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    AN ACT concerning public aid.
  
 
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    Be it enacted by the People of the State of Illinois,
 
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represented in the General Assembly:
  
 
 
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    Section 5. The Illinois Public Aid Code is amended  by 
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changing Section 12-13.1 as follows:
 



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    (305 ILCS 5/12-13.1)


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    Sec. 12-13.1. Inspector General. 

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    (a) The Governor shall appoint, and the Senate shall 
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confirm, an Inspector
General who shall function within the 
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Illinois Department of Public Aid (now Healthcare and Family 
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Services) and
report to the Governor.  The term of the Inspector 
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General shall expire on the
third Monday of January, 1997 and 
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every 4 years thereafter.

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    (b) In order to prevent, detect, and eliminate fraud, 
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waste, abuse,
mismanagement, and misconduct, the Inspector 
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General shall oversee the
 Department of Healthcare and Family 
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Services' integrity
functions, which include, but are not 
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limited to, the following:


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        (1) Investigation of misconduct by employees, vendors, 
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    contractors and
medical providers, except for allegations 
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    of violations of the State Officials and Employees Ethics 
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    Act which shall be referred to the Office of the Governor's 
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    Executive Inspector General for investigation.


 


 






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        (2) Audits of medical providers related to ensuring 
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    that appropriate
payments are made for services rendered 
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    and to the recovery of overpayments.


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        (3) Monitoring of quality assurance programs generally 
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    related to the
medical assistance program and specifically 
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    related to any managed care
program.


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        (4) Quality control measurements of the programs 
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    administered by the
 Department of Healthcare and Family 
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    Services.


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        (5) Investigations of fraud or intentional program 
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    violations committed by
clients of the Department of 
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    Healthcare and Family Services.


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        (6) Actions initiated against contractors or medical 
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    providers for any of
the following reasons:


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            (A) Violations of the medical assistance program.


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            (B) Sanctions against providers brought in 
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        conjunction with the
Department of Public Health or the 
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        Department of Human Services (as successor
to the 
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        Department of Mental Health and Developmental 
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        Disabilities).


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            (C) Recoveries of assessments against hospitals 
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        and long-term care
facilities.


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            (D) Sanctions mandated by the United States 
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        Department of Health and
Human Services against 
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        medical providers.


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            (E) Violations of contracts related to any managed 
 


 






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        care programs.


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        (7) Representation of the Department of Healthcare and 
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    Family Services at
hearings with the Illinois Department of 
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    Professional Regulation in actions
taken against 
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    professional licenses held by persons who are in violation 
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    of
orders for child support payments.

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    (b-5) At the request of the Secretary of Human Services, 
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the Inspector
General shall, in relation to any function 
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performed by the Department of Human
Services as successor to 
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the Department of Public Aid, exercise one or more
of the 
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powers provided under this Section as if those powers related 
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to the
Department of Human Services; in such matters, the 
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Inspector General shall
report his or her findings to the 
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Secretary of Human Services.

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    (c) The Inspector General shall have access to all 
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information, personnel
and facilities of the
Department of 
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Healthcare and Family Services and the Department of
Human 
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Services (as successor to the Department of Public Aid), their 
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employees, vendors, contractors and medical providers and any 
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federal,
State or local governmental agency that are necessary 
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to perform the duties of
the Office as directly related to 
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public assistance programs administered by
those departments.  
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No medical provider shall
be compelled, however, to provide 
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individual medical records of patients who
are not clients of 
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the Medical Assistance Program.  State and local
governmental 
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agencies are authorized and directed to provide the requested

 


 






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information, assistance or cooperation.

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    (d) The Inspector General shall serve as the
Department of 
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Healthcare and Family Services'

primary liaison with law 
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enforcement,
investigatory and prosecutorial agencies, 
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including but not limited to the
following:


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        (1) The Department of State Police.


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        (2) The Federal Bureau of Investigation and other 
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    federal law enforcement
agencies.


