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Full Text of HB5364

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HB5364 - 104th General Assembly

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HB5364 Enrolled
LRB104 19659 KTG 33108 b
1

AN ACT concerning public aid.

2

Be it enacted by the People of the State of Illinois,
3
represented in the General Assembly:

4

Section 5.
The Illinois Public Aid Code is amended by
5
changing Section 12-13.1 as follows:

6

(305 ILCS 5/12-13.1)
7

Sec. 12-13.1.
Inspector General.
8

(a) The Governor shall appoint, and the Senate shall
9
confirm, an Inspector General who shall function within the
10
Illinois Department of Public Aid (now Healthcare and Family
11
Services) and report to the Governor. The term of the
12
Inspector General shall expire on the third Monday of January,
13
1997 and every 4 years thereafter.
14

(b) In order to prevent, detect, and eliminate fraud,
15
waste, abuse, mismanagement, and misconduct, the Inspector
16
General shall oversee the Department of Healthcare and Family
17
Services' and the Department on Aging's integrity functions,
18
which include, but are not limited to, the following:

19

(1) Investigation of misconduct by employees, vendors,
20

contractors and medical providers, except for allegations
21

of violations of the State Officials and Employees Ethics
22

Act which shall be referred to the Office of the
23

Governor's Executive Inspector General for investigation.

HB5364 Enrolled
- 2 -
LRB104 19659 KTG 33108 b
1

(2) Prepayment and post-payment audits of medical
2

providers related to ensuring that appropriate payments
3

are made for services rendered and to the prevention and
4

recovery of overpayments.

5

(3) Monitoring of quality assurance programs
6

administered by the Department of Healthcare and Family
7

Services and the Community Care Program administered by
8

the Department on Aging.

9

(4) Quality control measurements of the programs
10

administered by the Department of Healthcare and Family
11

Services and the Community Care Program administered by
12

the Department on Aging.

13

(5) Investigations of fraud or intentional program
14

violations committed by clients of the Department of
15

Healthcare and Family Services and the Community Care
16

Program administered by the Department on Aging.

17

(6) Actions initiated against contractors, vendors, or
18

medical providers for any of the following reasons:

19

(A) Violations of the medical assistance program
20

and the Community Care Program administered by the
21

Department on Aging.

22

(B) Sanctions against providers brought in
23

conjunction with the Department of Public Health or
24

the Department of Human Services (as successor to the
25

Department of Mental Health and Developmental
26

Disabilities).

HB5364 Enrolled
- 3 -
LRB104 19659 KTG 33108 b
1

(C) Recoveries of assessments against hospitals
2

and long-term care facilities.

3

(D) Sanctions mandated by the United States
4

Department of Health and Human Services against
5

medical providers.

6

(E) Violations of contracts related to any
7

programs administered by the Department of Healthcare
8

and Family Services and the Community Care Program
9

administered by the Department on Aging.

10

(7) Representation of the Department of Healthcare and
11

Family Services at hearings with the Illinois Department
12

of Financial and Professional Regulation in actions taken
13

against professional licenses held by persons who are in
14

violation of orders for child support payments.
15

(b-5) At the request of the Secretary of Human Services
or
16
the Secretary of Early Childhood
, the Inspector General shall,
17
in relation to any function performed by the Department of
18
Human Services as successor to the Department of Public Aid,
19
exercise one or more of the powers provided under this Section
20
as if those powers related to the Department of Human Services
21
or the Department of Early Childhood
; in such matters, the
22
Inspector General shall report his or her findings to the
23
Secretary of Human Services
or the Secretary of Early
24
Childhood, respectively
.
25

(c) Notwithstanding, and in addition to, any other
26
provision of law, the Inspector General shall have access to

HB5364 Enrolled
- 4 -
LRB104 19659 KTG 33108 b
1
all information, personnel and facilities of the Department of
2
Healthcare and Family Services and the Department of Human
3
Services (as successor to the Department of Public Aid), their
4
employees, vendors, contractors and medical providers and any
5
federal, State or local governmental agency that are necessary
6
to perform the duties of the Office as directly related to
7
public assistance programs administered by those departments.
8
No medical provider shall be compelled, however, to provide
9
individual medical records of patients who are not clients of
10
the programs administered by the Department of Healthcare and
11
Family Services. State and local governmental agencies are
12
authorized and directed to provide the requested information,
13
assistance or cooperation.
14

For purposes of enhanced program integrity functions and
15
oversight, and to the extent consistent with applicable
16
information and privacy, security, and disclosure laws, State
17
agencies and departments shall provide the Office of Inspector
18
General access to confidential and other information and data,
19
and the Inspector General is authorized to enter into
20
agreements with appropriate federal agencies and departments
21
to secure similar data. This includes, but is not limited to,
22
information pertaining to: licensure; certification; earnings;
23
immigration status; citizenship; wage reporting; unearned and
24
earned income; pension income; employment; supplemental
25
security income; social security numbers; National Provider
26
Identifier (NPI) numbers; the National Practitioner Data Bank

HB5364 Enrolled
- 5 -
LRB104 19659 KTG 33108 b
1
(NPDB); program and agency exclusions; taxpayer identification
2
numbers; tax delinquency; corporate information; and death
3
records.
4

The Inspector General shall enter into agreements with
5
State agencies and departments, and is authorized to enter
6
into agreements with federal agencies and departments, under
7
which such agencies and departments shall share data necessary
8
for medical assistance program integrity functions and
9
oversight. The Inspector General shall enter into agreements
10
with State agencies and departments, and is authorized to
11
enter into agreements with federal agencies and departments,
12
under which such agencies shall share data necessary for
13
recipient and vendor screening, review, and investigation,
14
including but not limited to vendor payment and recipient
15
eligibility verification. The Inspector General shall develop,
16
in cooperation with other State and federal agencies and
17
departments, and in compliance with applicable federal laws
18
and regulations, appropriate and effective methods to share
19
such data. The Inspector General shall enter into agreements
20
with State agencies and departments, and is authorized to
21
enter into agreements with federal agencies and departments,
22
including, but not limited to: the Secretary of State; the
23
Department of Revenue; the Department of Public Health; the
24
Department of Human Services; and the Department of Financial
25
and Professional Regulation.
26

