2013 - 2014 LEGISLATURE
August 7, 2013 - Introduced by Senators Darling, Gudex, Grothman, Kedzie,
Lazich, Leibham and Olsen, cosponsored by Representatives Nygren, Krug,
Knodl, Endsley, Jacque, Kaufert, Kerkman, Kestell, Kleefisch, Nass, J.
Ott
, Pridemore, Sanfelippo, Schraa and Strachota. Referred to Committee
on Health and Human Services.
SB245,2,3 1An Act to repeal 49.141 (7) (b), 49.141 (9) (title), 49.141 (10) (title) and (b), 49.49
2(1) (title) and (a) (intro.), 49.49 (1) (b), 49.49 (2) (title) and (2) (a) (title), 49.49
3(2) (b) (title), 49.49 (2) (c) (title), 49.49 (3) (title), 49.49 (3m) (title), 49.49 (3m)
4(b), 49.49 (4) (title), 49.795 (1) (cm), 49.795 (7), 49.795 (8) (a), (b) and (c) and
549.95; to renumber 49.495 (title) and 49.795 (title) and (1) (intro.); to
6renumber and amend
49.141 (7) (a), 49.141 (9) (a) to (c), 49.141 (10) (a), 49.49
7(1) (a) 1. to 4., 49.49 (1) (c), 49.49 (2) (a), 49.49 (2) (b), 49.49 (2) (c), 49.49 (3), 49.49
8(3m) (a), 49.495, 49.795 (1) (a), (b), (c), (d) and (e), 49.795 (2) to (6), 49.795 (8)
9(d) 1., 49.795 (8) (d) 1m., 49.795 (8) (d) 2. and 49.795 (8) (e) and (f); to
10consolidate, renumber and amend
49.49 (4) (a) and (b); to amend 49.141
11(7) (c) (intro.) and 1., 49.141 (8), 49.32 (8), 49.45 (2) (b) 7. (intro.) and a., and (11),
1249.49 (3p) (title), 49.49 (5), 49.49 (7) (d), 49.688 (9) (a), 49.797 (2) (a), 59.54 (23)
13and 940.11 (2); to repeal and recreate 49.141 (7) (title); and to create 49.835,
1449.846 (1), 946.90 (title), 946.90 (1), 946.90 (2), 946.91 (title), (1) and (2) (intro.),

1946.92 (3) (a) and 946.93 of the statutes; relating to: applications for public
2assistance programs, offenses in public assistance programs, granting
3rule-making authority, and providing a penalty.
Analysis by the Legislative Reference Bureau
Under current law, various offenses related to the Medical Assistance program
(MA), Wisconsin Works (W-2), the federal Supplemental Nutrition Assistance
Program, formerly known as the food stamp program and currently known in
Wisconsin as FoodShare, and other public assistance programs administered by the
Department of Children and Families (DCF) and the Department of Health Services
(DHS) (public assistance programs) are subject to criminal penalties. For example,
a person who makes or causes to be made any false statement or representation of
a material fact in an application for a benefit or payment, or for use in determining
rights to any benefit or payment, under MA is subject to a Class H felony. Similarly,
a person who knowingly and willfully makes or causes to be made any false
statement or representation of a material fact in an application for W-2 benefits or
payments may be fined not more than $10,000, imprisoned for not more than nine
months, or both. This bill moves offenses related to public assistance programs to
the chapter of the Wisconsin Statutes that relates to crimes against government and
its administration. Specifically, under the bill, that chapter of the Wisconsin
Statutes contains provisions related to W-2 fraud, MA fraud, FoodShare fraud, and
general public assistance fraud.
Under current law, the Department of Justice (DOJ) or a district attorney is
authorized to prosecute violations of criminal laws affecting MA. Under the bill, DOJ
or a district attorney is authorized to prosecute violations of criminal laws affecting
any public assistance program, including W-2, FoodShare, and MA.
