102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
HB2832

 

Introduced 2/19/2021, by Rep. Jackie Haas

 

SYNOPSIS AS INTRODUCED:
 
305 ILCS 5/5-43 new

    Amends the Medical Assistance Article of the Illinois Public Aid Code. Provides that in order to recover an overpayment by recoupment or offset of future payments, a managed care organization's post-payment audit of any claim submitted by a provider must be completed no later than 2 years after the claim's payment date. Provides that the 2-year time limit does not apply to claims that are (i) submitted fraudulently, (ii) known, or should have been known, by the provider to be a pattern of inappropriate billing according to standard provider billing practices, or (iii) subject to any federal law or regulation that permits post-payment audits beyond 2 years.


LRB102 13984 KTG 19336 b

 

 

A BILL FOR

 

HB2832LRB102 13984 KTG 19336 b

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
5adding Section 5-43 as follows:
 
6    (305 ILCS 5/5-43 new)
7    Sec. 5-43. MCO post-payment audit; time period limitation.
8Notwithstanding any provision of this Code to the contrary, in
9order to recover an overpayment by recoupment or offset of
10future payments, a managed care organization's post-payment
11audit of any claim submitted by a provider must be completed no
12later than 2 years after the claim's payment date. The 2-year
13time limit does not apply to claims that are (i) submitted
14fraudulently, (ii) known, or should have been known, by the
15provider to be a pattern of inappropriate billing according to
16standard provider billing practices, or (iii) subject to any
17federal law or regulation that permits post-payment audits
18beyond 2 years.