Bill Amendment: IL HB5539 | 2015-2016 | 99th General Assembly

NOTE: For additional amemendments please see the Bill Drafting List

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Bill Title: POWER AGENCY-ANNUAL REPORTS

Status: 2016-11-17 - Total Veto Stands - No Positive Action Taken [HB5539 Detail]

Download: Illinois-2015-HB5539-Senate_Amendment_001.html

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Sen. Don Harmon

Filed: 5/20/2016

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AMENDMENT TO HOUSE BILL 5539
AMENDMENT NO. ______. Amend House Bill 5539 by replacing
everything after the enacting clause with the following:
"Section 5. The Illinois Public Aid Code is amended by
changing Section 12-4.25 as follows:
(305 ILCS 5/12-4.25) (from Ch. 23, par. 12-4.25)
Sec. 12-4.25. Medical assistance program; vendor
participation.
(A) The Illinois Department may deny, suspend, or terminate
the eligibility of any person, firm, corporation, association,
agency, institution or other legal entity to participate as a
vendor of goods or services to recipients under the medical
assistance program under Article V, or may exclude any such
person or entity from participation as such a vendor, and may
deny, suspend, or recover payments, if after reasonable notice
and opportunity for a hearing the Illinois Department finds:

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(a) Such vendor is not complying with the Department's
policy or rules and regulations, or with the terms and
conditions prescribed by the Illinois Department in its
vendor agreement, which document shall be developed by the
Department as a result of negotiations with each vendor
category, including physicians, hospitals, long term care
facilities, pharmacists, optometrists, podiatric
physicians, and dentists setting forth the terms and
conditions applicable to the participation of each vendor
group in the program; or
(b) Such vendor has failed to keep or make available
for inspection, audit or copying, after receiving a written
request from the Illinois Department, such records
regarding payments claimed for providing services. This
section does not require vendors to make available patient
records of patients for whom services are not reimbursed
under this Code; or
(c) Such vendor has failed to furnish any information
requested by the Department regarding payments for
providing goods or services; or
(d) Such vendor has knowingly made, or caused to be
made, any false statement or representation of a material
fact in connection with the administration of the medical
assistance program; or
(e) Such vendor has furnished goods or services to a
recipient which are (1) in excess of need, (2) harmful, or

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(3) of grossly inferior quality, all of such determinations
to be based upon competent medical judgment and
evaluations; or
(f) The vendor; a person with management
responsibility for a vendor; an officer or person owning,
either directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a corporate
vendor; an owner of a sole proprietorship which is a
vendor; or a partner in a partnership which is a vendor,
either:
(1) was previously terminated, suspended, or
excluded from participation in the Illinois medical
assistance program, or was terminated, suspended, or
excluded from participation in another state or
federal medical assistance or health care program; or
(2) was a person with management responsibility
for a vendor previously terminated, suspended, or
excluded from participation in the Illinois medical
assistance program, or terminated, suspended, or
excluded from participation in another state or
federal medical assistance or health care program
during the time of conduct which was the basis for that
vendor's termination, suspension, or exclusion; or
(3) was an officer, or person owning, either
directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a corporate or

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limited liability company vendor previously
terminated, suspended, or excluded from participation
in the Illinois medical assistance program, or
terminated, suspended, or excluded from participation
in a state or federal medical assistance or health care
program during the time of conduct which was the basis
for that vendor's termination, suspension, or
exclusion; or
(4) was an owner of a sole proprietorship or
partner of a partnership previously terminated,
suspended, or excluded from participation in the
Illinois medical assistance program, or terminated,
suspended, or excluded from participation in a state or
federal medical assistance or health care program
during the time of conduct which was the basis for that
vendor's termination, suspension, or exclusion; or
(f-1) Such vendor has a delinquent debt owed to the
Illinois Department; or
(g) The vendor; a person with management
responsibility for a vendor; an officer or person owning,
either directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a corporate or
limited liability company vendor; an owner of a sole
proprietorship which is a vendor; or a partner in a
partnership which is a vendor, either:
(1) has engaged in practices prohibited by

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applicable federal or State law or regulation; or
(2) was a person with management responsibility
for a vendor at the time that such vendor engaged in
practices prohibited by applicable federal or State
law or regulation; or
(3) was an officer, or person owning, either
directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a vendor at
the time such vendor engaged in practices prohibited by
applicable federal or State law or regulation; or
(4) was an owner of a sole proprietorship or
partner of a partnership which was a vendor at the time
such vendor engaged in practices prohibited by
applicable federal or State law or regulation; or
(h) The direct or indirect ownership of the vendor
(including the ownership of a vendor that is a sole
proprietorship, a partner's interest in a vendor that is a
partnership, or ownership of 5% or more of the shares of
stock or other evidences of ownership in a corporate
vendor) has been transferred by an individual who is
terminated, suspended, or excluded or barred from
participating as a vendor to the individual's spouse,
child, brother, sister, parent, grandparent, grandchild,
uncle, aunt, niece, nephew, cousin, or relative by
marriage.
(A-5) The Illinois Department may deny, suspend, or

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terminate the eligibility of any person, firm, corporation,
association, agency, institution, or other legal entity to
participate as a vendor of goods or services to recipients
under the medical assistance program under Article V, or may
exclude any such person or entity from participation as such a
vendor, if, after reasonable notice and opportunity for a
hearing, the Illinois Department finds that the vendor; a
person with management responsibility for a vendor; an officer
or person owning, either directly or indirectly, 5% or more of
the shares of stock or other evidences of ownership in a
corporate vendor; an owner of a sole proprietorship that is a
vendor; or a partner in a partnership that is a vendor has been
convicted of an offense based on fraud or willful
misrepresentation related to any of the following:
(1) The medical assistance program under Article V of
this Code.
(2) A medical assistance or health care program in
another state.
(3) The Medicare program under Title XVIII of the
Social Security Act.
(4) The provision of health care services.
(5) A violation of this Code, as provided in Article
VIIIA, or another state or federal medical assistance
program or health care program.
(A-10) The Illinois Department may deny, suspend, or
terminate the eligibility of any person, firm, corporation,

