Data-driven, cross-agency approach yields win-win for patients, taxpayers

CHICAGO — Gov. Bruce Rauner’s Health Care Fraud Elimination Task Force reported that the State has saved, prevented or recovered approximately $450 million in fraudulent or wasteful Medicaid spending in fiscal years 2016 and 2017.

In the Department of Healthcare and Family Services (DHFS), which manages the State’s $20 billion Medicaid program, the Office of Inspector General (OIG) saved or recouped an estimated $195 million in FY17. Last fiscal year, FY16, HFS-OIG reported $220.2 million in similar savings.

In addition, in FY16 the Illinois State Police Medicaid Fraud Control Unit reported 46 fraud convictions and $35.4 million in recoveries through criminal prosecutions, civil actions and administrative referrals.

“Medicaid fraud is a multibillion-dollar industry in the U.S.,” Rauner said. “Cheating through overpayments or improper billing may seem like a victimless crime to some, but every dollar that is diverted from our health programs is one that could have been spent on a needy beneficiary. That’s a crime our administration won’t tolerate.”

The governor’s Health Care Fraud Elimination Task Force was created in April of 2016. Under the leadership of Executive Inspector General Maggie Hickey, its purpose is to develop and coordinate a comprehensive plan to prevent and eliminate health care fraud, waste and abuse by deploying a cross-agency, data-driven approach.

“The collaboration among agencies for this effort has been outstanding,” Hickey said. “When agencies of the government come together to share resources and expertise, the outcomes can be extraordinary. We have more work to do, of course, but we have now set a standard for intergovernmental cooperation on fraud prevention in our health systems that will continue to produce results.”

The Illinois Department of Innovation and Technology (DoIT) now has agreements with 21 state agencies to use its system to review and analyze data across the board rather than viewing silos of information for individual programs or agencies.

The data sharing and resulting collaborations have led to outcomes like those released today by the Task Force in its October 2017 Interim Report.

“Identifying and eliminating fraud and abuse in the health care system is not just a matter of fiscal integrity and spending efficiency,” the governor said. “This is a matter of fairness and social justice for all Illinoisans.”

Rauner added that much remains to be done; the work of the task force is continuing.

“By using modern technology to collect data and improve operations, we can deliver better health care and help keep a lid on advancing costs,” he said. “It is a win-win for patients and taxpayers.”

Other members of the task force include:

From the Governor’s Office, Deputy Gov. Trey Childress; Deputy General Counsel and Chief Compliance Officer Jill Hutchison; Special Counsel and Health Care Policy Advisor Christopher Kantas.

Acting Directors Jean Bohnhoff at the Department on Aging, Michael Hoffman at CMS, Felicia Norwood at DHFS, James Dimas at DHS and Kirk Lonbom at the Department of Innovation Technology.

Directors Jennifer Hammer at the Illinois Department of Insurance and Capt. Brian Ley at the Illinois State Police Medicaid Fraud Control Unit. Chairman Joann Fratianni at the Workers’ Compensation Commission and Inspector General Bradley Hart at DHFS.

ELIZABETHTOWN – The Hardin County Sheriff’s office have released the names of the suspects from Tuesday’s robbery of Banterra Bank Cave In Rock branch.

Morris D. Thompson,33  of Davenport IA is being held in Williamson County Detention Center on a US Marshal Warrant with charges pending.

Angela J. Williams-Francis,39 of Eldorado,IL has been released pending investigation.

 

The alleged are presumed innocent until proven guilty in a court of law.

SB 772 will decrease prevalence of “doctor-shopping”

EAST ST. LOUIS — Gov. Bruce Rauner today signed into law SB 772, legislation that will require prescribers with an Illinois Controlled Substance License to register with and use the Illinois Prescription Monitoring Program (PMP), a database that records patient prescription history.

The PMP allows physicians to check previous patient prescriptions and requests for controlled substances. Increasing the required checkpoints in advance of prescribing controlled substances will cut down on “doctor-shopping,” the practice of patients obtaining opioid prescriptions from multiple physicians.

“This legislation helps us combat opioid abuse by addressing fraud at a critical point of access,” Rauner said. “Too often, users obtain dangerous amounts of opioids by ‘doctor-shopping’ prescriptions for their drugs of choice from prescribers in our health care system. The new PMP registration requirements will help deter this practice by tracking prescriptions and making information available to physicians before they write them.”

“I have had countless conversations with Illinoisans battling opioid use disorder who told me they would fuel their addiction with prescriptions from multiple doctors,” said Lt. Gov. Evelyn Sanguinetti, who chairs the Governor’s Opioid Overdose Prevention Task Force. “This law is an important new layer of protection against opioid abuse in Illinois because it gives prescribers the tools they need to ensure patients aren’t manipulating the system to support their addiction.”