Under current law, any person who makes any statement in a written
application for public assistance is considered to have made an admission as to the
existence, correctness, or validity of any fact stated, which may be used in an
enforcement action. Under the bill, an employee who accepts an application for
public assistance is authorized to administer an oath to the applicant that the
information given is true and correct to the best of the applicant's knowledge. The
bill also requires DCF and DHS to promulgate rules providing standards and
procedures for the administration of such an oath.
For further information see the state fiscal estimate, which will be printed as
an appendix to this bill.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
SB245,1 4Section 1. 49.141 (7) (title) of the statutes is repealed and recreated to read:
SB245,3,1
149.141 (7) (title) Suspensions.
SB245,2 2Section 2 . 49.141 (7) (a) of the statutes is renumbered 946.90 (3) and amended
3to read:
SB245,3,74 946.90 (3) A person who is convicted of violating sub. (6) in connection with the
5Whoever violates sub. (2) by furnishing by that person of items or services for which
6payment is or may be made under Wisconsin works Works is guilty of a Class H
7felony.
SB245,3 8Section 3. 49.141 (7) (b) of the statutes is repealed.
SB245,4 9Section 4. 49.141 (7) (c) (intro.) and 1. of the statutes are amended to read:
SB245,3,1410 49.141 (7) (c) (intro.) Except as provided in par. (d), in addition to the penalties
11applicable under par. (a) or (b) s. 946.90 (2) or (3), a person shall be suspended from
12participating in Wisconsin works Works for a period of 10 years, beginning on the
13date of conviction, if the person is convicted in a federal or state court for any of the
14following:
SB245,3,1815 1. Violating sub. (6) (a) or s. 946.90 (2) (a) with respect to his or her identity or
16place of residence for the purpose of receiving simultaneously from this state and at
17least one other state assistance funded by a block grant under Title I of the Federal
18Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
SB245,5 19Section 5. 49.141 (8) of the statutes is amended to read:
SB245,4,420 49.141 (8) Damages. If a person is convicted under sub. (6) s. 946.90 (2) or (3),
21the state has a cause of action for relief against the person in an amount equal to 3
22times the amount of actual damages sustained as a result of any excess payments
23made in connection with the offense for which the conviction was obtained. Proof by
24the state of a conviction under sub. (6) s. 946.90 (2) or (3) is conclusive proof in a civil
25action of the state's right to damages and the only issue in controversy shall be the

1amount, if any, of the actual damages sustained. Actual damages consist of the total
2amount of excess payments, any part of which is paid with state funds. In a civil
3action under this subsection, the state may elect to file a motion in expedition of the
4action. Upon receipt of the motion, the presiding judge shall expedite the action.
SB245,6 5Section 6. 49.141 (9) (title) of the statutes is repealed.
SB245,7 6Section 7. 49.141 (9) (a) to (c) of the statutes are renumbered 946.90 (4) (a) to
7(c), and 946.90 (4) (a), (b) and (c) 1., as renumbered, are amended to read:
SB245,4,168 946.90 (4) (a) Whoever solicits or receives any remuneration in cash or in-kind
9money, goods, services, or any other thing of value, in return for referring an
10individual to a person for the furnishing or arranging for the furnishing of any item
11or service for which payment may be made in whole or in part under Wisconsin works
12Works, or in return for purchasing, leasing, ordering, or arranging for or
13recommending purchasing, leasing, or ordering any good, facility, service, or item for
14which payment may be made in whole or in part under Wisconsin works Works, is
15guilty of a Class H felony, except that, notwithstanding the maximum fine specified
16in s. 939.50 (3) (h), the person may be fined not more than $25,000.
SB245,4,2517 (b) Whoever offers or pays any remuneration in cash or in-kind provides
18money, goods, services, or any other thing of value
to any person to induce the person
19to refer an individual to a person for the furnishing or arranging for the furnishing
20of any item or service for which payment may be made in whole or in part under
21Wisconsin works Works, or to purchase, lease, order, or arrange for or recommend
22purchasing, leasing, or ordering any good, facility, service or item for which payment
23may be made in whole or in part under any provision of Wisconsin works Works, is
24guilty of a Class H felony, except that, notwithstanding the maximum fine specified
25in s. 939.50 (3) (h), the person may be fined not more than $25,000.