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association, agency, institution, or other legal entity to
participate as a vendor of goods or services to recipients
under the medical assistance program under Article V, or may
exclude any such person or entity from participation as such a
vendor, if, after reasonable notice and opportunity for a
hearing, the Illinois Department finds that (i) the vendor,
(ii) a person with management responsibility for a vendor,
(iii) an officer or person owning, either directly or
indirectly, 5% or more of the shares of stock or other
evidences of ownership in a corporate vendor, (iv) an owner of
a sole proprietorship that is a vendor, or (v) a partner in a
partnership that is a vendor has been convicted of an offense
related to any of the following:
(1) Murder.
(2) A Class X felony under the Criminal Code of 1961 or
the Criminal Code of 2012.
(3) Sexual misconduct that may subject recipients to an
undue risk of harm.
(4) A criminal offense that may subject recipients to
an undue risk of harm.
(5) A crime of fraud or dishonesty.
(6) A crime involving a controlled substance.
(7) A misdemeanor relating to fraud, theft,
embezzlement, breach of fiduciary responsibility, or other
financial misconduct related to a health care program.
(A-15) The Illinois Department may deny the eligibility of

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any person, firm, corporation, association, agency,
institution, or other legal entity to participate as a vendor
of goods or services to recipients under the medical assistance
program under Article V if, after reasonable notice and
opportunity for a hearing, the Illinois Department finds:
(1) The applicant or any person with management
responsibility for the applicant; an officer or member of
the board of directors of an applicant; an entity owning
(directly or indirectly) 5% or more of the shares of stock
or other evidences of ownership in a corporate vendor
applicant; an owner of a sole proprietorship applicant; a
partner in a partnership applicant; or a technical or other
advisor to an applicant has a debt owed to the Illinois
Department, and no payment arrangements acceptable to the
Illinois Department have been made by the applicant.
(2) The applicant or any person with management
responsibility for the applicant; an officer or member of
the board of directors of an applicant; an entity owning
(directly or indirectly) 5% or more of the shares of stock
or other evidences of ownership in a corporate vendor
applicant; an owner of a sole proprietorship applicant; a
partner in a partnership vendor applicant; or a technical
or other advisor to an applicant was (i) a person with
management responsibility, (ii) an officer or member of the
board of directors of an applicant, (iii) an entity owning
(directly or indirectly) 5% or more of the shares of stock

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or other evidences of ownership in a corporate vendor, (iv)
an owner of a sole proprietorship, (v) a partner in a
partnership vendor, (vi) a technical or other advisor to a
vendor, during a period of time where the conduct of that
vendor resulted in a debt owed to the Illinois Department,
and no payment arrangements acceptable to the Illinois
Department have been made by that vendor.
(3) There is a credible allegation of the use,
transfer, or lease of assets of any kind to an applicant
from a current or prior vendor who has a debt owed to the
Illinois Department, no payment arrangements acceptable to
the Illinois Department have been made by that vendor or
the vendor's alternate payee, and the applicant knows or
should have known of such debt.
(4) There is a credible allegation of a transfer of
management responsibilities, or direct or indirect
ownership, to an applicant from a current or prior vendor
who has a debt owed to the Illinois Department, and no
payment arrangements acceptable to the Illinois Department
have been made by that vendor or the vendor's alternate
payee, and the applicant knows or should have known of such
debt.
(5) There is a credible allegation of the use,
transfer, or lease of assets of any kind to an applicant
who is a spouse, child, brother, sister, parent,
grandparent, grandchild, uncle, aunt, niece, relative by

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marriage, nephew, cousin, or relative of a current or prior
vendor who has a debt owed to the Illinois Department and
no payment arrangements acceptable to the Illinois
Department have been made.
(6) There is a credible allegation that the applicant's
previous affiliations with a provider of medical services
that has an uncollected debt, a provider that has been or
is subject to a payment suspension under a federal health
care program, or a provider that has been previously
excluded from participation in the medical assistance
program, poses a risk of fraud, waste, or abuse to the
Illinois Department.
As used in this subsection, "credible allegation" is
defined to include an allegation from any source, including,
but not limited to, fraud hotline complaints, claims data
mining, patterns identified through provider audits, civil
actions filed under the Illinois False Claims Act, and law
enforcement investigations. An allegation is considered to be
credible when it has indicia of reliability.
(B) The Illinois Department shall deny, suspend or
terminate the eligibility of any person, firm, corporation,
association, agency, institution or other legal entity to
participate as a vendor of goods or services to recipients
under the medical assistance program under Article V, or may
exclude any such person or entity from participation as such a
vendor:

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(1) immediately, if such vendor is not properly
licensed, certified, or authorized;
(2) within 30 days of the date when such vendor's
professional license, certification or other authorization
has been refused renewal, restricted, revoked, suspended,
or otherwise terminated; or
(3) if such vendor has been convicted of a violation of
this Code, as provided in Article VIIIA.
(C) Upon termination, suspension, or exclusion of a vendor
of goods or services from participation in the medical
assistance program authorized by this Article, a person with
management responsibility for such vendor during the time of
any conduct which served as the basis for that vendor's
termination, suspension, or exclusion is barred from
participation in the medical assistance program.
Upon termination, suspension, or exclusion of a corporate
vendor, the officers and persons owning, directly or
indirectly, 5% or more of the shares of stock or other
evidences of ownership in the vendor during the time of any
conduct which served as the basis for that vendor's
termination, suspension, or exclusion are barred from
participation in the medical assistance program. A person who
owns, directly or indirectly, 5% or more of the shares of stock
or other evidences of ownership in a terminated, suspended, or
excluded vendor may not transfer his or her ownership interest
in that vendor to his or her spouse, child, brother, sister,

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parent, grandparent, grandchild, uncle, aunt, niece, nephew,
cousin, or relative by marriage.
Upon termination, suspension, or exclusion of a sole
proprietorship or partnership, the owner or partners during the
time of any conduct which served as the basis for that vendor's
termination, suspension, or exclusion are barred from
participation in the medical assistance program. The owner of a
terminated, suspended, or excluded vendor that is a sole
proprietorship, and a partner in a terminated, suspended, or
excluded vendor that is a partnership, may not transfer his or
her ownership or partnership interest in that vendor to his or
her spouse, child, brother, sister, parent, grandparent,
grandchild, uncle, aunt, niece, nephew, cousin, or relative by
marriage.
A person who owns, directly or indirectly, 5% or more of
the shares of stock or other evidences of ownership in a
corporate or limited liability company vendor who owes a debt
to the Department, if that vendor has not made payment
arrangements acceptable to the Department, shall not transfer
his or her ownership interest in that vendor, or vendor assets
of any kind, to his or her spouse, child, brother, sister,
parent, grandparent, grandchild, uncle, aunt, niece, nephew,
cousin, or relative by marriage.
Rules adopted by the Illinois Department to implement these
provisions shall specifically include a definition of the term
"management responsibility" as used in this Section. Such

