State of Illinois
90th General Assembly
Legislation

   [ Search ]   [ Legislation ]   [ Bill Summary ]
[ Home ]   [ Back ]   [ Bottom ]


[ Introduced ][ Engrossed ][ Senate Amendment 001 ]

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 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 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.

[ Top ]