MEDICAID-VENDORS-PENALTIES Senate SponsorsSen. Kwame Raoul-John G. Mulroe-Jacqueline Y. Collins House Sponsors(Rep. Emily McAsey-Elgie R. Sims, Jr.-Scott Drury-Dennis M. Reboletti, Kathleen Willis, Silvana Tabares, Jack D. Franks, Keith Farnham, Carol A. Sente, Linda Chapa LaVia and Monique D. Davis) 8/27/2013SenatePublic Act . . . . . . . . . 98-0550 305 ILCS 5/12-4.25from Ch. 23, par. 12-4.25Amends the Administration Article of the Illinois Public Aid Code. Establishes civil penalties ranging from $10,000 to $50,000 for any person (including a vendor, organization, agency, or other entity, but excluding a recipient) who: knowingly presents or causes to be presented a fraudulent claim for payment under the State's medical assistance program; knowingly gives or causes to be given to any person, with respect to coverage for inpatient hospital services under the medical assistance program, information that he or she knows or should know is false or misleading; arranges or contracts (by employment or otherwise) with an individual or entity that the person knows or should know is excluded from participation in a federal or state health care program, including, but not limited to, the medical assistance program, for the provision of items or services for which payment may be made under such a program; or commits other specified fraudulent acts. Provides that the Director of Healthcare and Family Services may make a determination to terminate, suspend, bar, or exclude the person from participation in the medical assistance program, but not before granting the affected individual, entity, or vendor an opportunity for a hearing after reasonable notice. Provides that a final order, decision, or other determination made by the Director is subject to review in accordance with the Administrative Review Law. Removes language allowing the Department to recover interest on the amount of an overpayment. Makes other changes. Effective immediately.Senate Committee Amendment No. 1 Replaces everything after the enacting clause. Amends the Administration Article of the Illinois Public Aid Code. Establishes civil penalties ranging from $10,000 to $50,000 for any person (including a vendor, organization, agency, or other entity, but excluding a recipient) who: knowingly presents or causes to be presented a fraudulent claim for payment under the State's medical assistance program; knowingly gives or causes to be given to any person, with respect to medical assistance program coverage of inpatient hospital services, information that he or she knows or should know is false or misleading; arranges or contracts (by employment or otherwise) with an individual or entity that the person knows or should know is excluded from participation in the medical assistance program or a federal or state health care program for the provision of items or services for which payment may be made under such a program; or commits other specified fraudulent acts. Provides that the Director of Healthcare and Family Services may make a determination to exclude, terminate, suspend, or bar the person from participation in the medical assistance program, but not before granting the affected individual, entity, or vendor an opportunity for a hearing after reasonable notice. Provides that a final order, decision, or other determination made by the Director is subject to review in accordance with the Administrative Review Law. Removes language allowing the Department to recover interest on the amount of an overpayment. Defines terms. Makes other changes. Effective immediately.Senate Floor Amendment No. 2 Replaces everything after the enacting clause. Reinserts the provisions of the bill as amended by Senate Amendment No. 1, with the following changes: Permits the Department of Healthcare and Family Services to seek the civil monetary penalties identified in the amendatory Act as well as the exclusion, termination, suspension, or barment of persons who improperly file medical assistance claims. Provides that if a person has received an overpayment, the person shall (i) report and return the overpayment to the Department at the correct address; and (ii) notify the Department in writing of the reason for the overpayment. Provides that an overpayment must be reported and returned by the later of (i) the date which is 60 days after the date on which the overpayment was identified; or (ii) the date any corresponding cost report is due, if applicable. Changes "physician's service" to "vendor physician's service". Effective immediately.House Committee Amendment No. 1 Provides that a vendor who disputes an overpayment identified as part of a Department of Health Care and Family Services' audit shall utilize the Department's self-referral disclosure protocol to identify, investigate, and return to the Department any undisputed audit overpayment amount. Provides that unless the disputed overpayment amount is subject to a fraud payment suspension, or involves a termination sanction, the Department shall defer the recovery of the disputed overpayment amount up to one year