The Mission of the Inspector General is to prevent, detect and eliminate fraud, waste, abuse, misconduct and mismanagement in programs administered by Healthcare and Family Services and the Department of Human Services. The programs include Medicaid, KidCare, Temporary Assistance for Needy Families, food stamps, child care and other social services. The OIG's duties fall into several broad categories:
Recognizing that prevention is the first line of defense against fraud, the OIG uses a variety of techniques to deter fraud. The OIG employs advanced computer technology to research and detect trends that may lead to abuse. Other examples include pre-enrollment verifications for non-emergency transportation and durable medical equipment providers. The OIG also closely monitors selected providers to ensure services actually have been provided. Error-prone public assistance applications in Cook County are targeted to prevent ineligible persons from receiving welfare benefits.
When a public aid client, employee or contractor is suspected of fraud or other misconduct the OIG investigates the matter. The OIG also works closely with local, state or federal authorities to develop cases for possible prosecution against medical providers.
Audits and Reviews
The OIG conducts several types of audits and reviews to ensure the integrity of Illinois' Medicaid Program. Post-payment compliance audits are performed to identify any improper payments which may have been made to Medicaid providers. Quality of care reviews are conducted to ensure proper care is being given to our clients by health care providers. Eligibility reviews are performed to ensure that only those clients eligible for Medicaid services receive them.
Sanctions and Restrictions
The OIG acts against medical providers who violate Medicaid regulations or jeopardize the health and well-being of Medicaid patients. The OIG can sanction, suspend or terminate Medicaid providers and order repayment of state funds. The Recipient Restriction Program identifies Medicaid clients who excessively use health care services. For coordination of care, a client can be restricted to a single primary care physician and/or a single pharmacy for up to 24 months.
Safety and Security
The OIG is responsible for protecting the well being of employees, clients and visitors at all Healthcare and Family Services facilities in Illinois. It oversees security at all facilities occupied exclusively by Healthcare and Family Services staff.