Bill Text: IL HB3978 | 2011-2012 | 97th General Assembly | Introduced

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Bill Title: Amends the Administration Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services' Inspector General shall oversee the Department's integrity functions, which include, but are not limited to, the monitoring of quality assurance programs administered by the Department (rather than monitoring of quality assurance programs generally related to the medical assistance program and specifically related to any managed care program). Adds the offices of the Centers for Medicare and Medicaid Services that administer the Medicare and Medicaid integrity programs to the list of agencies the Inspector General shall liaison with on behalf of the Department. Makes other changes.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2013-01-08 - Session Sine Die [HB3978 Detail]

Download: Illinois-2011-HB3978-Introduced.html

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97TH GENERAL ASSEMBLY State of Illinois 2011 and 2012 HB3978 Introduced , by Rep. Kelly M. Cassidy SYNOPSIS AS INTRODUCED:
305 ILCS 5/12-13.1
Amends the Administration Article of the Illinois Public Aid Code. Provides that the Department of Healthcare and Family Services' Inspector General shall oversee the Department's integrity functions, which include, but are not limited to, the monitoring of quality assurance programs administered by the Department (rather than monitoring of quality assurance programs generally related to the medical assistance program and specifically related to any managed care program). Adds the offices of the Centers for Medicare and Medicaid Services that administer the Medicare and Medicaid integrity programs to the list of agencies the Inspector General shall liaison with on behalf of the Department. Makes other changes.
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FISCAL NOTE ACT MAY APPLY
A BILL FOR
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AN ACT concerning public aid.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Public Aid Code is amended by
changing Section 12-13.1 as follows:
(305 ILCS 5/12-13.1)
Sec. 12-13.1. Inspector General.
(a) The Governor shall appoint, and the Senate shall
confirm, an Inspector General who shall function within the
Illinois Department of Public Aid (now Healthcare and Family
Services) and report to the Governor. The term of the Inspector
General shall expire on the third Monday of January, 1997 and
every 4 years thereafter.
(b) In order to prevent, detect, and eliminate fraud,
waste, abuse, mismanagement, and misconduct, the Inspector
General shall oversee the Department of Healthcare and Family
Services' integrity functions, which include, but are not
limited to, the following:
(1) Investigation of misconduct by employees, vendors,
contractors and medical providers, except for allegations
of violations of the State Officials and Employees Ethics
Act which shall be referred to the Office of the Governor's
Executive Inspector General for investigation.

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(2) Audits of medical providers related to ensuring
that appropriate payments are made for services rendered
and to the recovery of overpayments.
(3) Monitoring of quality assurance programs
administered by the Department of Healthcare and Family
Services generally related to the medical assistance
program and specifically related to any managed care
program.
(4) Quality control measurements of the programs
administered by the Department of Healthcare and Family
Services.
(5) Investigations of fraud or intentional program
violations committed by clients of the Department of
Healthcare and Family Services.
(6) Actions initiated against contractors, vendors, or
medical providers for any of the following reasons:
(A) Violations of the medical assistance program.
(B) Sanctions against providers brought in
conjunction with the Department of Public Health or the
Department of Human Services (as successor to the
Department of Mental Health and Developmental
Disabilities).
(C) Recoveries of assessments against hospitals
and long-term care facilities.
(D) Sanctions mandated by the United States
Department of Health and Human Services against

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medical providers.
(E) Violations of contracts related to any
programs administered by the Department of Healthcare
and Family Services managed care programs.
(7) Representation of the Department of Healthcare and
Family Services at hearings with the Illinois Department of
Financial and Professional Regulation in actions taken
against professional licenses held by persons who are in
violation of orders for child support payments.
(b-5) At the request of the Secretary of Human Services,
the Inspector General shall, in relation to any function
performed by the Department of Human Services as successor to
the Department of Public Aid, exercise one or more of the
powers provided under this Section as if those powers related
to the Department of Human Services; in such matters, the
Inspector General shall report his or her findings to the
Secretary of Human Services.
(c) The Inspector General shall have access to all
information, personnel and facilities of the Department of
Healthcare and Family Services and the Department of Human
Services (as successor to the Department of Public Aid), their
employees, vendors, contractors and medical providers and any
federal, State or local governmental agency that are necessary
to perform the duties of the Office as directly related to
public assistance programs administered by those departments.
No medical provider shall be compelled, however, to provide

