Bill Text: IL SB2190 | 2017-2018 | 100th General Assembly | Introduced


Bill Title: Amends the Illinois Public Aid Code. Provides that notwithstanding any other provision of the Code to the contrary, the Department of Healthcare and Family Services' Inspector General shall report all suspected cases of provider fraud involving a vendor, a medical provider, or any other provider authorized to participate in the medical assistance program to the State's Attorney of the county where the alleged fraud occurred or, when appropriate, to the Office of the Attorney General or to the Offices of the several United States Attorneys in Illinois. Effective immediately.

Spectrum: Partisan Bill (Republican 3-0)

Status: (Introduced) 2017-05-12 - Rule 3-9(a) / Re-referred to Assignments [SB2190 Detail]

Download: Illinois-2017-SB2190-Introduced.html


100TH GENERAL ASSEMBLY
State of Illinois
2017 and 2018
SB2190

Introduced 4/26/2017, by Sen. Michael Connelly

SYNOPSIS AS INTRODUCED:
305 ILCS 5/12-13.1

Amends the Illinois Public Aid Code. Provides that notwithstanding any other provision of the Code to the contrary, the Department of Healthcare and Family Services' Inspector General shall report all suspected cases of provider fraud involving a vendor, a medical provider, or any other provider authorized to participate in the medical assistance program to the State's Attorney of the county where the alleged fraud occurred or, when appropriate, to the Office of the Attorney General or to the Offices of the several United States Attorneys in Illinois. Effective immediately.
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FISCAL NOTE ACT MAY APPLY

A BILL FOR

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1 AN ACT concerning public aid.
2 Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
4 Section 5. The Illinois Public Aid Code is amended by
5changing 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
9confirm, an Inspector General who shall function within the
10Illinois Department of Public Aid (now Healthcare and Family
11Services) and report to the Governor. The term of the Inspector
12General shall expire on the third Monday of January, 1997 and
13every 4 years thereafter.
14 (b) In order to prevent, detect, and eliminate fraud,
15waste, abuse, mismanagement, and misconduct, the Inspector
16General shall oversee the Department of Healthcare and Family
17Services' and the Department on Aging's integrity functions,
18which 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 Governor's
23 Executive Inspector General for investigation.

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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 the
8 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 the
12 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 the
24 Department of Human Services (as successor to the
25 Department of Mental Health and Developmental
26 Disabilities).

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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 of
12 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,
16the Inspector General shall, in relation to any function
17performed by the Department of Human Services as successor to
18the Department of Public Aid, exercise one or more of the
19powers provided under this Section as if those powers related
20to the Department of Human Services; in such matters, the
21Inspector General shall report his or her findings to the
22Secretary of Human Services.
23 (c) Notwithstanding, and in addition to, any other
24provision of law, the Inspector General shall have access to
25all information, personnel and facilities of the Department of
26Healthcare and Family Services and the Department of Human

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1Services (as successor to the Department of Public Aid), their
2employees, vendors, contractors and medical providers and any
3federal, State or local governmental agency that are necessary
4to perform the duties of the Office as directly related to
5public assistance programs administered by those departments.
6No medical provider shall be compelled, however, to provide
7individual medical records of patients who are not clients of
8the programs administered by the Department of Healthcare and
9Family Services. State and local governmental agencies are
10authorized and directed to provide the requested information,
11assistance or cooperation.
12 For purposes of enhanced program integrity functions and
13oversight, and to the extent consistent with applicable
14information and privacy, security, and disclosure laws, State
15agencies and departments shall provide the Office of Inspector
16General access to confidential and other information and data,
17and the Inspector General is authorized to enter into
18agreements with appropriate federal agencies and departments
19to secure similar data. This includes, but is not limited to,
20information pertaining to: licensure; certification; earnings;
21immigration status; citizenship; wage reporting; unearned and
22earned income; pension income; employment; supplemental
23security income; social security numbers; National Provider
24Identifier (NPI) numbers; the National Practitioner Data Bank
25(NPDB); program and agency exclusions; taxpayer identification
26numbers; tax delinquency; corporate information; and death

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1records.
2 The Inspector General shall enter into agreements with
3State agencies and departments, and is authorized to enter into
4agreements with federal agencies and departments, under which
5such agencies and departments shall share data necessary for
6medical assistance program integrity functions and oversight.
7The Inspector General shall enter into agreements with State
8agencies and departments, and is authorized to enter into
9agreements with federal agencies and departments, under which
10such agencies shall share data necessary for recipient and
11vendor screening, review, and investigation, including but not
12limited to vendor payment and recipient eligibility
13verification. The Inspector General shall develop, in
14cooperation with other State and federal agencies and
15departments, and in compliance with applicable federal laws and
16regulations, appropriate and effective methods to share such
17data. The Inspector General shall enter into agreements with
18State agencies and departments, and is authorized to enter into
19agreements with federal agencies and departments, including,
20but not limited to: the Secretary of State; the Department of
21Revenue; the Department of Public Health; the Department of
22Human Services; and the Department of Financial and
23Professional Regulation.
24 The Inspector General shall have the authority to deny
25payment, prevent overpayments, and recover overpayments.
26 The Inspector General shall have the authority to deny or

