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| Public Act 096-1316 | ||||
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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 | ||||
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 | ||||
confirm, an Inspector
General who shall function within the | ||||
Illinois Department of Public Aid (now Healthcare and Family | ||||
Services) and
report to the Governor. The term of the Inspector | ||||
General shall expire on the
third Monday of January, 1997 and | ||||
every 4 years thereafter.
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(b) In order to prevent, detect, and eliminate fraud, | ||||
waste, abuse,
mismanagement, and misconduct, the Inspector | ||||
General shall oversee the
Department of Healthcare and Family | ||||
Services' integrity
functions, which include, but are not | ||||
limited to, the following:
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(1) Investigation of misconduct by employees, vendors, | ||||
contractors and
medical providers, except for allegations | ||||
of violations of the State Officials and Employees Ethics | ||||
Act which shall be referred to the Office of the Governor's | ||||
Executive Inspector General for investigation.
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(2) Audits of medical providers related to ensuring | ||
that appropriate
payments are made for services rendered | ||
and to the recovery of overpayments.
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(3) Monitoring of quality assurance programs generally | ||
related to the
medical assistance program and specifically | ||
related to any managed care
program.
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(4) Quality control measurements of the programs | ||
administered by the
Department of Healthcare and Family | ||
Services.
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(5) Investigations of fraud or intentional program | ||
violations committed by
clients of the Department of | ||
Healthcare and Family Services.
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(6) Actions initiated against contractors or medical | ||
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 | ||
conjunction with the
Department of Public Health or the | ||
Department of Human Services (as successor
to the | ||
Department of Mental Health and Developmental | ||
Disabilities).
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(C) Recoveries of assessments against hospitals | ||
and long-term care
facilities.
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(D) Sanctions mandated by the United States | ||
Department of Health and
Human Services against | ||
medical providers.
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(E) Violations of contracts related to any managed | ||
care programs.
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(7) Representation of the Department of Healthcare and | ||
Family Services at
hearings with the Illinois Department of | ||
Professional Regulation in actions
taken against | ||
professional licenses held by persons who are in violation | ||
of
orders for child support payments.
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(b-5) At the request of the Secretary of Human Services, | ||
the Inspector
General shall, in relation to any function | ||
performed by the Department of Human
Services as successor to | ||
the Department of Public Aid, exercise one or more
of the | ||
powers provided under this Section as if those powers related | ||
to the
Department of Human Services; in such matters, the | ||
Inspector General shall
report his or her findings to the | ||
Secretary of Human Services.
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(c) The Inspector General shall have access to all | ||
information, personnel
and facilities of the
Department of | ||
Healthcare and Family Services and the Department of
Human | ||
Services (as successor to the Department of Public Aid), their | ||
employees, vendors, contractors and medical providers and any | ||
federal,
State or local governmental agency that are necessary | ||
to perform the duties of
the Office as directly related to | ||
public assistance programs administered by
those departments. | ||
No medical provider shall
be compelled, however, to provide | ||
individual medical records of patients who
are not clients of | ||
the Medical Assistance Program. State and local
governmental | ||
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 | ||
Healthcare and Family Services'
primary liaison with law | ||
enforcement,
investigatory and prosecutorial agencies, | ||
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 | ||
federal law enforcement
agencies.
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(3) The various Inspectors General of federal agencies | ||
overseeing the
programs administered by the
Department of | ||
Healthcare and Family Services.
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(4) The various Inspectors General of any other State | ||
agencies with
responsibilities for portions of programs | ||
primarily administered by the
Department of Healthcare and | ||
Family Services.
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(5) The Offices of the several United States Attorneys | ||
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 | ||
these entities to
share information regarding possible | ||
misconduct by any persons or entities
involved with the public | ||
aid programs administered by the Department
of Healthcare and | ||
Family Services.
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(e) All investigations conducted by the Inspector General | ||
shall be conducted
in a manner that ensures the preservation of | ||
evidence for use in criminal
prosecutions. If the Inspector | ||
General determines that a possible criminal act
relating to | ||
fraud in the provision or administration of the medical | ||
assistance
program has been committed, the Inspector General | ||
shall immediately notify the
Medicaid Fraud Control Unit. If | ||
the Inspector General determines that a
possible criminal act | ||
has been committed within the jurisdiction of the Office,
the | ||
Inspector General may request the special expertise of the | ||
Department of
State Police. The Inspector General may present | ||
for prosecution the findings
of any criminal investigation to | ||
the Office of the Attorney General, the
Offices of the several | ||
United States Attorneys in Illinois or the several
State's | ||
Attorneys.
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(f) To carry out his or her duties as described in this | ||
Section, the
Inspector General and his or her designees shall | ||
have the power to compel
by subpoena the attendance and | ||
testimony of witnesses and the production
of books, electronic | ||
records and papers as directly related to public
assistance | ||
programs administered by the Department of Healthcare and | ||
Family Services or
the Department of Human Services (as | ||
successor to the Department of Public
Aid). No medical provider | ||
shall be compelled, however, to provide individual
medical | ||
records of patients who are not clients of the Medical | ||
Assistance
Program.
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(g) The Inspector General shall report all convictions, | ||
terminations, and
suspensions taken against vendors, | ||
contractors and medical providers to the
Department of | ||
Healthcare and Family Services and to any agency responsible | ||
for
licensing or regulating those persons or entities.
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(h) The Inspector General shall make annual
reports, | ||
findings, and recommendations regarding the Office's | ||
investigations
into reports of fraud, waste, abuse, | ||
mismanagement, or misconduct relating to
any public aid | ||
programs administered by the Department
of Healthcare and | ||
Family Services or the Department of Human Services (as | ||
successor to the
Department of Public Aid) to the General | ||
Assembly and the Governor. These
reports shall include, but not | ||
be limited to, the following information:
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(1) Aggregate provider billing and payment | ||
information, including the
number of providers at various | ||
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 | ||
under the
Department of Healthcare and Family Services' | ||
Refill Too Soon program and the
dollar savings resulting | ||
from that program.
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(4) Provider sanctions, in the aggregate, including | ||
terminations and
suspensions.
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(5) A detailed summary of the investigations | ||
undertaken in the previous
fiscal year. These summaries | ||
shall comply with all laws and rules regarding
maintaining | ||
confidentiality in the public aid programs.
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(i) Nothing in this Section shall limit investigations by | ||
the
Department of Healthcare and Family Services or the | ||
Department of Human Services that may
otherwise be required by | ||
law or that may be necessary in their capacity as the
central | ||
administrative authorities responsible for administration of | ||
public aid
programs in this
State.
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(j) The Inspector General may issue shields or other | ||
distinctive identification to his or her employees not | ||
exercising the powers of a peace officer if the Inspector | ||
General determines that a shield or distinctive identification | ||
is needed by an employee to carry out his or her | ||
responsibilities. | ||
(Source: P.A. 95-331, eff. 8-21-07; 96-555, eff. 8-18-09.)
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