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individual medical records of patients who are not clients of
the programs administered by the Department of Healthcare and
Family Services Medical Assistance Program. State and local
governmental agencies are authorized and directed to provide
the requested information, assistance or cooperation.
(d) The Inspector General shall serve as the Department of
Healthcare and Family Services' primary liaison with law
enforcement, investigatory and prosecutorial agencies,
including but not limited to the following:
(1) The Department of State Police.
(2) The Federal Bureau of Investigation and other
federal law enforcement agencies.
(3) The various Inspectors General of federal agencies
overseeing the programs administered by the Department of
Healthcare and Family Services.
(4) The various Inspectors General of any other State
agencies with responsibilities for portions of programs
primarily administered by the Department of Healthcare and
Family Services.
(5) The Offices of the several United States Attorneys
in Illinois.
(6) The several State's Attorneys.
(7) The offices of the Centers for Medicare and
Medicaid Services that administer the Medicare and
Medicaid integrity programs.
The Inspector General shall meet on a regular basis with

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these entities to share information regarding possible
misconduct by any persons or entities involved with the public
aid programs administered by the Department of Healthcare and
Family Services.
(e) All investigations conducted by the Inspector General
shall be conducted in a manner that ensures the preservation of
evidence for use in criminal prosecutions. If the Inspector
General determines that a possible criminal act relating to
fraud in the provision or administration of the medical
assistance program has been committed, the Inspector General
shall immediately notify the Medicaid Fraud Control Unit. If
the Inspector General determines that a possible criminal act
has been committed within the jurisdiction of the Office, the
Inspector General may request the special expertise of the
Department of State Police. The Inspector General may present
for prosecution the findings of any criminal investigation to
the Office of the Attorney General, the Offices of the several
United States Attorneys in Illinois or the several State's
Attorneys.
(f) To carry out his or her duties as described in this
Section, the Inspector General and his or her designees shall
have the power to compel by subpoena the attendance and
testimony of witnesses and the production of books, electronic
records and papers as directly related to public assistance
programs administered by the Department of Healthcare and
Family Services or the Department of Human Services (as

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successor to the Department of Public Aid). No medical provider
shall be compelled, however, to provide individual medical
records of patients who are not clients of the Medical
Assistance Program.
(g) The Inspector General shall report all convictions,
terminations, and suspensions taken against vendors,
contractors and medical providers to the Department of
Healthcare and Family Services and to any agency responsible
for licensing or regulating those persons or entities.
(h) The Inspector General shall make annual reports,
findings, and recommendations regarding the Office's
investigations into reports of fraud, waste, abuse,
mismanagement, or misconduct relating to any public aid
programs administered by the Department of Healthcare and
Family Services or the Department of Human Services (as
successor to the Department of Public Aid) to the General
Assembly and the Governor. These reports shall include, but not
be limited to, the following information:
(1) Aggregate provider billing and payment
information, including the number of providers at various
Medicaid earning levels.
(2) The number of audits of the medical assistance
program and the dollar savings resulting from those audits.
(3) The number of prescriptions rejected annually
under the Department of Healthcare and Family Services'
Refill Too Soon program and the dollar savings resulting

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from that program.
(4) Provider sanctions, in the aggregate, including
terminations and suspensions.
(5) A detailed summary of the investigations
undertaken in the previous fiscal year. These summaries
shall comply with all laws and rules regarding maintaining
confidentiality in the public aid programs.
(i) Nothing in this Section shall limit investigations by
the Department of Healthcare and Family Services or the
Department of Human Services that may otherwise be required by
law or that may be necessary in their capacity as the central
administrative authorities responsible for administration of
their agency's public aid programs in this State.
(j) The Inspector General may issue shields or other
distinctive identification to his or her employees not
exercising the powers of a peace officer if the Inspector
General determines that a shield or distinctive identification
is needed by an employee to carry out his or her
responsibilities.
(Source: P.A. 95-331, eff. 8-21-07; 96-555, eff. 8-18-09;
96-1316, eff. 1-1-11.)