HB3547 Summary

• Requires the Department of Healthcare and Family Services to screen all healthcare service providers and suppliers before accepting them into Illinois's medical assistance program.

• Screening measures must include accreditation standards, proof of business integrity, full disclosure of ownership and business interests, an initial provisional period with enhanced oversight, onsite verification, and periodic recertification.

• Mandates regular audits and reviews of medical assistance payments to providers using coordinated databases and claims-processing mechanisms to detect improper claims before payment and prevent wasteful overspending.

• Requires each provider and supplier to file a written compliance plan as a condition of program participation, including policies to prevent fraud and abuse, and designate a compliance officer and committee with an anonymous hotline for reporting compliance issues.

• Obligates providers and state oversight agencies to respond swiftly to detected fraud, remedy program vulnerabilities, and impose sufficient penalties to deter fraudulent activities by medical assistance providers.