Sarah Pointer, clinical director of the PMP, said the new monitoring program requirements will be integral to combatting the crisis within Illinois.

“SB772 is another huge step forward to increasing prescriber awareness and building a more complete prescription history of their patients,” she said. “Prescribers will be able to make more informed decisions about care for high-risk patients who may benefit from early interventions, and ultimately help to save their lives.”

The Illinois Department of Human Services (DHS) maintains the PMP database. Physicians not in compliance may be subject to disciplinary action by the Illinois Department of Financial and Professional Regulation (IDFPR).

“As elected officials, we should be doing everything we can to prevent addiction and reduce opioid abuse,” said state Sen. Melinda Bush, D-Grayslake, the primary sponsor of SB 772. “Requiring doctors to check a patient’s prescription history before prescribing opioids is a simple way to ensure doctors aren’t overprescribing and patients aren’t doctor-shopping. This common-sense change has the potential to prevent overdoses, save thousands of lives and advance the shared goal of ending the opioid epidemic.”

“The scourge of opioid addiction has touched too many families in Illinois for far too long,” said chief House sponsor Rep. Mike Zalewski, D-Riverside. “Senate Bill 772 is a meaningful step toward ensuring that the medical community and pharmacies work collaboratively toward protecting patient safety through use of the of the prescription monitoring program. I thank Senator Melinda Bush for bringing the legislation forward and Governor Rauner for enacting it into law.”

“This Prescription Monitoring Program is extremely important because it will help fight the rapidly growing opioid epidemic in Illinois,” said Rep. Patti Bellock, R-Hinsdale, who is the Republican spokeswoman for the House Human Services Committee. “The support of the medical community and pharmaceutical industry stakeholders was crucial in passing this bill, which will equip prescribers with more information and increase patient safety by reducing opioid prescription fraud.”
SB 772 takes effect on Jan. 1, 2018.

Gov. Rauner signed landmark legislation in December 2016

CORDOVA— Addressing gatherings at nuclear power plants in Cordova and Clinton, Gov. Bruce Rauner today celebrated the jobs saved and gains made one year in to the state’s tenure with the Future Energy Jobs Act.

“Today we are here to celebrate the bright future of energy jobs in Illinois,” Rauner said. “Thanks to the Future Energy Jobs Act, Illinois is poised to compete head-to-head with any state in the nation to attract energy investment and jobs, while still protecting ratepayers and taxpayers.”

On Dec. 7, 2016, legislators, industry stakeholders and members of the Rauner Administration came together for the signing of FEJA. The landmark piece of legislation prevented the Quad Cities and Clinton power plants from closing, saving 800 jobs in the Quad Cities and 700 in Clinton while ushering in the addition of 100 more permanent Exelon jobs plus 400 construction jobs while capital improvements are under way.

“The passage of the Future Energy Jobs Act reaffirmed Illinois as an environmental leader and, when fully implemented, should preserve thousands of good-paying jobs for Illinois families,” said Dave Rhoades, Exelon Nuclear chief operating officer. “As a result of this landmark legislation that values nuclear’s environmental benefits, Clinton and Quad Cities stations are prepared for long-term operations.”

Through careful negotiations, not only were thousands of direct and indirect jobs saved at the Quad Cities and Clinton facilities, but a big win also was ensured for consumers who are set to enjoy $4 billion or more in lower energy bills over the 10-year lifetime of the act.

“This groundbreaking legislation kept more than 800 people in the Quad Cities area working,” said state Sen. Neil Anderson, R-Andalusia, chief co-sponsor of the legislation. “Equally important, this shows that positive things can happen when local communities come together and leaders listen and follow through.”

State Sen. Chapin Rose, another of the legislation’s key proponents, thanked the governor for signing the bill. “This is a huge deal for our area,” the Mahomet Republican said. “Keeping these jobs while also keeping the price of power low is of major importance to downstate Illinois.”

The provisions of FEJA place Illinois in the running for billions of dollars in private investment to grow tens of thousands of jobs. Overall, FEJA is expected to lead to $12 to $15 billion in additional energy investment, according to an Environmental Defense Fund analysis.

Also weighing in were state Rep. Tony McCombie, R-Savanna, and state Rep. Bill Mitchell, R-Decatur.

“The Quad Cities Nuclear Generating Station provides power to over a million people in the region,” McCombie said. “The Future Energy Jobs Act has spurred new local investment that solidifies Exelon’s commitment to our communities and directly employ hundreds of people from the Quad Cities area.”

“The Future Energy Jobs Act preserved our nuclear plants and protected thousands of jobs for Illinois working families,” said Mitchell, noting that Rauner and House Republican Leader Jim Durkin worked tirelessly on its passage. “This was not an easy bill to pass and they moved mountains to help get it done.”