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definition shall include, but not be limited to, typical job
titles, and duties and descriptions which will be considered as
within the definition of individuals with management
responsibility for a provider.
A vendor or a prior vendor who has been terminated,
excluded, or suspended from the medical assistance program, or
from another state or federal medical assistance or health care
program, and any individual currently or previously barred from
the medical assistance program, or from another state or
federal medical assistance or health care program, as a result
of being an officer or a person owning, directly or indirectly,
5% or more of the shares of stock or other evidences of
ownership in a corporate or limited liability company vendor
during the time of any conduct which served as the basis for
that vendor's termination, suspension, or exclusion, may be
required to post a surety bond as part of a condition of
enrollment or participation in the medical assistance program.
The Illinois Department shall establish, by rule, the criteria
and requirements for determining when a surety bond must be
posted and the value of the bond.
A vendor or a prior vendor who has a debt owed to the
Illinois Department and any individual currently or previously
barred from the medical assistance program, or from another
state or federal medical assistance or health care program, as
a result of being an officer or a person owning, directly or
indirectly, 5% or more of the shares of stock or other

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evidences of ownership in that corporate or limited liability
company vendor during the time of any conduct which served as
the basis for the debt, may be required to post a surety bond
as part of a condition of enrollment or participation in the
medical assistance program. The Illinois Department shall
establish, by rule, the criteria and requirements for
determining when a surety bond must be posted and the value of
the bond.
(D) If a vendor has been suspended from the medical
assistance program under Article V of the Code, the Director
may require that such vendor correct any deficiencies which
served as the basis for the suspension. The Director shall
specify in the suspension order a specific period of time,
which shall not exceed one year from the date of the order,
during which a suspended vendor shall not be eligible to
participate. At the conclusion of the period of suspension the
Director shall reinstate such vendor, unless he finds that such
vendor has not corrected deficiencies upon which the suspension
was based.
If a vendor has been terminated, suspended, or excluded
from the medical assistance program under Article V, such
vendor shall be barred from participation for at least one
year, except that if a vendor has been terminated, suspended,
or excluded based on a conviction of a violation of Article
VIIIA or a conviction of a felony based on fraud or a willful
misrepresentation related to (i) the medical assistance

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program under Article V, (ii) a federal or another state's
medical assistance or health care program, or (iii) the
provision of health care services, then the vendor shall be
barred from participation for 5 years or for the length of the
vendor's sentence for that conviction, whichever is longer. At
the end of one year a vendor who has been terminated,
suspended, or excluded may apply for reinstatement to the
program. Upon proper application to be reinstated such vendor
may be deemed eligible by the Director providing that such
vendor meets the requirements for eligibility under this Code.
If such vendor is deemed not eligible for reinstatement, he
shall be barred from again applying for reinstatement for one
year from the date his application for reinstatement is denied.
A vendor whose termination, suspension, or exclusion from
participation in the Illinois medical assistance program under
Article V was based solely on an action by a governmental
entity other than the Illinois Department may, upon
reinstatement by that governmental entity or upon reversal of
the termination, suspension, or exclusion, apply for
rescission of the termination, suspension, or exclusion from
participation in the Illinois medical assistance program. Upon
proper application for rescission, the vendor may be deemed
eligible by the Director if the vendor meets the requirements
for eligibility under this Code.
If a vendor has been terminated, suspended, or excluded and
reinstated to the medical assistance program under Article V

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and the vendor is terminated, suspended, or excluded a second
or subsequent time from the medical assistance program, the
vendor shall be barred from participation for at least 2 years,
except that if a vendor has been terminated, suspended, or
excluded a second time based on a conviction of a violation of
Article VIIIA or a conviction of a felony based on fraud or a
willful misrepresentation related to (i) the medical
assistance program under Article V, (ii) a federal or another
state's medical assistance or health care program, or (iii) the
provision of health care services, then the vendor shall be
barred from participation for life. At the end of 2 years, a
vendor who has been terminated, suspended, or excluded may
apply for reinstatement to the program. Upon application to be
reinstated, the vendor may be deemed eligible if the vendor
meets the requirements for eligibility under this Code. If the
vendor is deemed not eligible for reinstatement, the vendor
shall be barred from again applying for reinstatement for 2
years from the date the vendor's application for reinstatement
is denied.
(E) The Illinois Department may recover money improperly or
erroneously paid, or overpayments, either by setoff, crediting
against future billings or by requiring direct repayment to the
Illinois Department. The Illinois Department may suspend or
deny payment, in whole or in part, if such payment would be
improper or erroneous or would otherwise result in overpayment.
(1) Payments may be suspended, denied, or recovered

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from a vendor or alternate payee: (i) for services rendered
in violation of the Illinois Department's provider
notices, statutes, rules, and regulations; (ii) for
services rendered in violation of the terms and conditions
prescribed by the Illinois Department in its vendor
agreement; (iii) for any vendor who fails to grant the
Office of Inspector General timely access to full and
complete records, including, but not limited to, records
relating to recipients under the medical assistance
program for the most recent 6 years, in accordance with
Section 140.28 of Title 89 of the Illinois Administrative
Code, and other information for the purpose of audits,
investigations, or other program integrity functions,
after reasonable written request by the Inspector General;
this subsection (E) does not require vendors to make
available the medical records of patients for whom services
are not reimbursed under this Code or to provide access to
medical records more than 6 years old; (iv) when the vendor
has knowingly made, or caused to be made, any false
statement or representation of a material fact in
connection with the administration of the medical
assistance program; or (v) when the vendor previously
rendered services while terminated, suspended, or excluded
from participation in the medical assistance program or
while terminated or excluded from participation in another
state or federal medical assistance or health care program.

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Notwithstanding any other provision to the contrary, the
Department shall not seek recovery of overpayments,
adjustments, or other amounts due that are over 6 years old
unless such overpayments, adjustments, or other amounts
due were made pursuant to a vendor's criminal activity.
(2) Notwithstanding any other provision of law, if a
vendor has the same taxpayer identification number
(assigned under Section 6109 of the Internal Revenue Code
of 1986) as is assigned to a vendor with past-due financial
obligations to the Illinois Department, the Illinois
Department may make any necessary adjustments to payments
to that vendor in order to satisfy any past-due
obligations, regardless of whether the vendor is assigned a
different billing number under the medical assistance
program.
(E-5) Civil monetary penalties.
(1) As used in this subsection (E-5):
(a) "Knowingly" means that a person, with respect
to information: (i) has actual knowledge of the
information; (ii) acts in deliberate ignorance of the
truth or falsity of the information; or (iii) acts in
reckless disregard of the truth or falsity of the
information. No proof of specific intent to defraud is
required.
(b) "Overpayment" means any funds that a person
receives or retains from the medical assistance

