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90_SB1711enr 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 Enrolled 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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 Enrolled -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 annualquarterly11 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 Enrolled -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.