305 ILCS 5/12-13.1
2021 Illinois Compiled Statutes|Chapter 305 - PUBLIC AID|305 ILCS 5/ - Illinois Public Aid Code.|Article XII - Administration

Sec. 12-13.1. Inspector General.(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.(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' and the Department on Aging's integrity  functions, which include, but are not limited to, the following:(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.(2) Prepayment and post-payment audits of medical     providers related to ensuring that appropriate payments are made for services rendered and to the prevention and recovery of overpayments.(3) Monitoring of quality assurance programs     administered by the Department of Healthcare and Family Services and the Community Care Program administered by the Department on Aging.(4) Quality control measurements of the programs     administered by the  Department of Healthcare and Family Services and the Community Care Program administered by the Department on Aging.(5) Investigations of fraud or intentional program     violations committed by clients of the Department of Healthcare and Family Services and the Community Care Program administered by the Department on Aging.(6) Actions initiated against contractors, vendors,     or medical providers for any of the following reasons:(A) Violations of the medical assistance program         and the Community Care Program administered by the Department on Aging.(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).(C) Recoveries of assessments against hospitals         and long-term care facilities.(D) Sanctions mandated by the United States         Department of Health and Human Services against medical providers.(E) Violations of contracts related to any         programs administered by the Department of Healthcare and Family Services and the Community Care Program administered by the Department on Aging.(7) Representation of the Department of Healthcare     and Family Services at hearings with the Illinois Department of Financial and Professional Regulation in actions taken against professional licenses held by persons who are in violation of orders for child support payments.(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.(c) Notwithstanding, and in addition to, any other  provision of law, 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 programs administered by the Department of Healthcare and  Family Services.  State and local  governmental agencies are authorized and directed to provide the requested  information, assistance or cooperation.For purposes of enhanced program integrity functions and  oversight, and to the extent consistent with applicable  information and privacy, security, and disclosure laws, State  agencies and departments shall provide the Office of Inspector General access to confidential and other information and data, and the Inspector General is authorized to enter into agreements with appropriate federal agencies and departments to secure similar data. This includes, but is not limited to, information pertaining to: licensure; certification; earnings; immigration status; citizenship; wage reporting; unearned and earned income; pension income;  employment; supplemental security income; social security  numbers; National Provider Identifier (NPI) numbers; the  National Practitioner Data Bank (NPDB); program and agency  exclusions; taxpayer identification numbers; tax delinquency;  corporate information; and death records.The Inspector General shall enter into agreements with State agencies and departments, and is authorized to enter into agreements with federal agencies and departments, under which such agencies and departments shall share data necessary for medical assistance program integrity functions and oversight. The Inspector General shall enter into agreements with State agencies and departments, and is authorized to enter into agreements with federal agencies and departments, under which such agencies shall share data necessary for recipient and vendor screening, review, and investigation, including but not limited to vendor payment and recipient eligibility verification. The Inspector General shall develop, in cooperation with other State and federal agencies and departments, and in compliance with applicable federal laws and regulations, appropriate and effective  methods to share such data.  The Inspector General shall enter into agreements with State agencies and departments, and is authorized to enter into agreements with federal agencies and departments, including, but not limited to: the Secretary of State; the  Department of Revenue; the Department of Public Health; the  Department of Human Services; and the Department of Financial and Professional Regulation.The Inspector General shall have the authority to deny payment, prevent overpayments, and recover overpayments.The Inspector General shall have the authority to deny or  suspend payment to, and deny, terminate, or suspend the  eligibility of, any vendor who fails to grant the Inspector  General timely access to full and complete records, including records of recipients under the medical assistance program for the most recent 6 years, in accordance with Section 140.28 of Title 89 of the Illinois Administrative Code, and other information for the purpose of audits, investigations, or other program integrity functions, after reasonable written request by the Inspector General.(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:(1) The Department of State Police.(2) The Federal Bureau of Investigation and other     federal law enforcement agencies.(3) The various Inspectors General of federal     agencies overseeing the programs administered by the Department of Healthcare and Family Services.(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.(5) The Offices of the several United States     Attorneys in Illinois.(6) The several State's Attorneys.(7) The offices of the Centers for Medicare and     Medicaid Services that administer the Medicare and Medicaid integrity programs.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.(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.(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.(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.(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 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:(1) Aggregate provider billing and payment     information, including the number of providers at various Medicaid earning levels.(2) The number of audits of the medical assistance     program and the dollar savings resulting from those audits.(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.(4) Provider sanctions, in the aggregate, including     terminations and suspensions.(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.(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 their agency's  programs in this  State.(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. 97-689, eff. 6-14-12; 98-8, eff. 5-3-13.)