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program to which the person, after applicable
reconciliation, is not entitled under this Code.
(c) "Remuneration" means the offer or transfer of
items or services for free or for other than fair
market value by a person; however, remuneration does
not include items or services of a nominal value of no
more than $10 per item or service, or $50 in the
aggregate on an annual basis, or any other offer or
transfer of items or services as determined by the
Department.
(d) "Should know" means that a person, with respect
to information: (i) acts in deliberate ignorance of the
truth or falsity of the information; or (ii) acts in
reckless disregard of the truth or falsity of the
information. No proof of specific intent to defraud is
required.
(2) Any person (including a vendor, provider,
organization, agency, or other entity, or an alternate
payee thereof, but excluding a recipient) who:
(a) knowingly presents or causes to be presented to
an officer, employee, or agent of the State, a claim
that the Department determines:
(i) is for a medical or other item or service
that the person knows or should know was not
provided as claimed, including any person who
engages in a pattern or practice of presenting or

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causing to be presented a claim for an item or
service that is based on a code that the person
knows or should know will result in a greater
payment to the person than the code the person
knows or should know is applicable to the item or
service actually provided;
(ii) is for a medical or other item or service
and the person knows or should know that the claim
is false or fraudulent;
(iii) is presented for a vendor physician's
service, or an item or service incident to a vendor
physician's service, by a person who knows or
should know that the individual who furnished, or
supervised the furnishing of, the service:
(AA) was not licensed as a physician;
(BB) was licensed as a physician but such
license had been obtained through a
misrepresentation of material fact (including
cheating on an examination required for
licensing); or
(CC) represented to the patient at the
time the service was furnished that the
physician was certified in a medical specialty
by a medical specialty board, when the
individual was not so certified;
(iv) is for a medical or other item or service

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furnished during a period in which the person was
excluded from the medical assistance program or a
federal or state health care program under which
the claim was made pursuant to applicable law; or
(v) is for a pattern of medical or other items
or services that a person knows or should know are
not medically necessary;
(b) knowingly presents or causes to be presented to
any person a request for payment which is in violation
of the conditions for receipt of vendor payments under
the medical assistance program under Section 11-13 of
this Code;
(c) knowingly gives or causes to be given to any
person, with respect to medical assistance program
coverage of inpatient hospital services, information
that he or she knows or should know is false or
misleading, and that could reasonably be expected to
influence the decision when to discharge such person or
other individual from the hospital;
(d) in the case of a person who is not an
organization, agency, or other entity, is excluded
from participating in the medical assistance program
or a federal or state health care program and who, at
the time of a violation of this subsection (E-5):
(i) retains a direct or indirect ownership or
control interest in an entity that is

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participating in the medical assistance program or
a federal or state health care program, and who
knows or should know of the action constituting the
basis for the exclusion; or
(ii) is an officer or managing employee of such
an entity;
(e) offers or transfers remuneration to any
individual eligible for benefits under the medical
assistance program that such person knows or should
know is likely to influence such individual to order or
receive from a particular vendor, provider,
practitioner, or supplier any item or service for which
payment may be made, in whole or in part, under the
medical assistance program;
(f) arranges or contracts (by employment or
otherwise) with an individual or entity that the person
knows or should know is excluded from participation in
the medical assistance program or a federal or state
health care program, for the provision of items or
services for which payment may be made under such a
program;
(g) commits an act described in subsection (b) or
(c) of Section 8A-3;
(h) knowingly makes, uses, or causes to be made or
used, a false record or statement material to a false
or fraudulent claim for payment for items and services

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furnished under the medical assistance program;
(i) fails to grant timely access, upon reasonable
request (as defined by the Department by rule), to the
Inspector General, for the purpose of audits,
investigations, evaluations, or other statutory
functions of the Inspector General of the Department;
(j) orders or prescribes a medical or other item or
service during a period in which the person was
excluded from the medical assistance program or a
federal or state health care program, in the case where
the person knows or should know that a claim for such
medical or other item or service will be made under
such a program;
(k) knowingly makes or causes to be made any false
statement, omission, or misrepresentation of a
material fact in any application, bid, or contract to
participate or enroll as a vendor or provider of
services or a supplier under the medical assistance
program;
(l) knows of an overpayment and does not report and
return the overpayment to the Department in accordance
with paragraph (6);
shall be subject, in addition to any other penalties that
may be prescribed by law, to a civil money penalty of not
more than $10,000 for each item or service (or, in cases
under subparagraph (c), $15,000 for each individual with

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respect to whom false or misleading information was given;
in cases under subparagraph (d), $10,000 for each day the
prohibited relationship occurs; in cases under
subparagraph (g), $50,000 for each such act; in cases under
subparagraph (h), $50,000 for each false record or
statement; in cases under subparagraph (i), $15,000 for
each day of the failure described in such subparagraph; or
in cases under subparagraph (k), $50,000 for each false
statement, omission, or misrepresentation of a material
fact). In addition, such a person shall be subject to an
assessment of not more than 3 times the amount claimed for
each such item or service in lieu of damages sustained by
the State because of such claim (or, in cases under
subparagraph (g), damages of not more than 3 times the
total amount of remuneration offered, paid, solicited, or
received, without regard to whether a portion of such
remuneration was offered, paid, solicited, or received for
a lawful purpose; or in cases under subparagraph (k), an
assessment of not more than 3 times the total amount
claimed for each item or service for which payment was made
based upon the application, bid, or contract containing the
false statement, omission, or misrepresentation of a
material fact).
(3) In addition, the Director or his or her designee
may make a determination in the same proceeding to exclude,
terminate, suspend, or bar the person from participation in

09900HB5539sam001 - 25 - LRB099 19598 KTG 49013 a
the medical assistance program.
(4) The Illinois Department may seek the civil monetary
penalties and exclusion, termination, suspension, or
barment identified in this subsection (E-5). Prior to the
imposition of any penalties or sanctions, the affected
person shall be afforded an opportunity for a hearing after
reasonable notice. The Department shall establish hearing
procedures by rule.
(5) Any final order, decision, or other determination
made, issued, or executed by the Director under the
provisions of this subsection (E-5), whereby a person is
aggrieved, shall be subject to review in accordance with
the provisions of the Administrative Review Law, and the
rules adopted pursuant thereto, which shall apply to and
govern all proceedings for the judicial review of final
administrative decisions of the Director.
(6)(a) If a person has received an overpayment, the
person shall:
(i) report and return the overpayment to the
Department at the correct address; and
(ii) notify the Department in writing of the reason
for the overpayment.
(b) An overpayment must be reported and returned under
subparagraph (a) by the later of:
(i) the date which is 60 days after the date on
which the overpayment was identified; or