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        (3) The various Inspectors General of federal agencies 
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    overseeing the
programs administered by the
Department of 
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    Healthcare and Family Services.


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        (4) The various Inspectors General of any other State 
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    agencies with
responsibilities for portions of programs 
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    primarily administered by the
 Department of Healthcare and 
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    Family Services.


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        (5) The Offices of the several United States Attorneys 
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    in Illinois.


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        (6) The several State's Attorneys.

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    The Inspector General shall meet on a regular basis with 
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these entities to
share information regarding possible 
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misconduct by any persons or entities
involved with the public 
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aid programs administered by the Department
of Healthcare and 
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Family Services.

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    (e) All investigations conducted by the Inspector General 
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shall be conducted
in a manner that ensures the preservation of 
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evidence for use in criminal
prosecutions.  If the Inspector 
 


 






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General determines that a possible criminal act
relating to 
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fraud in the provision or administration of the medical 
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assistance
program has been committed, the Inspector General 
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shall immediately notify the
Medicaid Fraud Control Unit.  If 
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the Inspector General determines that a
possible criminal act 
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has been committed within the jurisdiction of the Office,
the 
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Inspector General may request the special expertise of the 
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Department of
State Police.  The Inspector General may present 
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for prosecution the findings
of any criminal investigation to 
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the Office of the Attorney General, the
Offices of the several 
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United States Attorneys in Illinois or the several
State's 
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Attorneys.

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    (f) To carry out his or her duties as described in this 
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Section, the
Inspector General and his or her designees shall 
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have the power to compel
by subpoena the attendance and 
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testimony of witnesses and the production
of books, electronic 
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records and papers as directly related to public
assistance 
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programs administered by the Department of Healthcare and 
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Family Services or
the Department of Human Services (as 
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successor to the Department of Public
Aid).  No medical provider 
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shall be compelled, however, to provide individual
medical 
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records of patients who are not clients of the Medical 
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Assistance
Program.

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    (g) The Inspector General shall report all convictions, 
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terminations, and
suspensions taken against vendors, 
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contractors and medical providers to the
 Department of 
 


 






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Healthcare and Family Services and to any agency responsible 
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for
licensing or regulating those persons or entities.

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    (h) The Inspector General shall make annual
reports, 
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findings, and recommendations regarding the Office's 
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investigations
into reports of fraud, waste, abuse, 
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mismanagement, or misconduct relating to
any public aid 
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programs administered by the Department
of Healthcare and 
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Family Services or the Department of Human Services (as 
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successor to the
Department of Public Aid) to the General 
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Assembly and the Governor.  These
reports shall include, but not 
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be limited to, the following information:


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        (1) Aggregate provider billing and payment 
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    information, including the
number of providers at various 
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    Medicaid earning levels.


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        (2) The number of audits of the medical assistance

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    program and the dollar savings resulting from those audits.


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        (3) The number of prescriptions rejected annually 
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    under the
Department of Healthcare and Family Services' 
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    Refill Too Soon program and the
dollar savings resulting 
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    from that program.


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        (4) Provider sanctions, in the aggregate, including 
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    terminations and
suspensions.


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        (5) A detailed summary of the investigations 
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    undertaken in the previous
fiscal year.  These summaries 
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    shall comply with all laws and rules regarding
maintaining 
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    confidentiality in the public aid programs.

 


 






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    (i) Nothing in this Section shall limit investigations by 
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the
Department of Healthcare and Family Services or the 
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Department of Human Services that may
otherwise be required by 
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law or that may be necessary in their capacity as the
central 
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administrative authorities responsible for administration of 
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public aid
programs in this
State.

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    (j) The Inspector General may issue shields or other 
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distinctive identification to his or her employees not 
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exercising the powers of a peace officer if the Inspector 
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General determines that a shield or distinctive identification 
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is needed by an employee to carry out his or her 
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responsibilities. 
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(Source: P.A. 95-331, eff. 8-21-07; 96-555, eff. 8-18-09.)