SB245,5,4
1(c) 1. A discount or other reduction in price obtained by a provider of services
2or other entity under chs. 46 to 51 and 58 if the reduction in price is properly disclosed
3and appropriately reflected in the costs claimed or charges made by the provider or
4entity under Wisconsin works Works.
SB245,8 5Section 8. 49.141 (10) (title) and (b) of the statutes are repealed.
SB245,9 6Section 9 . 49.141 (10) (a) of the statutes is renumbered 946.90 (5) and
7amended to read:
SB245,5,168 946.90 (5) A provider may not who knowingly impose imposes upon a recipient
9participant in Wisconsin Works charges in addition to payments received by the
10provider
for services under Wisconsin works Works or knowingly impose imposes
11direct charges upon a recipient participant in Wisconsin Works in lieu of obtaining
12payment under Wisconsin works unless Works is guilty of a Class H felony, except
13that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may
14be fined not more than $25,000. This subsection does not apply if
benefits or services
15are not provided under Wisconsin works Works and the recipient Wisconsin Works
16participant
is advised of this fact prior to receiving the service.
SB245,10 17Section 10. 49.32 (8) of the statutes is amended to read:
SB245,6,218 49.32 (8) Periodic earnings check by department. The department shall make
19a periodic check of the amounts earned by recipients of aid to families with dependent
20children under s. 49.19 and by participants under Wisconsin works under ss. 49.141
21to 49.161 through a check of the amounts credited to the recipient's social security
22number. The department shall make an investigation into any discrepancy between
23the amounts credited to a social security number and amounts reported as income
24on the declaration application and take appropriate action under s. 49.95 946.93
25when warranted. The department shall use the state wage reporting system under

11985 Wisconsin Act 17, section 65 (1), when the system is implemented, to make
2periodic earnings checks.
SB245,11 3Section 11. 49.45 (2) (b) 7. (intro.) and a., and (11) of the statutes are amended
4to read:
SB245,6,175 49.45 (2) (b) 7. (intro.) Require, as a condition of certification under par. (a) 11.,
6all providers of a specific service that is among those enumerated under s. 49.46 (2),
749.47 (6) (a), or 49.471 (11), as specified in this subdivision, to file with the
8department a surety bond issued by a surety company licensed to do business in this
9state. Providers subject to this subdivision provide those services specified under s.
1049.46 (2), 49.47 (6) (a), or 49.471 (11) for which providers have demonstrated
11significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a),
12or (4m) (a) or 946.91 (2), (3) (a) or (b), (4), (5), or (6), to require recovery under par.
13(a) 10., or to need additional sanctions under par. (a) 13. The surety bond shall be
14payable to the department in an amount that the department determines is
15reasonable in view of amounts of former recoveries against providers of the specific
16service and the department's costs to pursue those recoveries. The department shall
17promulgate rules to implement this subdivision that specify all of the following:
SB245,6,2118 a. Services under medical assistance Medical Assistance for which providers
19have demonstrated significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3),
20(3m) (a),
(3p), (4) (a), or (4m) (a) or 946.91 (2), (3) (a) or (b), (4), (5), or (6), to require
21recovery under par. (a) 10., or to need additional sanctions under par. (a) 13.
SB245,6,24 22(11) Penalty. Any person who receives or assists another in receiving
23assistance under this section, to which the recipient is not entitled, shall be subject
24to the penalties under s. 49.95 ss. 946.91 and 946.93.
SB245,12 25Section 12. 49.49 (1) (title) and (a) (intro.) of the statutes are repealed.
SB245,13
1Section 13. 49.49 (1) (a) 1. to 4. of the statutes are renumbered 946.91 (2) (a)
2to (d) and amended to read:
SB245,7,53 946.91 (2) (a) Knowingly and willfully make Intentionally makes or cause
4causes to be made any false statement or representation of a material fact in any
5application for any Medical Assistance benefit or payment.