09900HB5539sam001 - 26 - LRB099 19598 KTG 49013 a
(ii) the date any corresponding cost report is due,
if applicable.
(E-10) A vendor who disputes an overpayment identified as
part of a Department audit shall utilize the Department's
self-referral disclosure protocol as set forth under this Code
to identify, investigate, and return to the Department any
undisputed audit overpayment amount. Unless the disputed
overpayment amount is subject to a fraud payment suspension, or
involves a termination sanction, the Department shall defer the
recovery of the disputed overpayment amount up to one year
after the date of the Department's final audit determination,
or earlier, or as required by State or federal law. If the
administrative hearing extends beyond one year, and such delay
was not caused by the request of the vendor, then the
Department shall not recover the disputed overpayment amount
until the date of the final administrative decision. If a final
administrative decision establishes that the disputed
overpayment amount is owed to the Department, then the amount
shall be immediately due to the Department. The Department
shall be entitled to recover interest from the vendor on the
overpayment amount from the date of the overpayment through the
date the vendor returns the overpayment to the Department at a
rate not to exceed the Wall Street Journal Prime Rate, as
published from time to time, but not to exceed 5%. Any interest
billed by the Department shall be due immediately upon receipt
of the Department's billing statement.

09900HB5539sam001 - 27 - LRB099 19598 KTG 49013 a
(F) The Illinois Department may withhold payments to any
vendor or alternate payee prior to or during the pendency of
any audit or proceeding under this Section, and through the
pendency of any administrative appeal or administrative review
by any court proceeding. The Illinois Department shall state by
rule with as much specificity as practicable the conditions
under which payments will not be withheld under this Section.
Payments may be denied for bills submitted with service dates
occurring during the pendency of a proceeding, after a final
decision has been rendered, or after the conclusion of any
administrative appeal, where the final administrative decision
is to terminate, exclude, or suspend eligibility to participate
in the medical assistance program. The Illinois Department
shall state by rule with as much specificity as practicable the
conditions under which payments will not be denied for such
bills. The Illinois Department shall state by rule a process
and criteria by which a vendor or alternate payee may request
full or partial release of payments withheld under this
subsection. The Department must complete a proceeding under
this Section in a timely manner.
Notwithstanding recovery allowed under subsection (E) or
this subsection (F), the Illinois Department may withhold
payments to any vendor or alternate payee who is not properly
licensed, certified, or in compliance with State or federal
agency regulations. Payments may be denied for bills submitted
with service dates occurring during the period of time that a

09900HB5539sam001 - 28 - LRB099 19598 KTG 49013 a
vendor is not properly licensed, certified, or in compliance
with State or federal regulations. Facilities licensed under
the Nursing Home Care Act shall have payments denied or
withheld pursuant to subsection (I) of this Section.
(F-5) The Illinois Department may temporarily withhold
payments to a vendor or alternate payee if any of the following
individuals have been indicted or otherwise charged under a law
of the United States or this or any other state with an offense
that is based on alleged fraud or willful misrepresentation on
the part of the individual related to (i) the medical
assistance program under Article V of this Code, (ii) a federal
or another state's medical assistance or health care program,
or (iii) the provision of health care services:
(1) If the vendor or alternate payee is a corporation:
an officer of the corporation or an individual who owns,
either directly or indirectly, 5% or more of the shares of
stock or other evidence of ownership of the corporation.
(2) If the vendor is a sole proprietorship: the owner
of the sole proprietorship.
(3) If the vendor or alternate payee is a partnership:
a partner in the partnership.
(4) If the vendor or alternate payee is any other
business entity authorized by law to transact business in
this State: an officer of the entity or an individual who
owns, either directly or indirectly, 5% or more of the
evidences of ownership of the entity.

09900HB5539sam001 - 29 - LRB099 19598 KTG 49013 a
If the Illinois Department withholds payments to a vendor
or alternate payee under this subsection, the Department shall
not release those payments to the vendor or alternate payee
while any criminal proceeding related to the indictment or
charge is pending unless the Department determines that there
is good cause to release the payments before completion of the
proceeding. If the indictment or charge results in the
individual's conviction, the Illinois Department shall retain
all withheld payments, which shall be considered forfeited to
the Department. If the indictment or charge does not result in
the individual's conviction, the Illinois Department shall
release to the vendor or alternate payee all withheld payments.
(F-10) If the Illinois Department establishes that the
vendor or alternate payee owes a debt to the Illinois
Department, and the vendor or alternate payee subsequently
fails to pay or make satisfactory payment arrangements with the
Illinois Department for the debt owed, the Illinois Department
may seek all remedies available under the law of this State to
recover the debt, including, but not limited to, wage
garnishment or the filing of claims or liens against the vendor
or alternate payee.
(F-15) Enforcement of judgment.
(1) Any fine, recovery amount, other sanction, or costs
imposed, or part of any fine, recovery amount, other
sanction, or cost imposed, remaining unpaid after the
exhaustion of or the failure to exhaust judicial review

09900HB5539sam001 - 30 - LRB099 19598 KTG 49013 a
procedures under the Illinois Administrative Review Law is
a debt due and owing the State and may be collected using
all remedies available under the law.
(2) After expiration of the period in which judicial
review under the Illinois Administrative Review Law may be
sought for a final administrative decision, unless stayed
by a court of competent jurisdiction, the findings,
decision, and order of the Director may be enforced in the
same manner as a judgment entered by a court of competent
jurisdiction.
(3) In any case in which any person or entity has
failed to comply with a judgment ordering or imposing any
fine or other sanction, any expenses incurred by the
Illinois Department to enforce the judgment, including,
but not limited to, attorney's fees, court costs, and costs
related to property demolition or foreclosure, after they
are fixed by a court of competent jurisdiction or the
Director, shall be a debt due and owing the State and may
be collected in accordance with applicable law. Prior to
any expenses being fixed by a final administrative decision
pursuant to this subsection (F-15), the Illinois
Department shall provide notice to the individual or entity
that states that the individual or entity shall appear at a
hearing before the administrative hearing officer to
determine whether the individual or entity has failed to
comply with the judgment. The notice shall set the date for

