Bill Text: IL HB5242 | 2009-2010 | 96th General Assembly | Enrolled

---

Bill Title: Amends the Illinois Public Aid Code. Provides that no later then January 1, 2011, the Inspector General of the Department of Healthcare and Family Services shall contract with an independent certified public accountant to perform a forensic audit of the medical assistance program under Article V of the Code as well as additional programs which receive funds through common budgetary lines appropriated to the Department of Healthcare and Family Services for comprehensive medical assistance operated under the Children's Health Insurance Program Act and the Covering ALL KIDS Health Insurance Act. Provides that the forensic audit shall include, but not be limited to, a review of the application and enrollment of individuals for services and reimbursements to providers for medical assistance, and that the audit shall focus on any fraud or inefficiencies which may be eliminated to contain costs and improve the delivery of care to eligible individuals. Requires the Director of the Department of Healthcare and Family Services to report the findings of the audit to the General Assembly along with recommendations to address any adverse findings contained in the audit. Effective immediately.

Spectrum: Slight Partisan Bill (Republican 16-9)

Status: (Passed) 2010-06-25 - Public Act . . . . . . . . . 96-0942 [HB5242 Detail]

Download: Illinois-2009-HB5242-Enrolled.html

---

HB5242 Enrolled LRB096 18832 KTG 34218 b
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
adding Section 12-4.40 as follows:
(305 ILCS 5/12-4.40 new)
Sec. 12-4.40. Payment Recapture Audits. The Department of
Healthcare and Family Services is authorized to contract with
third-party entities to conduct Payment Recapture Audits to
detect and recapture payments made in error or as a result of
fraud or abuse. Payment Recapture Audits under this Section may
be performed in conjunction with similar audits performed under
federal authorization.
A Payment Recapture Audit shall include the process of
identifying improper payments paid to providers or other
entities whereby accounting specialists and fraud examination
specialists examine payment records and uncover such problems
as duplicate payments, payments for services not rendered,
overpayments, payments for unauthorized services, and
fictitious vendors. This audit may include the use of
professional and specialized auditors on a contingency basis,
with compensation tied to the identification of misspent funds.
The use of Payment Recapture Audits does not preclude the

HB5242 Enrolled - 2 - LRB096 18832 KTG 34218 b
Office of the Inspector General or any other authorized agency
employee from performing activities to identify and prevent
improper payments.
Section 99. Effective date. This Act takes effect upon
becoming law.