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1suspend payment to, and deny, terminate, or suspend the
2eligibility of, any vendor who fails to grant the Inspector
3General timely access to full and complete records, including
4records of recipients under the medical assistance program for
5the most recent 6 years, in accordance with Section 140.28 of
6Title 89 of the Illinois Administrative Code, and other
7information for the purpose of audits, investigations, or other
8program integrity functions, after reasonable written request
9by the Inspector General.
10 (d) The Inspector General shall serve as the Department of
11Healthcare and Family Services' primary liaison with law
12enforcement, investigatory and prosecutorial agencies,
13including but not limited to the following:
14 (1) The Department of State Police.
15 (2) The Federal Bureau of Investigation and other
16 federal law enforcement agencies.
17 (3) The various Inspectors General of federal agencies
18 overseeing the programs administered by the Department of
19 Healthcare and Family Services.
20 (4) The various Inspectors General of any other State
21 agencies with responsibilities for portions of programs
22 primarily administered by the Department of Healthcare and
23 Family Services.
24 (5) The Offices of the several United States Attorneys
25 in Illinois.
26 (6) The several State's Attorneys.

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1 (7) The offices of the Centers for Medicare and
2 Medicaid Services that administer the Medicare and
3 Medicaid integrity programs.
4 The Inspector General shall meet on a regular basis with
5these entities to share information regarding possible
6misconduct by any persons or entities involved with the public
7aid programs administered by the Department of Healthcare and
8Family Services.
9 (e) All investigations conducted by the Inspector General
10shall be conducted in a manner that ensures the preservation of
11evidence for use in criminal prosecutions. If the Inspector
12General determines that a possible criminal act relating to
13fraud in the provision or administration of the medical
14assistance program has been committed, the Inspector General
15shall immediately notify the Medicaid Fraud Control Unit. If
16the Inspector General determines that a possible criminal act
17has been committed within the jurisdiction of the Office, the
18Inspector General may request the special expertise of the
19Department of State Police. The Inspector General may present
20for prosecution the findings of any criminal investigation to
21the Office of the Attorney General, the Offices of the several
22United States Attorneys in Illinois or the several State's
23Attorneys.
24 (f) To carry out his or her duties as described in this
25Section, the Inspector General and his or her designees shall
26have the power to compel by subpoena the attendance and

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1testimony of witnesses and the production of books, electronic
2records and papers as directly related to public assistance
3programs administered by the Department of Healthcare and
4Family Services or the Department of Human Services (as
5successor to the Department of Public Aid). No medical provider
6shall be compelled, however, to provide individual medical
7records of patients who are not clients of the Medical
8Assistance Program.
9 (g) The Inspector General shall report all convictions,
10terminations, and suspensions taken against vendors,
11contractors and medical providers to the Department of
12Healthcare and Family Services and to any agency responsible
13for licensing or regulating those persons or entities.
14 (h) The Inspector General shall make annual reports,
15findings, and recommendations regarding the Office's
16investigations into reports of fraud, waste, abuse,
17mismanagement, or misconduct relating to any programs
18administered by the Department of Healthcare and Family
19Services or the Department of Human Services (as successor to
20the Department of Public Aid) to the General Assembly and the
21Governor. These reports shall include, but not be limited to,
22the following information:
23 (1) Aggregate provider billing and payment
24 information, including the number of providers at various
25 Medicaid earning levels.
26 (2) The number of audits of the medical assistance

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1 program and the dollar savings resulting from those audits.
2 (3) The number of prescriptions rejected annually
3 under the Department of Healthcare and Family Services'
4 Refill Too Soon program and the dollar savings resulting
5 from that program.
6 (4) Provider sanctions, in the aggregate, including
7 terminations and suspensions.
8 (5) A detailed summary of the investigations
9 undertaken in the previous fiscal year. These summaries
10 shall comply with all laws and rules regarding maintaining
11 confidentiality in the public aid programs.
12 (i) Nothing in this Section shall limit investigations by
13the Department of Healthcare and Family Services or the
14Department of Human Services that may otherwise be required by
15law or that may be necessary in their capacity as the central
16administrative authorities responsible for administration of
17their agency's programs in this State.
18 (j) The Inspector General may issue shields or other
19distinctive identification to his or her employees not
20exercising the powers of a peace officer if the Inspector
21General determines that a shield or distinctive identification
22is needed by an employee to carry out his or her
23responsibilities.
24 (k) Notwithstanding any other provision of this Code to the
25contrary, the Inspector General shall report all suspected
26cases of provider fraud involving a vendor, a medical provider,

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1or any other provider authorized to participate in the medical
2assistance program to the State's Attorney of the county where
3the alleged fraud occurred or, when appropriate, to the Office
4of the Attorney General or to the Offices of the several United
5States Attorneys in Illinois.
6(Source: P.A. 97-689, eff. 6-14-12; 98-8, eff. 5-3-13.)
7 Section 99. Effective date. This Act takes effect upon
8becoming law.
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