09900HB5539sam001 - 31 - LRB099 19598 KTG 49013 a
such a hearing, which shall not be less than 7 days from
the date that notice is served. If notice is served by
mail, the 7-day period shall begin to run on the date that
the notice was deposited in the mail.
(4) Upon being recorded in the manner required by
Article XII of the Code of Civil Procedure or by the
Uniform Commercial Code, a lien shall be imposed on the
real estate or personal estate, or both, of the individual
or entity in the amount of any debt due and owing the State
under this Section. The lien may be enforced in the same
manner as a judgment of a court of competent jurisdiction.
A lien shall attach to all property and assets of such
person, firm, corporation, association, agency,
institution, or other legal entity until the judgment is
satisfied.
(5) The Director may set aside any judgment entered by
default and set a new hearing date upon a petition filed at
any time (i) if the petitioner's failure to appear at the
hearing was for good cause, or (ii) if the petitioner
established that the Department did not provide proper
service of process. If any judgment is set aside pursuant
to this paragraph (5), the hearing officer shall have
authority to enter an order extinguishing any lien which
has been recorded for any debt due and owing the Illinois
Department as a result of the vacated default judgment.
(G) The provisions of the Administrative Review Law, as now

09900HB5539sam001 - 32 - LRB099 19598 KTG 49013 a
or hereafter amended, and the rules adopted pursuant thereto,
shall apply to and govern all proceedings for the judicial
review of final administrative decisions of the Illinois
Department under this Section. The term "administrative
decision" is defined as in Section 3-101 of the Code of Civil
Procedure.
(G-5) Vendors who pose a risk of fraud, waste, abuse, or
harm.
(1) Notwithstanding any other provision in this
Section, the Department may terminate, suspend, or exclude
vendors who pose a risk of fraud, waste, abuse, or harm
from participation in the medical assistance program prior
to an evidentiary hearing but after reasonable notice and
opportunity to respond as established by the Department by
rule.
(2) Vendors who pose a risk of fraud, waste, abuse, or
harm shall submit to a fingerprint-based criminal
background check on current and future information
available in the State system and current information
available through the Federal Bureau of Investigation's
system by submitting all necessary fees and information in
the form and manner prescribed by the Department of State
Police. The following individuals shall be subject to the
check:
(A) In the case of a vendor that is a corporation,
every shareholder who owns, directly or indirectly, 5%

09900HB5539sam001 - 33 - LRB099 19598 KTG 49013 a
or more of the outstanding shares of the corporation.
(B) In the case of a vendor that is a partnership,
every partner.
(C) In the case of a vendor that is a sole
proprietorship, the sole proprietor.
(D) Each officer or manager of the vendor.
Each such vendor shall be responsible for payment of
the cost of the criminal background check.
(3) Vendors who pose a risk of fraud, waste, abuse, or
harm may be required to post a surety bond. The Department
shall establish, by rule, the criteria and requirements for
determining when a surety bond must be posted and the value
of the bond.
(4) The Department, or its agents, may refuse to accept
requests for authorization from specific vendors who pose a
risk of fraud, waste, abuse, or harm, including
prior-approval and post-approval requests, if:
(A) the Department has initiated a notice of
termination, suspension, or exclusion of the vendor
from participation in the medical assistance program;
or
(B) the Department has issued notification of its
withholding of payments pursuant to subsection (F-5)
of this Section; or
(C) the Department has issued a notification of its
withholding of payments due to reliable evidence of

09900HB5539sam001 - 34 - LRB099 19598 KTG 49013 a
fraud or willful misrepresentation pending
investigation.
(5) As used in this subsection, the following terms are
defined as follows:
(A) "Fraud" means an intentional deception or
misrepresentation made by a person with the knowledge
that the deception could result in some unauthorized
benefit to himself or herself or some other person. It
includes any act that constitutes fraud under
applicable federal or State law.
(B) "Abuse" means provider practices that are
inconsistent with sound fiscal, business, or medical
practices and that result in an unnecessary cost to the
medical assistance program or in reimbursement for
services that are not medically necessary or that fail
to meet professionally recognized standards for health
care. It also includes recipient practices that result
in unnecessary cost to the medical assistance program.
Abuse does not include diagnostic or therapeutic
measures conducted primarily as a safeguard against
possible vendor liability.
(C) "Waste" means the unintentional misuse of
medical assistance resources, resulting in unnecessary
cost to the medical assistance program. Waste does not
include diagnostic or therapeutic measures conducted
primarily as a safeguard against possible vendor

09900HB5539sam001 - 35 - LRB099 19598 KTG 49013 a
liability.
(D) "Harm" means physical, mental, or monetary
damage to recipients or to the medical assistance
program.
(G-6) The Illinois Department, upon making a determination
based upon information in the possession of the Illinois
Department that continuation of participation in the medical
assistance program by a vendor would constitute an immediate
danger to the public, may immediately suspend such vendor's
participation in the medical assistance program without a
hearing. In instances in which the Illinois Department
immediately suspends the medical assistance program
participation of a vendor under this Section, a hearing upon
the vendor's participation must be convened by the Illinois
Department within 15 days after such suspension and completed
without appreciable delay. Such hearing shall be held to
determine whether to recommend to the Director that the
vendor's medical assistance program participation be denied,
terminated, suspended, placed on provisional status, or
reinstated. In the hearing, any evidence relevant to the vendor
constituting an immediate danger to the public may be
introduced against such vendor; provided, however, that the
vendor, or his or her counsel, shall have the opportunity to
discredit, impeach, and submit evidence rebutting such
evidence.
(H) Nothing contained in this Code shall in any way limit

09900HB5539sam001 - 36 - LRB099 19598 KTG 49013 a
or otherwise impair the authority or power of any State agency
responsible for licensing of vendors.
(I) Based on a finding of noncompliance on the part of a
nursing home with any requirement for certification under Title
XVIII or XIX of the Social Security Act (42 U.S.C. Sec. 1395 et
seq. or 42 U.S.C. Sec. 1396 et seq.), the Illinois Department
may impose one or more of the following remedies after notice
to the facility:
(1) Termination of the provider agreement.
(2) Temporary management.
(3) Denial of payment for new admissions.
(4) Civil money penalties.
(5) Closure of the facility in emergency situations or
transfer of residents, or both.
(6) State monitoring.
(7) Denial of all payments when the U.S. Department of
Health and Human Services has imposed this sanction.
The Illinois Department shall by rule establish criteria
governing continued payments to a nursing facility subsequent
to termination of the facility's provider agreement if, in the
sole discretion of the Illinois Department, circumstances
affecting the health, safety, and welfare of the facility's
residents require those continued payments. The Illinois
Department may condition those continued payments on the
appointment of temporary management, sale of the facility to
new owners or operators, or other arrangements that the

