(305 ILCS 5/8A-7.1) (from Ch. 23, par. 8A-7.1)
Sec. 8A-7.1. The Director, upon making a
determination based upon information in the possession of the Illinois
Department, that continuation in practice of a licensed health care
professional would constitute an immediate danger to the public, shall submit
a written communication to the Director of Professional Regulation indicating
such determination and
additionally providing a complete summary of the information upon which
such determination is based, and recommending that the Director of
Professional Regulation immediately suspend such person's
license. All relevant evidence, or copies thereof, in the Illinois
Department's possession may also be submitted in conjunction with the written
communication. A copy of such written communication, which is exempt from
the copying and inspection provisions of the Freedom of Information Act,
shall at the time of submittal to the Director
of Professional Regulation
be simultaneously mailed to the last known business address of such licensed
health care professional by certified or registered postage, United States
Mail, return receipt requested. Any evidence, or copies thereof, which is
submitted in conjunction with the written communication is also exempt from
the copying and inspection provisions of the Freedom of Information Act.
The Director, upon making a determination based upon information in the
possession of the Illinois Department, that a licensed health care
professional is willfully committing fraud upon the Illinois Department's
medical assistance program, shall submit a written communication to the
Director of Professional Regulation indicating such
determination and additionally providing a complete summary of the
information upon which such determination is based. All relevant evidence,
or copies thereof, in the Illinois Department's possession may also be
submitted in conjunction with the written communication.
Upon receipt of such written communication, the Director of
Professional Regulation shall promptly investigate the
allegations contained in such written communication. A copy of such
written communication, which is exempt from the copying and inspection
provisions of the Freedom of Information Act, shall at the time of
submission to the Director of Professional Regulation,
be simultaneously mailed to the last known address of such licensed health
care professional by certified or registered postage, United States Mail,
return receipt requested. Any evidence, or copies thereof, which
is submitted in conjunction with the written communication is also exempt
from the copying and inspection provisions of the Freedom of Information Act.
For the purposes of this Section, "licensed health care professional"
means any person licensed under the Illinois Dental Practice Act, the Nurse Practice Act, the Medical Practice Act of 1987, the
Pharmacy Practice Act, the Podiatric Medical Practice Act of 1987,
or the Illinois Optometric Practice Act of 1987.
(Source: P.A. 95-639, eff. 10-5-07; 95-689, eff. 10-29-07; 95-876, eff. 8-21-08.)
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(305 ILCS 5/8A-8) (from Ch. 23, par. 8A-8)
Sec. 8A-8.
Future Participation in the Public Assistance Program.
(a) Any person applying for public assistance under this Code who has been
found
guilty of a violation of this Article or of any law of the United States or
of any state which is substantially similar to Sections 8A-2 through 8A-5
for violations related to public assistance or medical assistance
programs of the kind provided under this Code and who has not been previously
convicted
for a violation of this Article or of any law of the United States or of any
state which is substantially similar to Sections 8A-2 through 8A-5
for violations related to public assistance or medical assistance
programs
of the kind provided under this Code shall have applications for public
assistance
under this Code reviewed by an administrative review board to determine
the person's eligibility and the need for administrative safeguards to prevent
any such further violations. The administrative review board shall be
composed of not less than two persons who are selected in accordance with
regulations of the Illinois Department or the local governmental unit. Hearings
conducted by the board shall:
(1) be of an informal nature, permitting the |
| applicant to attend at his option;
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(2) be open to the public, unless the applicant and
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| the administrative review board determine otherwise;
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(3) be subject to reasonable time and notification
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| requirements as determined by regulations of the Illinois Department or local governmental units; and
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(4) be held at a location convenient to the applicant.
At the hearing, the administrative review board may deny the application
based on an investigation of the person's eligibility, or the board may
appoint a substitute payee, require more frequent visits or consultations,
more frequent financial reports or require any other action to the extent
permitted by State and federal law and regulations. A decision by the
administrative review board to deny a person's application shall only be
based on the person's failure to qualify under the eligibility criteria
applicable to all applicants for the public assistance program in question.