The Inspector General shall have the authority to deny

HB5364 Enrolled
- 6 -
LRB104 19659 KTG 33108 b
1
payment, prevent overpayments, and recover overpayments.
2

The Inspector General shall have the authority to deny or
3
suspend payment to, and deny, terminate, or suspend the
4
eligibility of, any vendor who fails to grant the Inspector
5
General timely access to full and complete records, including
6
records of recipients under the medical assistance program for
7
the most recent 6 years, in accordance with Section 140.28 of
8
Title 89 of the Illinois Administrative Code, and other
9
information for the purpose of audits, investigations, or
10
other program integrity functions, after reasonable written
11
request by the Inspector General.
12

(d) The Inspector General shall serve as the Department of
13
Healthcare and Family Services' primary liaison with law
14
enforcement, investigatory and prosecutorial agencies,
15
including but not limited to the following:

16

(1) The Department of State Police.

17

(2) The Federal Bureau of Investigation and other
18

federal law enforcement agencies.

19

(3) The various Inspectors General of federal agencies
20

overseeing the programs administered by the Department of
21

Healthcare and Family Services.

22

(4) The various Inspectors General of any other State
23

agencies with responsibilities for portions of programs
24

primarily administered by the Department of Healthcare and
25

Family Services.

26

(5) The Offices of the several United States Attorneys

HB5364 Enrolled
- 7 -
LRB104 19659 KTG 33108 b
1

in Illinois.

2

(6) The several State's Attorneys.
3

(7) The offices of the Centers for Medicare and
4

Medicaid Services that administer the Medicare and
5

Medicaid integrity programs.
6

The Inspector General shall meet on a regular basis with
7
these entities to share information regarding possible
8
misconduct by any persons or entities involved with the public
9
aid programs administered by the Department of Healthcare and
10
Family Services.
11

(e) All investigations conducted by the Inspector General
12
shall be conducted in a manner that ensures the preservation
13
of evidence for use in criminal prosecutions. If the Inspector
14
General determines that a possible criminal act relating to
15
fraud in the provision or administration of the medical
16
assistance program has been committed, the Inspector General
17
shall immediately notify the Medicaid Fraud Control Unit. If
18
the Inspector General determines that a possible criminal act
19
has been committed within the jurisdiction of the Office, the
20
Inspector General may request the special expertise of the
21
Department of State Police. The Inspector General may present
22
for prosecution the findings of any criminal investigation to
23
the Office of the Attorney General, the Offices of the several
24
United States Attorneys in Illinois or the several State's
25
Attorneys.
26

(f) To carry out his or her duties as described in this

HB5364 Enrolled
- 8 -
LRB104 19659 KTG 33108 b
1
Section, the Inspector General and his or her designees shall
2
have the power to compel by subpoena the attendance and
3
testimony of witnesses and the production of books, electronic
4
records and papers as directly related to public assistance
5
programs administered by the Department of Healthcare and
6
Family Services or the Department of Human Services (as
7
successor to the Department of Public Aid). No medical
8
provider shall be compelled, however, to provide individual
9
medical records of patients who are not clients of the Medical
10
Assistance Program.
11

(g) The Inspector General shall report all convictions,
12
terminations, and suspensions taken against vendors,
13
contractors and medical providers to the Department of
14
Healthcare and Family Services and to any agency responsible
15
for licensing or regulating those persons or entities.
16

(h) The Inspector General shall make annual reports,
17
findings, and recommendations regarding the Office's
18
investigations into reports of fraud, waste, abuse,
19
mismanagement, or misconduct relating to any programs
20
administered by the Department of Healthcare and Family
21
Services or the Department of Human Services (as successor to
22
the Department of Public Aid) to the General Assembly and the
23
Governor. These reports shall include, but not be limited to,
24
the following information:

25

(1) Aggregate provider billing and payment
26

information, including the number of providers at various

HB5364 Enrolled
- 9 -
LRB104 19659 KTG 33108 b
1

Medicaid earning levels.

2

(2) The number of audits of the medical assistance
3

program and the dollar savings resulting from those
4

audits.

5

(3) The number of prescriptions rejected annually
6

under the Department of Healthcare and Family Services'
7

Refill Too Soon program and the dollar savings resulting
8

from that program.

9

(4) Provider sanctions, in the aggregate, including
10

terminations and suspensions.

11

(5) A detailed summary of the investigations
12

undertaken in the previous fiscal year. These summaries
13

shall comply with all laws and rules regarding maintaining
14

confidentiality in the public aid programs.
15

(i) Nothing in this Section shall limit investigations by
16
the Department of Healthcare and Family Services or the
17
Department of Human Services that may otherwise be required by
18
law or that may be necessary in their capacity as the central
19
administrative authorities responsible for administration of
20
their agency's programs in this State.
21

(j) The Inspector General may issue shields or other
22
distinctive identification to his or her employees not
23
exercising the powers of a peace officer if the Inspector
24
General determines that a shield or distinctive identification
25
is needed by an employee to carry out his or her
26
responsibilities.

HB5364 Enrolled
- 10 -
LRB104 19659 KTG 33108 b
1
(Source: P.A. 97-689, eff. 6-14-12; 98-8, eff. 5-3-13.)

2

Section 99.
Effective date.
This Act takes effect upon
3
becoming law.

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