Wis. ForwardHealth Online Handbook, Hospice, Topic #13277

The Wisconsin DHS (Department of Health Services) OIG (Office of Inspector General) investigates fraud and abuses including

the following:

• Billing Medicaid for services or equipment that were not provided

• Submitting false applications for a DHS-funded assistance program such as Medicaid, BadgerCare Plus, WIC (Special

Supplemental Nutrition Program for Women, Infants, and Children), or FoodShare

• Trafficking FoodShare benefits

• Crime, misconduct, and/or mismanagement by a DHS employee, official, or contractor

Those who suspect fraudulent activity in Medicaid programs are required to notify the OIG if they have reason to believe that a

person is misusing or abusing any DHS health care program or the ForwardHealth identification card.

Wisconsin Stat. § 49.49 defines actions that represent member misuse or abuse of benefits and the resulting sanctions that may be

imposed. Providers are under no obligation to inform the member that they are misusing or abusing their benefits. A provider may

not confiscate a ForwardHealth card from a member in question.

Reporting Suspected Fraud and Abuse

Those who suspect any form of fraud, waste, or abuse of a program by providers, trading partners, billing services, agencies, or

recipients of any government assistance program are required to report it. Those reporting allegations of fraud and abuse may

remain anonymous. However, not providing contact information may prevent OIG from fully investigating the complaint if

questions arise during the review process.

If a provider suspects that someone is committing fraudulent activities or is misusing their ForwardHealth card, the provider is

required to notify ForwardHealth by one of the following methods:

• Going to the OIG fraud and abuse reporting website

• Calling the DHS fraud and abuse hotline at 877-865-3432

The following information is helpful when reporting fraud and abuse:

• A description of the fraud, waste, and/or abuse, including the nature, scope, and timeframe of the activity in question (The

description should include sufficient detail for the complaint to be evaluated.)

• The names and dates of birth (or approximate ages) of the people involved, as well as the number of occurrences and

length of the suspected activity

• The names and date(s) of other people or agencies to which the activity may have been reported

After the allegation is received, DHS OIG will evaluate it and take appropriate action. If the name and contact information of the

person reporting the allegation was provided, the OIG may be in contact to verify details or ask for additional information.