Any decision by the administrative review board may be appealed pursuant to
the provisions of this Code. In no instance shall the administrative review
board delay the hearing or its decision beyond the time allowed under State
or federal law and regulations for determining an applicant's eligibility
for public assistance.
If the person has been determined eligible, the Illinois Department or
the local governmental unit may recoup prior payments obtained in violation
of this Article from the current cash assistance grants, unless such payments
have previously been repaid. The Illinois Department or the local governmental
unit, on a case by case basis, shall limit the amount deducted from the current
cash assistance grant so as not to cause undue hardship to the person.
(b) To the extent permitted under federal law, any person found
guilty of a first violation of this Article or of any law of the United
States
or
of any state which is substantially similar to Sections 8A-2 through 8A-5 for
violations related to public assistance or medical assistance programs of the
kind provided under this Code may be suspended from eligibility for public
aid under this Code. Any person found guilty of a second or subsequent
violation of this Article or of any law of the United States or of any state
which is substantially similar to Sections 8A-2 through 8A-5 for violations
related to public assistance or medical assistance programs of the kind
provided under this Code shall be ineligible for public aid under this
Code.
(c) In no instance shall this Section adversely affect the eligibility
of children who are in need of public aid under this Code, or the amount
of the grant received by such children. If a child's caretaker relative
is adversely affected by this Section, a substitute payee may be appointed
until the Illinois Department can determine, by rule, that the caretaker
relative can manage the public aid in the best interest of the child.
(d) Any person, firm, corporation, association, agency, institution or
other legal entity that has been convicted of a violation of this Article
shall be prohibited from participating as a vendor of goods or services
to recipients of public aid under this Code. Such prohibition shall extend
to any person with management responsibility in a firm, corporation,
association, agency, institution, or other legal entity that has been
convicted of any such violation and to an officer or person owning, either
directly or indirectly, 5% or more of the shares of stock or other
evidences of ownership in a corporation.
(e) Any employee of the Illinois Department, county department or local
governmental unit who has been found guilty of a violation of this Article
shall be terminated from employment.
(Source: P.A. 89-489, eff. 1-1-97; 90-725, eff. 8-7-98.)
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(305 ILCS 5/8A-11) (from Ch. 23, par. 8A-11)
Sec. 8A-11. (a) No person shall:
(1) Knowingly charge a resident of a nursing home for |
| any services provided pursuant to Article V of the Illinois Public Aid Code, money or other consideration at a rate in excess of the rates established for covered services by the Illinois Department pursuant to Article V of the Illinois Public Aid Code; or
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(2) Knowingly charge, solicit, accept or receive, in
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| addition to any amount otherwise authorized or required to be paid pursuant to Article V of the Illinois Public Aid Code, any gift, money, donation or other consideration:
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(i) As a precondition to admitting or expediting
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| the admission of a recipient or applicant, pursuant to Article V of the Illinois Public Aid Code, to a long-term care facility as defined in Section 1-113 of the Nursing Home Care Act or a facility as defined in Section 1-113 of the ID/DD Community Care Act, Section 1-113 of the MC/DD Act, or Section 1-102 of the Specialized Mental Health Rehabilitation Act of 2013; and
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(ii) As a requirement for the recipient's or
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| applicant's continued stay in such facility when the cost of the services provided therein to the recipient is paid for, in whole or in part, pursuant to Article V of the Illinois Public Aid Code.
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(b) Nothing herein shall prohibit a person from making a voluntary
contribution, gift or donation to a long-term care facility.
(c) This paragraph shall not apply to agreements to provide continuing
care or life care between a life care facility as defined by the Life
Care Facilities Act, and a person financially eligible for benefits pursuant to
Article V of the Illinois Public Aid Code.
(d) Any person who violates this Section shall be guilty of a business
offense and fined not less than $5,000 nor more than $25,000.
(e) "Person", as used in this Section, means an individual, corporation,
partnership, or unincorporated association.
(f) The State's Attorney of the county in which the facility is located
and the Attorney General shall be notified by the Illinois Department of
any alleged violations of this Section known to the Department.