09900HB5539sam001 - 37 - LRB099 19598 KTG 49013 a
Illinois Department determines best serve the needs of the
facility's residents.
Except in the case of a facility that has a right to a
hearing on the finding of noncompliance before an agency of the
federal government, a facility may request a hearing before a
State agency on any finding of noncompliance within 60 days
after the notice of the intent to impose a remedy. Except in
the case of civil money penalties, a request for a hearing
shall not delay imposition of the penalty. The choice of
remedies is not appealable at a hearing. The level of
noncompliance may be challenged only in the case of a civil
money penalty. The Illinois Department shall provide by rule
for the State agency that will conduct the evidentiary
hearings.
The Illinois Department may collect interest on unpaid
civil money penalties.
The Illinois Department may adopt all rules necessary to
implement this subsection (I).
(J) The Illinois Department, by rule, may permit individual
practitioners to designate that Department payments that may be
due the practitioner be made to an alternate payee or alternate
payees.
(a) Such alternate payee or alternate payees shall be
required to register as an alternate payee in the Medical
Assistance Program with the Illinois Department.
(b) If a practitioner designates an alternate payee,

09900HB5539sam001 - 38 - LRB099 19598 KTG 49013 a
the alternate payee and practitioner shall be jointly and
severally liable to the Department for payments made to the
alternate payee. Pursuant to subsection (E) of this
Section, any Department action to suspend or deny payment
or recover money or overpayments from an alternate payee
shall be subject to an administrative hearing.
(c) Registration as an alternate payee or alternate
payees in the Illinois Medical Assistance Program shall be
conditional. At any time, the Illinois Department may deny
or cancel any alternate payee's registration in the
Illinois Medical Assistance Program without cause. Any
such denial or cancellation is not subject to an
administrative hearing.
(d) The Illinois Department may seek a revocation of
any alternate payee, and all owners, officers, and
individuals with management responsibility for such
alternate payee shall be permanently prohibited from
participating as an owner, an officer, or an individual
with management responsibility with an alternate payee in
the Illinois Medical Assistance Program, if after
reasonable notice and opportunity for a hearing the
Illinois Department finds that:
(1) the alternate payee is not complying with the
Department's policy or rules and regulations, or with
the terms and conditions prescribed by the Illinois
Department in its alternate payee registration

09900HB5539sam001 - 39 - LRB099 19598 KTG 49013 a
agreement; or
(2) the alternate payee has failed to keep or make
available for inspection, audit, or copying, after
receiving a written request from the Illinois
Department, such records regarding payments claimed as
an alternate payee; or
(3) the alternate payee has failed to furnish any
information requested by the Illinois Department
regarding payments claimed as an alternate payee; or
(4) the alternate payee has knowingly made, or
caused to be made, any false statement or
representation of a material fact in connection with
the administration of the Illinois Medical Assistance
Program; or
(5) the alternate payee, a person with management
responsibility for an alternate payee, an officer or
person owning, either directly or indirectly, 5% or
more of the shares of stock or other evidences of
ownership in a corporate alternate payee, or a partner
in a partnership which is an alternate payee:
(a) was previously terminated, suspended, or
excluded from participation as a vendor in the
Illinois Medical Assistance Program, or was
previously revoked as an alternate payee in the
Illinois Medical Assistance Program, or was
terminated, suspended, or excluded from

09900HB5539sam001 - 40 - LRB099 19598 KTG 49013 a
participation as a vendor in a medical assistance
program in another state that is of the same kind
as the program of medical assistance provided
under Article V of this Code; or
(b) was a person with management
responsibility for a vendor previously terminated,
suspended, or excluded from participation as a
vendor in the Illinois Medical Assistance Program,
or was previously revoked as an alternate payee in
the Illinois Medical Assistance Program, or was
terminated, suspended, or excluded from
participation as a vendor in a medical assistance
program in another state that is of the same kind
as the program of medical assistance provided
under Article V of this Code, during the time of
conduct which was the basis for that vendor's
termination, suspension, or exclusion or alternate
payee's revocation; or
(c) was an officer, or person owning, either
directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a
corporate vendor previously terminated, suspended,
or excluded from participation as a vendor in the
Illinois Medical Assistance Program, or was
previously revoked as an alternate payee in the
Illinois Medical Assistance Program, or was

09900HB5539sam001 - 41 - LRB099 19598 KTG 49013 a
terminated, suspended, or excluded from
participation as a vendor in a medical assistance
program in another state that is of the same kind
as the program of medical assistance provided
under Article V of this Code, during the time of
conduct which was the basis for that vendor's
termination, suspension, or exclusion; or
(d) was an owner of a sole proprietorship or
partner in a partnership previously terminated,
suspended, or excluded from participation as a
vendor in the Illinois Medical Assistance Program,
or was previously revoked as an alternate payee in
the Illinois Medical Assistance Program, or was
terminated, suspended, or excluded from
participation as a vendor in a medical assistance
program in another state that is of the same kind
as the program of medical assistance provided
under Article V of this Code, during the time of
conduct which was the basis for that vendor's
termination, suspension, or exclusion or alternate
payee's revocation; or
(6) the alternate payee, a person with management
responsibility for an alternate payee, an officer or
person owning, either directly or indirectly, 5% or
more of the shares of stock or other evidences of
ownership in a corporate alternate payee, or a partner

09900HB5539sam001 - 42 - LRB099 19598 KTG 49013 a
in a partnership which is an alternate payee:
(a) has engaged in conduct prohibited by
applicable federal or State law or regulation
relating to the Illinois Medical Assistance
Program; or
(b) was a person with management
responsibility for a vendor or alternate payee at
the time that the vendor or alternate payee engaged
in practices prohibited by applicable federal or
State law or regulation relating to the Illinois
Medical Assistance Program; or
(c) was an officer, or person owning, either
directly or indirectly, 5% or more of the shares of
stock or other evidences of ownership in a vendor
or alternate payee at the time such vendor or
alternate payee engaged in practices prohibited by
applicable federal or State law or regulation
relating to the Illinois Medical Assistance
Program; or
(d) was an owner of a sole proprietorship or
partner in a partnership which was a vendor or
alternate payee at the time such vendor or
alternate payee engaged in practices prohibited by
applicable federal or State law or regulation
relating to the Illinois Medical Assistance
Program; or

