Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS › Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS › Section 104.246 - Evidence at Hearings

Current through Register Vol. 48, No. 28, July 12, 2024
a) The
				vendor may introduce evidence at the hearing that was not made available to the
				Department at the time the application or request for special permission was
				denied. If additional evidence is introduced at the hearing and the hearing
				officer determines that the vendor did not demonstrate he should be admitted
				based on the evidence available at the time the application or request for
				special permission was denied, but would have so demonstrated had the
				additional evidence at the hearing been available, the hearing shall be
				remanded to the Department for a new decision that considers such additional
				evidence. If additional evidence is introduced at the hearing and the hearing
				officer determines that the vendor would not have demonstrated that he should
				be admitted to the Medical Assistance Program or granted special permission
				even if such additional evidence had been considered, the recommendation shall
				be to uphold the Department's decision.
b) Irrelevant, immaterial or unduly
				repetitious evidence shall be excluded. The rules of evidence and privilege as
				applied in civil cases in the Circuit Courts of this State shall be followed.
				However, evidence not admissible under such rules of evidence may be admitted
				(except where precluded by statute) if it is of the type commonly relied upon
				by reasonably prudent men in the conduct of their affairs. When the
				admissibility of evidence is in dispute and depends upon fairly arguable
				interpretations of law, such evidence shall be admitted. Objections to
				evidentiary offers may be made and shall be noted in the record. Subject to
				these requirements, when a hearing will be expedited and the interests of the
				parties will not be prejudiced, any part of the evidence may be received in
				written form. Any party may submit evidence in rebuttal or
				surrebuttal.
c) Summaries of
				voluminous documents may be admitted into evidence. The document summarized
				need not itself be admitted into evidence. Copies of the document need not be
				provided so long as all parties are accorded a reasonable opportunity to
				inspect the document summarized and no substantial injustice results.
d) If the hearing is related in whole or in
				part to the Department's intent to recover money and the Department's recovery
				is based on sampling and extrapolation, the vendor or alternate payee may:
1) present evidence to show that the sample
				used by the Department was invalid and, therefore, should not be used to
				project the overpayments identified in the sample to total billings for the
				audit period; or
2) the vendor or
				alternate payee may also conduct an audit of 100% of the medical records of
				payments received during the audit period and present the results of such an
				audit at the hearing. Any such audit should demonstrate that the vendor's
				records for the unaudited services provided during the audit period were in
				compliance with the regulations, provider handbooks and other written
				requirements of the Department. The vendor should be prepared to submit
				supporting documentation to demonstrate this compliance.