(g) The Illinois Department shall adopt rules and regulations to carry
out the provisions of this Section.
(Source: P.A. 98-104, eff. 7-22-13; 99-180, eff. 7-29-15.)
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(305 ILCS 5/8A-12)
Sec. 8A-12.
Early fraud prevention and detection program.
The Illinois
Department may conduct an early fraud prevention and detection program as
provided in this Section. If conducted, the program shall apply to all
categories of assistance and all applicants for aid. The program may be
conducted in appropriate counties as determined by the Department. The
program shall have the following features:
(1) No intimidation of applicants or recipients may |
| occur, either by referral or threat of referral for a fraud prevention investigation.
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(2) An applicant may not be referred for a fraud
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| prevention investigation until an application for aid is completed and signed by the applicant or any authorized representative.
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(3) An applicant may be referred to the Inspector
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| General for a fraud prevention investigation if there are reasonable grounds to question the accuracy of any information, statements, documents, or other representations by the applicant or any authorized representative. Referrals for fraud prevention investigations shall be made in accordance with guidelines to be jointly determined by the Inspector General and the Department.
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(Source: P.A. 89-118, eff. 7-7-95.)
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(305 ILCS 5/8A-13)
Sec. 8A-13. Managed health care fraud.
(a) As used in this Section, "health plan" means any of the following:
(1) Any health care reimbursement plan sponsored |
| wholly or partially by the State.
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(2) Any private insurance carrier, health care
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| cooperative or alliance, health maintenance organization, insurer, organization, entity, association, affiliation, or person that contracts to provide or provides goods or services that are reimbursed by or are a required benefit of a health benefits program funded wholly or partially by the State.
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(3) Anyone who provides or contracts to provide goods
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| and services to an entity described in paragraph (1) or (2) of this subsection.
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For purposes of item (2) in subsection (b), "representation" and "statement"
include, but are not limited to, reports, claims, certifications,
acknowledgments and ratifications of financial information, enrollment claims,
demographic statistics, encounter data, health services available or rendered,
and the qualifications of person rendering health care and ancillary services.
(b) Any person, firm, corporation, association, agency, institution, or
other legal entity that, with the intent to obtain benefits or payments under
this Code to which the person or entity is not entitled or in a greater amount
than that to which the person or entity is entitled, knowingly or willfully:
(1) executes or conspires to execute a scheme or
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| artifice to defraud any State or federally funded or mandated health plan in connection with the delivery of or payment for health care benefits, items, or services;
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(2) executes or conspires to execute a scheme or
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| artifice to obtain by means of false or fraudulent pretense, representation, statement, or promise money or anything of value in connection with the delivery of or payment for health care benefits, items, or services that are in whole or in part paid for, reimbursed, or subsidized by, or are a required benefit of, a State or federally funded or mandated health plan;
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(3) falsifies, conceals, or covers up by any trick,
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| scheme, or device a material fact in connection with the delivery of or payment for health care benefits, items, or services that are in whole or in part paid for or reimbursed by a State or federal health plan;
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(4) makes any materially false, fictitious, or
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| fraudulent statements or representations, or makes or uses any materially false writing or document knowing the same to contain any materially false, fictitious, or fraudulent statement or entry, in connection with the delivery of or payment for health care benefits, items, or services that are in whole or in part paid for or reimbursed by a State or federal health plan; or
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(5) makes or uses any false writing or document
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| knowing the same to contain any materially false, fictitious, or fraudulent statement or entry in connection with the delivery of or payment for health care benefits, items, or services that are in whole or in part paid for or reimbursed by a State or federal health plan;
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is guilty of a
violation of this Article and shall be punished as provided in Section 8A-6.
(Source: P.A. 98-354, eff. 8-16-13.)
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(305 ILCS 5/8A-14)
Sec. 8A-14.
Bribery and graft in connection with health care.
(a) As used in this Section:
"Health care official" means any of the following:
(1) An administrator, officer, trustee, fiduciary, |
| custodian, counsel, agent, or employee of any health plan.
