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Provider Sanctions

Summary

State law grants the Illinois Department of Healthcare and Family Services the authority to impose sanctions on entities and individuals, as set forth in 305 Ill. Comp. Stat. 5/12-4.25 and Title 89 of the Illinois Administrative Code. Services rendered or ordered by sanctioned providers are not eligible for Medicaid reimbursement. In addition, services provided by entities owned or managed by sanctioned providers are not eligible for Medicaid reimbursement. The Department may recoup treble damages and fines of up to $10,000 per claim for any services billed while a vendor is owned by, managed by, or employs sanctioned providers. 

Entities and individuals may also voluntarily withdraw from participation in the Medical Assistance Program, regardless of any imposition of sanctions. Upon withdrawal, such entities or individuals are no longer eligible to submit claims for Medicaid services, or to order services for Medicaid patients. 

Types of Sanctions

A sanction is the result of an administrative action taken against an entity or individual that is found to be in violation of an administrative rule, civil law, or criminal offense.  The administrative actions result in disenrollment from the Medical Assistance Program. 

  • Termination, Barment, and Exclusion: Termination, barment, and exclusion result in a vendor's disenrollment from the Medical Assistance Program. Such vendors are not eligible to submit claims for Medicaid services. In addition, these terminated, barred, and excluded vendors may not own, or be employed by, Medicaid vendors.  
  • Suspension: Suspension is a time-limited revocation of a vendor's eligibility to participate in the Program, during which time the vendor cannot receive payment for Medicaid services. Suspended vendors also may not own, or be employed by, vendors submitting claims to the Department. Suspended providers may be required to apply for readmission to the Program. A provider who has successfully petitioned for readmission will be removed from this data set so that it no longer appears.

 

For a full description of these sanctions, please see the Illinois Medicaid Act at 305 Ill. Comp. Stat. 5/12-4.25, and the Illinois Administrative Code at Tile 89, Chapter 1, Sections 140.13 through 140.18. 

This data set also includes providers that have voluntarily withdrawn from the Program.  

Provider Sanction Search

To Search the OIG Provider Sanction listing, please use Provider Sanctions Search webpage

Additional Sanction Lists and Disciplinary Reports

The U.S. Department of Health and Human Services and the Illinois Department of Financial and Professional Regulation maintain exclusion lists and disciplinary reports, respectively, that may supplement this data set. Those exclusion lists can be accessed via the following links:


 

Disclaimer 

The Office of Inspector General updates this data set regularly, and all attempts are made to ensure the accuracy of the data. Neither the Department, nor the Office of Inspector General, is liable for any errors or omissions. If you believe that the data displayed here is incorrect or incomplete, you may request a correction by contacting the Office of Inspector General at the following email address: 

hfs.oigwebmaster@illinois.gov 

Title 89, Section 140.16(a)(6) of the Illinois Administrative Code states that the Department may terminate or suspend a provider's eligibility to participate in the Program, may terminate or decline to renew a provider agreement, or may exclude a provider from participating in the Program if, at any time, the provider: 

[K]new or should have known that a person with management responsibility for a vendor; an officer or person owning (directly or indirectly) 5% or more of the shares of stock or other evidences of ownership in a corporate vendor; an investor in the vendor; a technical or other advisor of the vendor; an owner of a sole proprietorship which is a vendor; or a partner in a partnership which is a vendor was previously terminated or barred from participation in the Medical Assistance Program. 

If a provider reviews the data set in an effort to avoid such prohibited relationships with another entity or individual, and the entity or individual in question does not appear in the data set due to the Department's omission, the Department will consider such while enforcing the Administrative Code and Department policies.   

 
 

Office of Inspector General

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Illinois Department of Healthcare and Family Services

JB Pritzker, Governor • Theresa Eagleson, Director