SB245,7,86 (b) Knowingly and willfully make Intentionally makes or cause causes to be
7made any false statement or representation of a material fact for use in determining
8rights to such eligibility for any Medical Assistance benefit or payment.
SB245,7,159 (c) Having knowledge of the occurrence of any event affecting the initial or
10continued right to eligibility for any such Medical Assistance benefit or payment or
11the initial or continued right to eligibility for any such benefit or payment of any
12other individual in whose behalf he or she has applied for or is receiving such benefit
13or payment, conceal conceals or fail fails to disclose such event with an intent to
14fraudulently to secure such benefit or payment either in a greater amount or
15quantity than is due or when no such benefit or payment is authorized.
SB245,7,2016 (d) Having made application applied to receive any such Medical Assistance
17benefit or payment for the use and benefit of another and having received it,
18knowingly and willfully convert such converts the benefit or payment or any part
19thereof to a use other than for the use and that is not for the benefit of such other
20person.
SB245,14 21Section 14. 49.49 (1) (b) of the statutes is repealed.
SB245,15 22Section 15. 49.49 (1) (c) of the statutes is renumbered 49.49 (1d) and amended
23to read:
SB245,8,824 49.49 (1d) Damages. If any person is convicted under this subsection s. 946.91
25(2)
, the state shall have a cause of action for relief against such person in an amount

13 times the amount of actual damages sustained as a result of any excess payments
2made in connection with the offense for which the conviction was obtained. Proof by
3the state of a conviction under this section s. 946.91 (2) in a civil action shall be
4conclusive regarding the state's right to damages and the only issue in controversy
5shall be the amount, if any, of the actual damages sustained. Actual damages shall
6consist of the total amount of excess payments, any part of which is paid by state
7funds. In any such civil action the state may elect to file a motion in expedition of
8the action. Upon receipt of the motion, the presiding judge shall expedite the action.
SB245,16 9Section 16. 49.49 (2) (title) and (2) (a) (title) of the statutes are repealed.
SB245,17 10Section 17 . 49.49 (2) (a) of the statutes is renumbered 946.91 (3) (a) and
11amended to read:
SB245,8,2212 946.91 (3) (a) Any person who Whoever solicits or receives any remuneration,
13including any kickback, bribe, or rebate
, directly or , indirectly, overtly, or covertly, in
14cash or in kind,
money, goods, services, or any other thing of value in return for
15referring an individual to a person for the furnishing or arranging for the furnishing
16of any item or service for which payment may be made in whole or in part under a
17medical assistance program
Medical Assistance, or in return for purchasing, leasing,
18ordering, or arranging for or recommending purchasing, leasing, or ordering any
19good, facility, service, or item for which payment may be made in whole or in part
20under a medical assistance program Medical Assistance, is guilty of a Class H felony,
21except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the
22person may be fined not more than $25,000.
SB245,18 23Section 18. 49.49 (2) (b) (title) of the statutes is repealed.
SB245,19 24Section 19 . 49.49 (2) (b) of the statutes is renumbered 946.91 (3) (b) and
25amended to read:
SB245,9,11
1946.91 (3) (b) Whoever offers or pays any remuneration including any
2kickback, bribe, or rebate
provides, directly or, indirectly, overtly, or covertly, in cash
3or in kind
money, goods, services, or any other thing of value to any person to induce
4such person to refer an individual to a person for the furnishing or arranging for the
5furnishing of any item or service for which payment may be made in whole or in part
6under a medical assistance program Medical Assistance, or to purchase, lease, order,
7or arrange for or recommend purchasing, leasing, or ordering any good, facility,
8service or item for which payment may be made in whole or in part under a medical
9assistance program
Medical Assistance, is guilty of a Class H felony, except that,
10notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be
11fined not more than $25,000.