09900HB5539sam001 - 43 - LRB099 19598 KTG 49013 a
(7) the direct or indirect ownership of the vendor
or alternate payee (including the ownership of a vendor
or alternate payee that is a partner's interest in a
vendor or alternate payee, or ownership of 5% or more
of the shares of stock or other evidences of ownership
in a corporate vendor or alternate payee) has been
transferred by an individual who is terminated,
suspended, or excluded or barred from participating as
a vendor or is prohibited or revoked as an alternate
payee to the individual's spouse, child, brother,
sister, parent, grandparent, grandchild, uncle, aunt,
niece, nephew, cousin, or relative by marriage.
(K) The Illinois Department of Healthcare and Family
Services may withhold payments, in whole or in part, to a
provider or alternate payee where there is credible evidence,
received from State or federal law enforcement or federal
oversight agencies or from the results of a preliminary
Department audit, that the circumstances giving rise to the
need for a withholding of payments may involve fraud or willful
misrepresentation under the Illinois Medical Assistance
program. The Department shall by rule define what constitutes
"credible" evidence for purposes of this subsection. The
Department may withhold payments without first notifying the
provider or alternate payee of its intention to withhold such
payments. A provider or alternate payee may request a
reconsideration of payment withholding, and the Department

09900HB5539sam001 - 44 - LRB099 19598 KTG 49013 a
must grant such a request. The Department shall state by rule a
process and criteria by which a provider or alternate payee may
request full or partial release of payments withheld under this
subsection. This request may be made at any time after the
Department first withholds such payments.
(a) The Illinois Department must send notice of its
withholding of program payments within 5 days of taking
such action. The notice must set forth the general
allegations as to the nature of the withholding action, but
need not disclose any specific information concerning its
ongoing investigation. The notice must do all of the
following:
(1) State that payments are being withheld in
accordance with this subsection.
(2) State that the withholding is for a temporary
period, as stated in paragraph (b) of this subsection,
and cite the circumstances under which withholding
will be terminated.
(3) Specify, when appropriate, which type or types
of Medicaid claims withholding is effective.
(4) Inform the provider or alternate payee of the
right to submit written evidence for reconsideration
of the withholding by the Illinois Department.
(5) Inform the provider or alternate payee that a
written request may be made to the Illinois Department
for full or partial release of withheld payments and

09900HB5539sam001 - 45 - LRB099 19598 KTG 49013 a
that such requests may be made at any time after the
Department first withholds such payments.
(b) All withholding-of-payment actions under this
subsection shall be temporary and shall not continue after
any of the following:
(1) The Illinois Department or the prosecuting
authorities determine that there is insufficient
evidence of fraud or willful misrepresentation by the
provider or alternate payee.
(2) Legal proceedings related to the provider's or
alternate payee's alleged fraud, willful
misrepresentation, violations of this Act, or
violations of the Illinois Department's administrative
rules are completed.
(3) The withholding of payments for a period of 3
years.
(c) The Illinois Department may adopt all rules
necessary to implement this subsection (K).
(K-5) The Illinois Department may withhold payments, in
whole or in part, to a provider or alternate payee upon
initiation of an audit, quality of care review, investigation
when there is a credible allegation of fraud, or the provider
or alternate payee demonstrating a clear failure to cooperate
with the Illinois Department such that the circumstances give
rise to the need for a withholding of payments. As used in this
subsection, "credible allegation" is defined to include an

09900HB5539sam001 - 46 - LRB099 19598 KTG 49013 a
allegation from any source, including, but not limited to,
fraud hotline complaints, claims data mining, patterns
identified through provider audits, civil actions filed under
the Illinois False Claims Act, and law enforcement
investigations. An allegation is considered to be credible when
it has indicia of reliability. The Illinois Department may
withhold payments without first notifying the provider or
alternate payee of its intention to withhold such payments. A
provider or alternate payee may request a hearing or a
reconsideration of payment withholding, and the Illinois
Department must grant such a request. The Illinois Department
shall state by rule a process and criteria by which a provider
or alternate payee may request a hearing or a reconsideration
for the full or partial release of payments withheld under this
subsection. This request may be made at any time after the
Illinois Department first withholds such payments.
(a) The Illinois Department must send notice of its
withholding of program payments within 5 days of taking
such action. The notice must set forth the general
allegations as to the nature of the withholding action but
need not disclose any specific information concerning its
ongoing investigation. The notice must do all of the
following:
(1) State that payments are being withheld in
accordance with this subsection.
(2) State that the withholding is for a temporary

09900HB5539sam001 - 47 - LRB099 19598 KTG 49013 a
period, as stated in paragraph (b) of this subsection,
and cite the circumstances under which withholding
will be terminated.
(3) Specify, when appropriate, which type or types
of claims are withheld.
(4) Inform the provider or alternate payee of the
right to request a hearing or a reconsideration of the
withholding by the Illinois Department, including the
ability to submit written evidence.
(5) Inform the provider or alternate payee that a
written request may be made to the Illinois Department
for a hearing or a reconsideration for the full or
partial release of withheld payments and that such
requests may be made at any time after the Illinois
Department first withholds such payments.
(b) All withholding of payment actions under this
subsection shall be temporary and shall not continue after
any of the following:
(1) The Illinois Department determines that there
is insufficient evidence of fraud, or the provider or
alternate payee demonstrates clear cooperation with
the Illinois Department, as determined by the Illinois
Department, such that the circumstances do not give
rise to the need for withholding of payments; or
(2) The withholding of payments has lasted for a
period in excess of 3 years.

09900HB5539sam001 - 48 - LRB099 19598 KTG 49013 a
(c) The Illinois Department may adopt all rules
necessary to implement this subsection (K-5).
(L) The Illinois Department shall establish a protocol to
enable health care providers to disclose an actual or potential
violation of this Section pursuant to a self-referral
disclosure protocol, referred to in this subsection as "the
protocol". The protocol shall include direction for health care
providers on a specific person, official, or office to whom
such disclosures shall be made. The Illinois Department shall
post information on the protocol on the Illinois Department's
public website. The Illinois Department may adopt rules
necessary to implement this subsection (L). In addition to
other factors that the Illinois Department finds appropriate,
the Illinois Department may consider a health care provider's
timely use or failure to use the protocol in considering the
provider's failure to comply with this Code.
(M) Notwithstanding any other provision of this Code, the
Illinois Department, at its discretion, may exempt an entity
licensed under the Nursing Home Care Act, the ID/DD Community
Care Act, or the MC/DD Act from the provisions of subsections
(A-15), (B), and (C) of this Section if the licensed entity is
in receivership.
(Source: P.A. 98-214, eff. 8-9-13; 98-550, eff. 8-27-13;
98-756, eff. 7-16-14; 99-180, eff. 7-29-15.)
Section 99. Effective date. This Act takes effect upon

09900HB5539sam001 - 49 - LRB099 19598 KTG 49013 a
becoming law.".