Illinois Administrative Code
Title 89 - SOCIAL SERVICES
Part 140 - MEDICAL PAYMENT
Subpart J - ALTERNATE PAYEE PARTICIPATION
Section 140.1005 - Revocation of an Alternate Payee
Universal Citation: 89 IL Admin Code ยง 140.1005
Current through Register Vol. 48, No. 38, September 20, 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certificate, or other authorization has not been renewed or has been revoked,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.
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