SB245,20 12Section 20. 49.49 (2) (c) (title) of the statutes is repealed.
SB245,21 13Section 21. 49.49 (2) (c) of the statutes is renumbered 946.91 (3) (c) and
14amended to read:
SB245,9,1515 946.91 (3) (c) This subsection shall does not apply to any of the following:
SB245,9,1916 1. A discount or other reduction in price obtained by a provider of services or
17other entity under chs. 46 to 51 and 58 if the reduction in price is properly disclosed
18and appropriately reflected in the costs claimed or charges made by the provider or
19entity under a medical assistance program Medical Assistance.
SB245,9,2220 2. Any An amount paid by an employer to an employee who has a bona fide
21employment relationship with such employer for employment in the provision of
22covered items or services.
SB245,22 23Section 22. 49.49 (3) (title) of the statutes is repealed.
SB245,23 24Section 23 . 49.49 (3) of the statutes is renumbered 946.91 (4) and amended
25to read:
SB245,10,9
1946.91 (4) No person may Whoever knowingly and willfully make makes or
2cause causes to be made, or induce induces or seek seeks to induce the making of, any
3false statement or representation of a material fact with respect to the conditions or
4operation of any institution or facility in order that such institution or facility may
5qualify either upon initial certification or upon recertification as a hospital, skilled
6nursing facility, intermediate care facility, or home health agency . A person who
7violates this subsection
is guilty of a Class H felony, except that, notwithstanding the
8maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than
9$25,000.
SB245,24 10Section 24. 49.49 (3m) (title) of the statutes is repealed.
SB245,25 11Section 25 . 49.49 (3m) (a) of the statutes is renumbered 946.91 (5), and 946.91
12(5) (intro.), (a), (b) and (c), as renumbered, are amended to read:
SB245,10,1913 946.91 (5) (intro.) No provider may Whoever knowingly impose imposes upon
14a Medical Assistance recipient charges in addition to payments received for services
15under ss. 49.45 to 49.471 or knowingly impose imposes direct charges upon a
16recipient in lieu of obtaining payment under ss. 49.45 to 49.471 except under the
17following conditions
is guilty of a Class H felony, except that, notwithstanding the
18maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than
19$25,000. This subsection does not apply under any of the following circumstances
:
SB245,10,2120 (a) Benefits or services are not provided under s. 49.46 (2) or 49.471 (11) and
21the Medical Assistance recipient is advised of this fact prior to receiving the service.
SB245,11,622 (b) If an An applicant is determined to be eligible retroactively under s. 49.46
23(1) (b), 49.47 (4) (d), or 49.471 and, a provider bills the applicant directly for services
24and benefits rendered during the retroactive period, the provider shall, upon
25notification of the applicant's retroactive eligibility, submit claims submits a claim

1for payment under s. 49.45 for covered services or benefits rendered to the recipient
2during the retroactive period. Upon receipt of payment under s. 49.45, the provider
3shall reimburse
, and the provider reimburses the recipient or other person who has
4made prior payment to the provider for services provided to the recipient during the
5retroactive eligibility period, by the amount of the prior payment made upon receipt
6of payment under s. 49.45
.
SB245,11,107 (c) Benefits or services are provided for which recipient copayment,
8coinsurance, or deductible is required under s. 49.45 (18), not to exceed maximum
9amounts allowable under 42 CFR 447.53 to 447.58, or for which recipient copayment
10or coinsurance is required under s. 49.471 (11).
SB245,26 11Section 26. 49.49 (3m) (b) of the statutes is repealed.
SB245,27 12Section 27. 49.49 (3p) (title) of the statutes is amended to read:
SB245,11,1313 49.49 (3p) (title) Other prohibited provider charges.
SB245,28 14Section 28. 49.49 (4) (title) of the statutes is repealed.