after the date of the Department's final audit determination, or earlier, or as required by State or federal law. Provides that if the administrative hearing extends beyond one year, and such delay was not caused by the request of the vendor, then the Department shall not recover the disputed overpayment amount until the date of the final administrative decision; and that if a final administrative decision establishes that the disputed overpayment amount is owed to the Department, then the amount shall be immediately due to the Department. Provides that the Department shall be entitled to recover interest from the vendor on the overpayment amount from the date of the overpayment through the date the vendor returns the overpayment to the Department at a rate not to exceed the Wall Street Journal Prime Rate, as published from time to time, but not to exceed 5%; and that any interest billed by the Department shall be due immediately upon receipt of the Department's billing statement. 2/5/2013SenateFiled with Secretary by Sen. Kwame Raoul 2/5/2013SenateFirst Reading 2/5/2013SenateReferred to Assignments 2/14/2013SenateAssigned to Judiciary 3/5/2013SenatePostponed - Judiciary 3/15/2013SenateSenate Committee Amendment No. 1 Filed with Secretary by Sen. Kwame Raoul 3/15/2013SenateSenate Committee Amendment No. 1 Referred to Assignments 3/19/2013SenateSenate Committee Amendment No. 1 Assignments Refers to Judiciary 3/19/2013SenateSenate Committee Amendment No. 1 Adopted 3/19/2013SenateDo Pass as Amended Judiciary; 009-000-000 3/19/2013SenatePlaced on Calendar Order of 2nd Reading March 20, 2013 4/12/2013SenateSenate Floor Amendment No. 2 Filed with Secretary by Sen. Kwame Raoul 4/12/2013SenateSenate Floor Amendment No. 2 Referred to Assignments 4/16/2013SenateSenate Floor Amendment No. 2 Assignments Refers to Judiciary 4/17/2013SenateSenate Floor Amendment No. 2 Recommend Do Adopt Judiciary; 010-000-000 4/18/2013SenateAdded as Chief Co-Sponsor Sen. John G. Mulroe 4/18/2013SenateSecond Reading 4/18/2013SenateSenate Floor Amendment No. 2 Adopted; Raoul 4/18/2013SenatePlaced on Calendar Order of 3rd Reading April 23, 2013 4/24/2013SenateThird Reading - Passed; 051-000-000 4/25/2013HouseArrived in House 4/25/2013HouseChief House Sponsor Rep. Emily McAsey 4/29/2013HouseFirst Reading 4/29/2013HouseReferred to Rules Committee 4/29/2013HouseAssigned to Judiciary 5/7/2013HouseAdded Alternate Co-Sponsor Rep. Kathleen Willis 5/8/2013HouseMotion Do Pass - Lost Judiciary; 003-010-001 5/8/2013HouseRemains in Judiciary 5/9/2013HouseAdded Alternate Co-Sponsor Rep. Silvana Tabares 5/10/2013HouseFinal Action Deadline Extended-9(b) May 24, 2013 5/20/2013HouseHouse Committee Amendment No. 1 Filed with Clerk by Rep. Emily McAsey 5/20/2013HouseHouse Committee Amendment No. 1 Referred to Rules Committee 5/21/2013HouseHouse Committee Amendment No. 1 Rules Refers to Judiciary 5/22/2013HouseHouse Committee Amendment No. 1 Adopted in Judiciary; by Voice Vote 5/22/2013HouseDo Pass as Amended / Short Debate Judiciary; 016-000-000 5/23/2013HousePlaced on Calendar 2nd Reading - Short Debate 5/23/2013HouseSecond Reading - Short Debate 5/23/2013HouseHeld on Calendar Order of Second Reading - Short Debate 5/24/2013HouseFinal Action Deadline Extended-9(b) May 31, 2013 5/28/2013HousePlaced on Calendar Order of 3rd Reading - Short Debate 5/28/2013HouseAdded Alternate Chief Co-Sponsor Rep. Elgie R. Sims, Jr. 5/28/2013HouseAlternate Chief Co-Sponsor Changed to Rep. Elgie R. Sims, Jr. 5/29/2013HouseAdded Alternate Chief Co-Sponsor Rep. Scott Drury 5/29/2013HouseThird Reading - Short Debate - Passed 111-004-001 5/29/2013HouseAdded Alternate Chief Co-Sponsor Rep. Dennis M. Reboletti 5/29/2013HouseAdded Alternate Co-Sponsor Rep. Jack D. Franks 5/29/2013HouseAdded Alternate Co-Sponsor Rep. Keith Farnham 5/29/2013HouseAdded Alternate Co-Sponsor Rep. Carol A. Sente 5/29/2013HouseAdded Alternate Co-Sponsor Rep. Linda Chapa LaVia 5/29/2013HouseAdded Alternate Co-Sponsor Rep. Monique D. Davis 5/29/2013SenateSecretary's Desk - Concurrence House Amendment(s) 1 5/29/2013SenatePlaced on Calendar Order of Concurrence House Amendment(s) 1 - May 30, 2013 5/30/2013SenateHouse Committee Amendment No. 1 Motion to Concur Filed with Secretary Sen. Kwame Raoul 5/30/2013SenateHouse Committee Amendment No. 1 Motion to Concur Referred to Assignments 5/30/2013SenateHouse Committee Amendment No. 1 Motion to Concur Assignments Referred to Judiciary 5/30/2013SenateHouse Committee Amendment No. 1 Motion to Concur Referred to Assignments 5/30/2013SenateHouse Committee Amendment No. 1 Motion to Concur Assignments Referred to Criminal Law 5/30/2013SenateHouse Committee Amendment No. 1 Motion To Concur Recommended Do Adopt Criminal Law; 007-000-000 5/31/2013SenateAdded as Chief Co-Sponsor Sen. Jacqueline Y. Collins 5/31/2013SenateHouse Committee Amendment No. 1 Senate Concurs 059-000-000 5/31/2013SenatePassed Both Houses 6/28/2013SenateSent to the Governor 8/27/2013SenateGovernor Approved 8/27/2013SenateEffective Date August 27, 2013 8/27/2013SenatePublic Act . . . . . . . . . 98-0550