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Federal and State Program Integrity in Wisconsin

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        Wisconsin imposes both civil and criminal liability on persons that defraud or attempt to defraud the state or federal government by submitting false claims for medical

        Persons that defraud or attempt to defraud the Wisconsin or federal governments by submitting false claims for medical assistance may be subject to both civil and criminal liability.1 Additionally, persons may not solicit, accept, or offer payment in exchange for referrals for services or items covered by medical assistance funds.2 Finally, providers may not charge and additional fee while providing services covered by medical assistance.3

 

Footnotes

  • 1. W.S.A. § 20.931; W.S.A. § 49.49
  • 2. W.S.A. § 49.49
  • 3. W.S.A. § 49.49

 

Federal and State Program Integrity in Wisconsin

Subtopic Statute/Regulation Description
Penalties for false claims 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 offenses – Wis. Stat. Ann. § 49.49 Medical Assistance Offenses Wisconsin prohibits persons from "knowingly and willfully" making false statements while applying for medical assistance...
Fraud and abuse provisions about Medicaid or Medicare: Laws prohibiting self-referrals 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...
Fraud and abuse provisions about Medicaid or Medicare: False claims submitted to Medicaid or Medicare 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...
Fraud and abuse provisions about Medicaid or Medicare: Anti-kickback laws 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...
Use of false information for eligibility purposes Medical assistance offenses – Wis. Stat. Ann. § 49.49 Medical Assistance Offenses Wisconsin prohibits persons from "knowingly and willfully" making false statements while applying for medical assistance...
Click on the individual state law in the table above to see our summary of the individual law.


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