provided under Article V of this
11 Code, (iii) the Medicare program under Title XVIII of the
12 Social Security Act, or (iv) the provision of health care
13 services:
14 (1) If the vendor is a corporation: an officer of
15 the corporation or an individual who owns, either
16 directly or indirectly, 5% or more of the shares of
17 stock or other evidence of ownership of the corporation.
18 (2) If the vendor is a sole proprietorship: the
19 owner of the sole proprietorship.
20 (3) If the vendor is a partnership: a partner in the
21 partnership.
22 (4) If the vendor is any other business entity
23 authorized by law to transact business in this State:
24 an officer of the entity or an individual who owns,
25 either directly or indirectly, 5% or more of the
26 evidences of ownership of the entity.
27 If the Illinois Department withholds payments to a vendor
28 under this subsection, the Department shall not release
29 those payments to the vendor while any criminal proceeding
30 related to the indictment or charge is pending unless the
31 Department determines that there is good cause to release the
32 payments before completion of the proceeding. If the
33 indictment or charge results in the individual's conviction,
34 the Illinois Department shall retain all withheld payments,
SB1711 Engrossed -11- LRB9008936DJgc
1 which shall be considered forfeited to the Department. If
2 the indictment or charge does not result in the individual's
3 conviction, the Illinois Department shall release to the
4 vendor all withheld payments.
5 (G) The provisions of the Administrative Review Law, as
6 now or hereafter amended, and the rules adopted pursuant
7 thereto, shall apply to and govern all proceedings for the
8 judicial review of final administrative decisions of the
9 Illinois Department under this Section. The term
10 "administrative decision" is defined as in Section 3-101 of
11 the Code of Civil Procedure.
12 (H) Nothing contained in this Code shall in any way
13 limit or otherwise impair the authority or power of any State
14 agency responsible for licensing of vendors.
15 (I) Based on a finding of noncompliance on the part of a
16 nursing home with any requirement for certification under
17 Title XVIII or XIX of the Social Security Act (42 U.S.C. Sec.
18 1395 et seq. or 42 U.S.C. Sec. 1396 et seq.), the Illinois
19 Department may impose one or more of the following remedies
20 after notice to the facility:
21 (1) Termination of the provider agreement.
22 (2) Temporary management.
23 (3) Denial of payment for new admissions.
24 (4) Civil money penalties.
25 (5) Closure of the facility in emergency situations
26 or transfer of residents, or both.
27 (6) State monitoring.
28 (7) Denial of all payments when the Health Care
29 Finance Administration has imposed this sanction.
30 The Illinois Department shall by rule establish criteria
31 governing continued payments to a nursing facility subsequent
32 to termination of the facility's provider agreement if, in
33 the sole discretion of the Illinois Department, circumstances
34 affecting the health, safety, and welfare of the facility's
SB1711 Engrossed -12- LRB9008936DJgc
1 residents require those continued payments. The Illinois
2 Department may condition those continued payments on the
3 appointment of temporary management, sale of the facility to
4 new owners or operators, or other arrangements that the
5 Illinois Department determines best serve the needs of the
6 facility's residents.
7 Except in the case of a facility that has a right to a
8 hearing on the finding of noncompliance before an agency of
9 the federal government, a facility may request a hearing
10 before a State agency on any finding of noncompliance within
11 60 days after the notice of the intent to impose a remedy.
12 Except in the case of civil money penalties, a request for a
13 hearing shall not delay imposition of the penalty. The
14 choice of remedies is not appealable at a hearing. The level
15 of noncompliance may be challenged only in the case of a
16 civil money penalty. The Illinois Department shall provide
17 by rule for the State agency that will conduct the
18 evidentiary hearings.
19 The Illinois Department may collect interest on unpaid
20 civil money penalties.
21 The Illinois Department may adopt all rules necessary to
22 implement this subsection (I).
23 (Source: P.A. 88-554, eff. 7-26-94; 89-21, eff. 1-1-96.)
24 (305 ILCS 5/12-13.1)
25 Sec. 12-13.1. Inspector General.
26 (a) The Governor shall appoint, and the Senate shall
27 confirm, an Inspector General who shall function within the
28 Illinois Department of Public Aid and report to the Governor.
29 The term of the Inspector General shall expire on the third
30 Monday of January, 1997 and every 4 years thereafter.
31 (b) In order to prevent, detect, and eliminate fraud,
32 waste, abuse, mismanagement, and misconduct, the Inspector
33 General shall oversee the Illinois Department of Public Aid's
SB1711 Engrossed -13- LRB9008936DJgc
1 integrity functions, which include, but are not limited to,
2 the following:
3 (1) Investigation of misconduct by employees,
4 vendors, contractors and medical providers.
5 (2) Audits of medical providers related to ensuring
6 that appropriate payments are made for services rendered
7 and to the recovery of overpayments.
8 (3) Monitoring of quality assurance programs
9 generally related to the medical assistance program and
10 specifically related to any managed care program.
11 (4) Quality control measurements of the programs
12 administered by the Illinois Department of Public Aid.
13 (5) Investigations of fraud or intentional program
14 violations committed by clients of the Illinois
15 Department of Public Aid.
16 (6) Actions initiated against contractors or
17 medical providers for any of the following reasons:
18 (A) Violations of the medical assistance
19 program.
20 (B) Sanctions against providers brought in
21 conjunction with the Department of Public Health or
22 the Department of Human Services (as successor to
23 the Department of Mental Health and Developmental
24 Disabilities).
25 (C) Recoveries of assessments against
26 hospitals and long-term care facilities.
