False claims for medical assistance; actions by or on behalf of state – Wis. Stat. Ann. § 20.931

False claims for medical assistance; actions by or on behalf of state

Wisconsin prohibits the following actions:

• "Knowingly" submits a claim for medical assistance to an employee or agent of the State.
• "Knowingly" uses a false statement to obtain a medical assistance payment.
•  Engaging in a conspiracy to defraud the state by obtaining a medical assistance payment based on a false claim or using a false statement to avoid an obligation to pay the medical assistance program.]
• "Knowingly" making a false statement to avoid an obligation to pay the medical assistance program.
• Knows, as a beneficiary, that a claim for medical assistance on their behalf is false, and fails to alert the state "within a reasonable time."

Persons that engage in the above behaviors may be liable to the state for three times the state's damages and a penalty between $5,000 and $10,000.  A court may reduce these damages if a person who engaged in such behavior provides the attorney general with information regarding their violation, and cooperates with the investigation before any prosecution or enforcement action commences.

The law also allows any person to bring a civil action on behalf of the government against a person who commits such an act, and provides some detailed procedural information with respect to such suits.  Once such action is brought, the state has primary responsibility for prosecuting the action, while the person who brought the suit can continue as a party to the action.  The law allows the state to ask for dismissal of the action or proceeding for good cause.  The attorney general is allowed to settle such an action with the approval of the governor as long as the person bringing the action is given the right to a hearing to present evidence in opposition to the proposed settlement.  The law further allows the court to limit the participation of the person who brought the suit in certain ways as long as good cause is shown for it.  The law further sets forth rules related to evidence, remedies, settlement amounts, jurisdiction, and statute of limitations with respect to these suits.