SB245,29 15Section 29 . 49.49 (4) (a) and (b) of the statutes are consolidated, renumbered
16946.91 (6) and amended to read:
SB245,12,317 946.91 (6) No person Whoever, in connection with the medical assistance
18program Medical Assistance when the cost of the services provided to the patient is
19paid for in whole or in part by the state, may knowingly and willfully charge, solicit,
20accept or receive
intentionally charges, solicits, accepts, or receives, in addition to
21any amount otherwise required to be paid under a medical assistance program
22Medical Assistance, any gift, money, donation, or other consideration, other than a
23charitable, religious, or philanthropic contribution from an organization or from a
24person unrelated to the patient, as a precondition of admitting a patient to a hospital,
25skilled nursing facility, or intermediate care facility, or as a requirement for the

1patient's continued stay in such a facility. (b) A person who violates this subsection
2is guilty of a Class H felony, except that, notwithstanding the maximum fine specified
3in s. 939.50 (3) (h), the person may be fined not more than $25,000.
SB245,30 4Section 30. 49.49 (5) of the statutes is amended to read:
SB245,12,105 49.49 (5) County collection. Any county may retain 15% 15 percent of state
6medical assistance Medical Assistance funds that are recovered due to the efforts of
7a county employee or officer or, if the county initiates action by the department of
8justice, due to the efforts of the department of justice under s. 49.495 49.846. This
9subsection applies only to recovery of medical assistance that was provided as a
10result of fraudulent activity by a recipient or by a provider.
SB245,31 11Section 31. 49.49 (7) (d) of the statutes is amended to read:
SB245,12,1912 49.49 (7) (d) A commission's imposition of an assessment described under par.
13(b), a member's payment of the assessment as described under par. (c), and
14acceptance of the payment by the commission do not constitute conduct prohibited
15under sub. (4) s. 946.91 (6) or prohibited under s. DHS 106.04 (3), Wis. Adm. Code,
16in effect on May 26, 2010. It is the intent of the legislature to create a mechanism
17whereby 2 or more political subdivisions may share in the operation, use, and
18funding of a nursing home or intermediate care facility without violating 42 USC
191320a-7b
(d) or 42 USC 1396a (a) (25) (C).
SB245,32 20Section 32. 49.495 (title) of the statutes is renumbered 49.846 (title).
SB245,33 21Section 33. 49.495 of the statutes is renumbered 49.846 (2) and amended to
22read:
SB245,13,1123 49.846 (2) The department of justice or the district attorney may institute,
24manage, control, and direct, in the proper county, any prosecution for violation of
25criminal laws affecting the medical a public assistance program, including but not

1limited to
laws in this chapter, chs. 939 to 951 relating to medical assistance
2contained in this subchapter
Medical Assistance, Wisconsin Works, the food stamp
3program, or any other public assistance program,
and laws affecting the health,
4safety, and welfare of public assistance program recipients of medical assistance. For
5this purpose the department of justice shall have and exercise all powers conferred
6upon district attorneys in such cases. The If a prosecution under this section involves
7a person holding a license granted by the medical examining board or an interested
8affiliated credentialing board, the
department of justice or district attorney shall
9notify the medical examining board or the interested affiliated credentialing board
10of any such the prosecution of a person holding a license granted by the board or
11affiliated credentialing board
.
SB245,34 12Section 34. 49.688 (9) (a) of the statutes is amended to read:
SB245,13,1513 49.688 (9) (a) The department shall promulgate rules relating to prohibitions
14on fraud that are substantially similar to applicable provisions under s. 49.49 (1) (a)
15946.91 (2).
SB245,35 16Section 35. 49.795 (title) and (1) (intro.) of the statutes are renumbered 946.92
17(title) and (1) (intro.).
SB245,36 18Section 36 . 49.795 (1) (a), (b), (c), (d) and (e) of the statutes are renumbered
19946.92 (1) (a), (b), (c), (d) and (e), and 946.92 (1) (b), (c) and (d), as renumbered, are
20amended to read:
SB245,13,2221 946.92 (1) (b) "Food" means items which that may be purchased using food
22coupons
stamp program benefits under 7 USC 2012 (g) and 2016 (b).
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