Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 104 - PRACTICE IN ADMINISTRATIVE HEARINGS
Subpart C - MEDICAL VENDOR AND ALTERNATE PAYEE HEARINGS
Section 104.217 - Purpose of Formal Conference

1) An opportunity for the vendor and/or alternate payee to rebut the Department's audit findings. If the Department's findings were based on sampling and extrapolation, the vendor and/or alternate payee may present evidence to show that the sample used by the Department was invalid and, therefore, cannot be used to project the overpayments identified in the sample to total billings for the audit period.

2) The vendor and/or alternate payee may also conduct an audit of 100% of the medical records of payments received during the audit period and present the result of such an audit at the formal conference. 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 and/or alternate payee should be prepared to submit supporting documentation to demonstrate this compliance;

1) that the respondent has received all applicable written communications, including the notice of intent to recover money as provided in Section 104.206;

2) all procedural matters, including appearances made by both parties and the respondent's request for hearing and answer; and

3) a list of witnesses and any evidence to be presented at the hearing by all parties;