27 (D) Sanctions mandated by the United States
28 Department of Health and Human Services against
29 medical providers.
30 (E) Violations of contracts related to any
31 managed care programs.
32 (7) Representation of the Illinois Department of
33 Public Aid at hearings with the Illinois Department of
34 Professional Regulation in actions taken against
SB1711 Engrossed -14- LRB9008936DJgc
1 professional licenses held by persons who are in
2 violation of orders for child support payments.
3 (b-5) At the request of the Secretary of Human Services,
4 the Inspector General shall, in relation to any function
5 performed by the Department of Human Services as successor to
6 the Department of Public Aid, exercise one or more of the
7 powers provided under this Section as if those powers related
8 to the Department of Human Services; in such matters, the
9 Inspector General shall report his or her findings to the
10 Secretary of Human Services.
11 (c) The Inspector General shall have access to all
12 information, personnel and facilities of the Illinois
13 Department of Public Aid and the Department of Human Services
14 (as successor to the Department of Public Aid), their
15 employees, vendors, contractors and medical providers and any
16 federal, State or local governmental agency that are
17 necessary to perform the duties of the Office as directly
18 related to public assistance programs administered by those
19 departments. No medical provider shall be compelled,
20 however, to provide individual medical records of patients
21 who are not clients of the Medical Assistance Program. State
22 and local governmental agencies are authorized and directed
23 to provide the requested information, assistance or
24 cooperation.
25 (d) The Inspector General shall serve as the Illinois
26 Department of Public Aid's primary liaison with law
27 enforcement, investigatory and prosecutorial agencies,
28 including but not limited to the following:
29 (1) The Department of State Police.
30 (2) The Federal Bureau of Investigation and other
31 federal law enforcement agencies.
32 (3) The various Inspectors General of federal
33 agencies overseeing the programs administered by the
34 Illinois Department of Public Aid.
SB1711 Engrossed -15- LRB9008936DJgc
1 (4) The various Inspectors General of any other
2 State agencies with responsibilities for portions of
3 programs primarily administered by the Illinois
4 Department of Public Aid.
5 (5) The Offices of the several United States
6 Attorneys in Illinois.
7 (6) The several State's Attorneys.
8 The Inspector General shall meet on a regular basis with
9 these entities to share information regarding possible
10 misconduct by any persons or entities involved with the
11 public aid programs administered by the Illinois Department
12 of Public Aid.
13 (e) All investigations conducted by the Inspector
14 General shall be conducted in a manner that ensures the
15 preservation of evidence for use in criminal prosecutions.
16 If the Inspector General determines that a possible criminal
17 act relating to fraud in the provision or administration of
18 the medical assistance program has been committed, the
19 Inspector General shall immediately notify the Medicaid Fraud
20 Control Unit. If the Inspector General determines that a
21 possible criminal act has been committed within the
22 jurisdiction of the Office, the Inspector General may request
23 the special expertise of the Department of State Police. The
24 Inspector General may present for prosecution the findings of
25 any criminal investigation to the Office of the Attorney
26 General, the Offices of the several United State Attorneys in
27 Illinois or the several State's Attorneys.
28 (f) To carry out his or her duties as described in this
29 Section, the Inspector General and his or her designees shall
30 have the power to compel by subpoena the attendance and
31 testimony of witnesses and the production of books,
32 electronic records and papers as directly related to public
33 assistance programs administered by the Illinois Department
34 of Public Aid or the Department of Human Services (as
SB1711 Engrossed -16- LRB9008936DJgc
1 successor to the Department of Public Aid). No medical
2 provider shall be compelled, however, to provide individual
3 medical records of patients who are not clients of the
4 Medical Assistance Program.
5 (g) The Inspector General shall report all convictions,
6 terminations, and suspensions taken against vendors,
7 contractors and medical providers to the Illinois Department
8 of Public Aid and to any agency responsible for licensing or
9 regulating those persons or entities.
10 (h) The Inspector General shall make annual quarterly
11 reports, findings, and recommendations regarding the Office's
12 investigations into reports of fraud, waste, abuse,
13 mismanagement, or misconduct relating to any public aid
14 programs administered by the Illinois Department of Public
15 Aid or the Department of Human Services (as successor to the
16 Department of Public Aid) to the General Assembly and the
17 Governor. These reports shall include, but not be limited
18 to, the following information:
19 (1) Aggregate provider billing and payment
20 information, including the number of providers at various
21 Medicaid earning levels.
22 (2) The number of audits of the medical assistance
23 program and the dollar savings resulting from those
24 audits.
25 (3) The number of prescriptions rejected annually
26 under the Illinois Department of Public Aid's Refill Too
27 Soon program and the dollar savings resulting from that
28 program.
29 (4) Provider sanctions, in the aggregate, including
30 terminations and suspensions.
31 (5) A detailed summary of the investigations
32 undertaken in the previous fiscal year. These summaries
33 shall comply with all laws and rules regarding
34 maintaining confidentiality in the public aid programs.
SB1711 Engrossed -17- LRB9008936DJgc
1 (i) Nothing in this Section shall limit investigations
2 by the Illinois Department of Public Aid or the Department of
3 Human Services that may otherwise be required by law or that
4 may be necessary in their capacity as the central
5 administrative authorities responsible for administration of
6 public aid programs in this State.
7 (Source: P.A. 88-554, eff. 7-26-94; 89-507, eff. 7-1-97.)
8 Section 99. Effective date. This Act takes effect upon
9 becoming law.