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(2) An officer, counsel, agent, or employee of an
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| organization that provides, proposes to provide, or contracts to provide services to any health plan.
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(3) An official, employee, or agent of a State or
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| federal agency having regulatory or administrative authority over any health plan.
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"Health plan" has the meaning attributed to that term in Section 8A-13.
(b) Any person, firm, corporation, association, agency, institution, or
other legal entity that
(1) directly or indirectly gives, offers, or promises
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| anything of value to a health care official, or offers or promises to a health care official to give anything of value to another person, with the intent
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(A) to influence or reward any act or decision of
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| any health care official exercising any authority in any State or federally funded or mandated health plan other than as specifically allowed by law, or
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(B) to influence the official to commit, aid in
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| the commission of, or conspire to allow any fraud in a State or federally funded or mandated health plan, or
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(C) to induce the official to engage in any
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| conduct in violation of the official's lawful duty, or
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(2) being a health care official, directly or
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| indirectly demands, solicits, receives, accepts, or agrees to accept anything of value personally or for any other person or entity, the giving of which would violate paragraph (1) of this subsection,
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is guilty of a violation of this Article and shall be punished as
provided in Section 8A-6.
(Source: P.A. 90-538, eff. 12-1-97.)
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(305 ILCS 5/8A-15)
Sec. 8A-15. False statements relating to health care delivery. Any
person, firm, corporation, association, agency, institution, or other legal
entity that, in any matter related to a State or federally funded or mandated
health plan, knowingly and wilfully falsifies, conceals, or omits by any trick,
scheme, artifice, or device a material fact, or makes any false, fictitious, or
fraudulent statement or representation, or makes or uses any false writing or
document, knowing the same to contain any false, fictitious, or fraudulent
statement or entry in connection with the provision of health care or related
services, is guilty of a Class 4 felony.
(Source: P.A. 98-354, eff. 8-16-13.)
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(305 ILCS 5/8A-16)
Sec. 8A-16.
Unfair or deceptive marketing practices.
(a) As used in this Section, "health plan" has the meaning attributed to
that term in Section 8A-13.
(b) It is unlawful to knowingly and willfully engage in any unfair or
deceptive marketing practice
in connection with proposing, offering, selling, soliciting, or providing any
health care service or any health plan. Unfair or deceptive marketing
practices include the following:
(1) Making a false and misleading oral or written |
| statement, visual description, advertisement, or other representation of any kind that has the capacity, tendency, or effect of deceiving or misleading health care consumers with respect to any health care service, health plan, or health care provider.
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(2) Making a representation that a health care plan
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| or a health care provider offers any service, benefit, access to care, or choice that it does not in fact offer.
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(3) Making a representation that a health plan or
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| health care provider has any status, certification, qualification, sponsorship, affiliation, or licensure that it does not have.
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(4) A failure to state a material fact if the failure
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| deceives or tends to deceive.
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(5) Offering any kickback, bribe, reward, or benefit
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| to any person as an inducement to select or to refrain from selecting any health care service, health plan, or health care provider, unless the benefit offered is medically necessary health care or is permitted by the Illinois Department.
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(6) The use of health care consumer or other
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| information that is confidential or privileged or that cannot be disclosed to or obtained by the user without violating a State or federal confidentiality law, including:
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(A) medical records information; and
(B) information that identifies the health care
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| consumer or any member of his or her group as a recipient of any government sponsored or mandated welfare program.
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(7) The use of any device or artifice in advertising
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| a health plan or soliciting a health care consumer that misrepresents the solicitor's profession, status, affiliation, or mission.
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(c) Any person who commits a first violation of this Section is guilty of a
Class
A misdemeanor and is subject to a fine of not more than $5,000. Any person who
commits a second or subsequent violation of this Section is guilty of a Class 4
felony and is subject to a fine of not more than $25,000.
(Source: P.A. 90-538, eff. 12-1-97.)
