99TH GENERAL ASSEMBLY
State of Illinois
2015 and 2016
HB0098
 
Introduced , by Rep. Greg Harris
 
SYNOPSIS AS INTRODUCED:






305 ILCS 5/12-13.1

 Amends the Illinois Public Aid Code. Makes a
technical
change in a Section concerning the appointment of an Inspector General.



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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 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(Source: P.A. 97-689, eff. 6-14-12; 98-8, eff. 5-3-13.)