SB3890 102ND GENERAL ASSEMBLY

LRB102 23061 KTG 32217 b

102ND GENERAL ASSEMBLY
State of Illinois
2021 and 2022
SB3890

Introduced 1/21/2022, by Sen. Brian W. Stewart - Chapin Rose - Dale Fowler

SYNOPSIS AS INTRODUCED:

305 ILCS 5/12-14.2 new

Amends the Illinois Public Aid Code. Requires the Auditor General to conduct a performance audit on the Department of Healthcare and Family Services to review and assess the Department's protocols for detecting and preventing Medicaid fraud and abuse under the State's medical assistance program. Provides that the audit shall cover the Department's administration of the medical assistance program during State fiscal years 2020 through 2022. Requires the Auditor General to, at a minimum, review, evaluate, and report to the General Assembly on the following: (1) the total amount in payments the Department made during the reporting period on behalf of medical assistance beneficiaries; (2) the total amount of payments identified in paragraph (1) that were made in error or as a result of fraud or abuse during the reporting period, including duplicate payments, payments for services not rendered, payments for unauthorized services, payments to fictitious vendors, payments made on behalf of deceased beneficiaries, and payments made on behalf of individuals for any period during which they were ineligible to receive medical assistance; (3) the total amount of payments identified in paragraph (2) that were recovered by the Department; (4) emerging trends of fraud, waste, and abuse under the medical assistance program and the Department's actions to identify and address these emerging trends; (5) the frequency and success of eligibility checks conducted during the reporting period to prevent the improper use of State and federal Medicaid funds; and (6) the Department's compliance with applicable State and federal requirements concerning fraud detection and prevention. Requires the Auditor General to commence the audit as soon as possible and report his or her findings to the General Assembly no later than 2 years after the effective date of the amendatory Act. Requires the Auditor General's report to include any issues or deficiencies and recommendations. Effective immediately.

A BILL FOR

AN ACT concerning public aid.

Be it enacted by the People of the State of Illinois, represented in the General Assembly:

Section 5. The Illinois Public Aid Code is amended by adding Section 12-14.2 as follows:

(305 ILCS 5/12-14.2 new)

Sec. 12-14.2. Auditor General; medical assistance fraud. The Auditor General shall conduct a performance audit on the Department of Healthcare and Family Services to review and assess the Department's protocols for detecting and preventing Medicaid fraud and abuse under the State's medical assistance program. The audit shall cover the Department's administration of the medical assistance program during State fiscal years 2020 through 2022. At a minimum, the Auditor General shall review, evaluate, and report to the General Assembly on the following:

(1) The total amount of payments the Department made during the reporting period on behalf of medical assistance beneficiaries.

(2) The total amount of payments identified in paragraph (1) that were made in error or as a result of fraud or abuse during the reporting period. The reported amount under this paragraph shall, at a minimum, include and identify duplicate payments, payments for services not rendered, payments for unauthorized services, payments to fictitious vendors, payments made on behalf of deceased beneficiaries, and payments made on behalf of individuals for any period during which they were ineligible to receive medical assistance.

(3) The total amount of payments identified in paragraph (2) that were recovered by the Department through recoupment, setoff, crediting of future billings, or direct repayment.

(4) Emerging trends of fraud, waste, and abuse under the medical assistance program and the Department's actions to identify and address these emerging trends.

(5) The frequency and success of eligibility checks conducted during the reporting period to prevent the improper use of State and federal Medicaid funds.

(6) The Department's compliance with applicable State and federal requirements concerning fraud detection and prevention.

The Department of Healthcare and Family Services and, if applicable, the Department of Human Services shall cooperate with the Auditor General in the conduct of this audit.

The Auditor General shall commence this audit as soon as possible and report his or her findings to the General Assembly no later than 2 years after the effective date of this amendatory Act of the 102nd General Assembly. The Auditor General's report shall include any issues or deficiencies and recommendations. The audit required by this Section shall be in accordance with and subject to the Illinois State Auditing Act.

Section 99. Effective date. This Act takes effect upon becoming law.