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(305 ILCS 5/9-1) (from Ch. 23, par. 9-1)
Sec. 9-1. Declaration of Purpose. It is the purpose
of this Article to aid applicants for and
recipients of public aid under Articles III, IV, V, and VI, to
increase their capacities for self-support, self-care, and responsible
citizenship, and to assist them in maintaining and strengthening family
life. If authorized pursuant to Section 9-8, this Article may be
extended to former and potential recipients and to persons whose income
does not exceed the standard established to determine eligibility for
aid as a medically indigent person under Article V. The Department, with
the written consent of the Governor, may also:
(a) extend this Article to individuals and their |
| families with income closely related to national indices of poverty who have special needs resulting from institutionalization of a family member or conditions that may lead to institutionalization or who live in impoverished areas or in facilities developed to serve persons of low income;
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(b) establish, where indicated, schedules of payment
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| for service provided based on ability to pay;
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(c) provide for the coordinated delivery of the
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| services described in this Article and related services offered by other public or private agencies or institutions, and cooperate with the Illinois Department on Aging to enable it to properly execute and fulfill its duties pursuant to the provisions of Section 4.01 of the "Illinois Act on the Aging", as now or hereafter amended;
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(d) provide in-home care services, such as chore and
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| housekeeping services or homemaker services, to recipients of public aid under Articles IV and VI, the scope and eligibility criteria for such services to be determined by rule;
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(e) contract with other State agencies for the
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| purchase of social service under Title XX of the Social Security Act, such services to be provided pursuant to such other agencies' enabling legislation; and
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(f) cooperate with the Department of Healthcare and
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| Family Services to provide services to public aid recipients for the treatment and prevention of alcoholism and substance abuse.
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(Source: P.A. 95-331, eff. 8-21-07.)
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(305 ILCS 5/9-6) (from Ch. 23, par. 9-6)
Sec. 9-6.
Job Search, Training and Work Programs.
The Illinois Department
and local governmental units shall initiate, promote and develop job search,
training and work programs which will provide employment for and contribute
to the training and experience of persons receiving aid under Articles III,
V, and VI.
The job search, training and work programs shall be designed to preserve and
improve the work habits and skills of recipients for whom jobs are not
otherwise immediately available and to provide training and experience for
recipients who lack the skills required for such employment opportunities as
are or may become available. The Illinois Department and local governmental
unit shall determine by rule those classes of recipients who shall be subject
to participation in such programs. If made subject to participation, every
applicant for or recipient of public aid who is determined to be "able to
engage in employment", as defined by the Department or local governmental unit
pursuant to rules and regulations, for whom unsubsidized jobs are not otherwise
immediately available shall be required to participate in any program
established under this Section.
The Illinois Department shall establish with the Director of Central
Management Services an outreach and training
program designed to encourage and assist recipients participating in job
search, training and work programs to participate in open competitive
examinations for trainee and other entry level positions to maximize
opportunities for placement on open competitive eligible listings and
referral to State agencies for employment consideration.
The Department shall provide payment for transportation, day-care and
Workers' Compensation costs which occur for recipients as a result of
participating in job search, training and work programs as described in
this Section. The Department may decline to initiate such programs in
areas where eligible recipients would be so few in number as to not
economically justify such programs; and in this event the Department shall
not require persons in such areas to participate in any job search,
training, or work programs whatsoever as a condition of their continued
receipt of, or application for, aid.
The programs may include, but shall not be limited to, service in child
care centers, in preschool programs as teacher aides and in public health
programs as home visitors and health aides; the
maintenance of or services required in connection with public offices,
buildings and grounds; state, county and municipal hospitals, forest
preserves, parks, playgrounds, streets and highways, and other
governmental maintenance or construction directed toward environmental
improvement; and similar facilities.
The Illinois Department or local governmental units may enter into agreements
with local taxing bodies and private not-for-profit organizations, agencies
and institutions to provide for the supervision and administration of job
search, work and training projects authorized by this Section. Such agreements
shall stipulate the requirements for utilization of recipients in such
projects. In addition to any other requirements dealing with the
administration of these programs, the Department shall assure, pursuant to
rules and regulations, that:
(a) Recipients may not displace regular employees.
