Illinois Administrative Code › Title 89 - SOCIAL SERVICES › Part 140 - MEDICAL PAYMENT › Subpart J - ALTERNATE PAYEE PARTICIPATION › Section 140.1005 - Revocation of an Alternate Payee

Current through Register Vol. 48, No. 28, July 12, 2024
a)
				The Department may seek a revocation of any alternate payee that has
				participated in the Program, and all owners, officers, a partners, and
				individuals with management responsibility for the alternate payee shall be
				permanently prohibited from participating as an owner, an officer, a partner,
				or an individual with management responsibility with an alternate payee in the
				Illinois Medical Assistance Program if, after reasonable notice and opportunity
				for a hearing, the Department finds that:
1)
				the alternate payee is not complying with Department policy or rules, or with
				the terms and conditions prescribed by the Department in its alternate payee
				registration and alternate payee agreements; or
2) the alternate payee is not properly
				licensed or qualified, or the alternate payee's professional license,
				certificate, or other authorization has not been renewed or has been revoked,
				suspended, or otherwise terminated as determined by the appropriate licensing,
				certifying, or authorizing agency; or
3) the alternate payee has failed to make
				available for inspection, audit, or copying, after receiving a written request
				from the Department, records regarding payments claimed as an alternate payee;
				or
4) the alternate payee has
				failed to furnish any information requested by the Department regarding
				payments claimed as an alternate payee; or
5) the alternate payee has knowingly made, or
				caused to be made, any false statement or representation of a material fact in
				connection with the administration of the Medical Assistance Program. For
				purposes of this Section, statements or representations made "knowingly" shall
				include statements or representations made with actual knowledge that they were
				false, as well as those statements made when the individual making the
				statement had knowledge of such facts or information as would cause one to be
				aware that the statements or representations were false when made; or
6) the alternate payee has submitted claims
				on behalf of an individual practitioner for services or supplies that were not
				rendered or delivered by the practitioner for which the alternate payee was
				designated; or
7) the alternate
				payee, a person with management responsibility for an alternate payee, an
				officer or person owning, either directly or indirectly, 5% or more of the
				shares of stock or other evidences of ownership in a corporate alternate payee,
				a partner in a partnership alternate payee, or a member of a group practice
				alternate payee:
A) was previously terminated
				from participation in the Medical Assistance Program, or was previously revoked
				as an alternate payee in the Illinois Medical Assistance Program, or was
				terminated from participation as a vendor in a medical assistance program in
				another state that is of the same kind as the program of medical assistance
				provided under Article V of the Public Aid Code; or
B) was a person with management
				responsibility of a vendor previously terminated from participation as a vendor
				in the Illinois Medical Assistance Program, or was previously revoked or
				prohibited as an alternate payee in the Illinois Medical Assistance Program, or
				was terminated from participation as a vendor in a medical assistance program
				in another state that is of the same kind as the program of medical assistance
				provided under Article V of the Public Aid Code, during the time of conduct
				that was the basis for that vendor's termination or alternate payee's
				revocation; or
C) was an officer,
				or person owning, either directly or indirectly, 5% or more of the shares of
				stock or other evidences of ownership in a corporate vendor previously
				terminated from participation as a vendor in the Illinois Medical Assistance
				Program, or was previously revoked or prohibited as an alternate payee in the
				Illinois Medical Assistance Program, or was terminated from participation as a
				vendor in a medical assistance program in another state that is of the same
				kind as the program of medical assistance provided under Article V of the
				Public Aid Code, during the time of conduct that was the basis for that
				vendor's termination; or
D) was an
				owner of a sole proprietorship or partner in a partnership or a member in a
				group practice previously terminated from participation as a vendor in the
				Illinois Medical Assistance Program, or was previously revoked or prohibited as
				an alternate payee in the Illinois Medical Assistance Program, or was
				terminated from participation as a vendor in a medical assistance program in
				another state that is of the same kind as the program of medical assistance
				provided under Article V of the Public Aid Code, during the time of conduct
				that was the basis for that vendor's termination or alternate payee's
				revocation; or
8) the
				alternate payee, a person with management responsibility for an alternate
				payee, an officer or person owning, either directly or indirectly, 5% or more
				of the shares of stock or other evidences of ownership in a corporate alternate
				payee, a partner in a partnership alternate payee or a member in a group
				practice alternate payee:
A) has engaged in
				conduct prohibited by applicable federal or State law or regulation relating to
				the Illinois Medical Assistance Program; or
B) was a person with management
				responsibility for a vendor or alternate payee at the time the vendor or
				alternate payee engaged in practices prohibited by applicable federal or State
				law or regulation relating to the Illinois Medical Assistance Program;
				or
C) was an officer or person
				owning, either directly or indirectly, 5% or more of the shares of stock or
				other evidences of ownership in a vendor or alternate payee at the time the
				vendor or alternate payee engaged in practices prohibited by applicable federal
				or State law or regulation relating to the Illinois Medical Assistance Program;
				or
D) was an owner of a sole
				proprietorship, partner of a partnership, or member in a group practice that
				was a vendor or alternate payee engaged in practices prohibited by applicable
				federal or State law or regulation relating to the Illinois Medical Assistance
				Program; or
i) For purposes of subsection
				(a)(8) of this Section, "applicable federal or State law or regulation" shall
				include licensing or certification standards contained in State or federal law
				or regulation related to the Medical Assistance Program, any other licensing
				standards as they related to the alternate payee's practice or business or any
				federal or State law or regulation related to the Medical Assistance
				Program;
ii) For purposes of
				subsection (a)(8) of this Section, conviction or a plea of guilty to activities
				in violation of applicable federal or State law or regulation shall be
				conclusive proof that such activities were engaged in; or
9) the alternate payee, a person
				with management responsibility for an alternate payee, an officer or person
				owning, either directly or indirectly, 5% or more of the shares of stock or
				other evidences of ownership in a corporate alternate payee, a partner in a
				partnership alternate payee, or a member of a group practice alternate payee,
				has been convicted in this or any other State, or in any federal court, of any
				felony related to the Medical Assistance Program; or
10) the direct or indirect ownership of the
				vendor or alternate payee (including the ownership of a vendor or alternate
				payee that is a partner's interest in a vendor or alternate payee, or ownership
				of 5% or more of the shares of stock or other evidences of ownership in a
				corporate vendor or alternate payee) has been transferred by an individual who
				is terminated or barred from participating as a vendor or is prohibited or
				revoked as a alternate payee to the individual's spouse, child, brother,
				sister, parent, grandparent, grandchild, uncle, aunt, niece, nephew, cousin, or
				relative by marriage.