(b) The maximum number of hours of mandatory work is |
| 8 hours per day and 40 hours per week, not to exceed 120 hours per month.
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(c) The maximum number of hours per month shall be
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| determined by dividing the recipient's benefits by the federal minimum wage, rounded to the lowest full hour. "Recipient's benefits" in this subsection includes: (i) both cash assistance and food stamps provided to the entire assistance unit or household by the Illinois Department where the job search, work and training program is administered by the Illinois Department and, where federal programs are involved, includes all such cash assistance and food stamps provided to the greatest extent allowed by federal law; or (ii) includes only cash assistance provided to the entire assistance unit by the local governmental unit where the job search, work and training program is administered by the local governmental unit.
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(d) The recipient shall be provided or compensated
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| for transportation to and from the work location.
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(e) Appropriate terms regarding recipient
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Local taxing bodies and private not-for-profit organizations, agencies
and institutions which utilize recipients in job search, work and training
projects authorized by this Section are urged to include such recipients in the
formulation of their employment policies.
Unless directly paid by an employing local taxing body or not-for-profit
agency, a recipient participating in a work project who meets all requirements
set forth by the Illinois Department shall receive credit towards his or
her monthly assistance benefits for work performed based upon the applicable
minimum wage rate. Where a recipient is paid directly by an employing agency,
the Illinois Department or local governmental unit shall provide for payment
to such employing entity the appropriate amount of assistance benefits to
which the recipient would otherwise be entitled under this Code.
The Illinois Department or its designee, including local governmental units,
may enter into agreements with the agencies or institutions providing work
under programs established hereunder for payment to each such employer
(hereinafter called "public service employer") of all or a portion of the
wages to be paid to persons for the work performed and other appropriate costs.
If the number of persons receiving aid under Article VI is insufficient
to justify the establishment of job search, training and work programs
on a local basis by a local governmental unit, or if for other good cause the
establishment of a local program is impractical or unwarranted, the local
governmental unit shall cooperate with other local governmental units, with
civic and non-profit community agencies, and with the Illinois Department in
developing a program or programs which will jointly serve the participating
governmental units and agencies.
A local governmental unit receiving State funds shall refer all
recipients able to engage in employment to such job search, training and work
programs as are established, whether within or without the governmental
unit, and as are accessible to persons receiving aid from the governmental
unit. The Illinois Department shall withhold allocation of state funds to
any governmental unit which fails or refuses to make such referrals.
Participants in job search, training and work programs shall be required
to maintain current registration for regular employment under Section 11-10
and to accept any bona fide offer of regular employment. They shall
likewise be required to accept education, work and training opportunities
available to them under other provisions of this Code or Federal law. The
Illinois Department or local governmental unit shall provide by rule for
periodic review of the circumstances of each participant to determine the
feasibility of his placement in regular employment or other work, education
and training opportunities.
Moneys made available for public aid purposes under Articles IV
and VI may be expended to pay public service employers all or a
portion of the wages of public service employees and other appropriate
costs, to provide necessary supervisory personnel and equipment, to
purchase Workers' Compensation Insurance or to pay Workers' Compensation
claims, and to provide transportation to and from work sites.
The Department shall provide through rules and regulations for sanctions
against applicants and recipients of aid under this Code who fail to cooperate
with the regulations and requirements established pursuant to this Section.
Such sanctions may include the loss of eligibility to receive aid under
Article VI of this Code for up to 3 months.
The Department, in cooperation with a local governmental unit, may maintain
a roster of persons who are required to participate in a local job search,
training and work program. In such cases, the roster shall be available
for inspection by employers for the selection of possible workers.
In addition to the programs authorized by this Section, the Illinois
Department is authorized to administer any job search, training or work
projects in conjunction with the Federal Food Stamp Program, either under
this Section or under other regulations required by the Federal government.
The Illinois Department may also administer pilot programs to provide job
search, training and work programs to unemployed parents of children
receiving child support enforcement services under Article X of this
Code.
(Source: P.A. 92-111, eff. 1-1-02; 92-590, eff. 7-1-02.)
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