2013 WISCONSIN ACT 226
An Act to repeal 49.141 (7) (b), 49.141 (9) (title), 49.141 (10) (title) and (b), 49.49 (1) (title) and (a) (intro.), 49.49 (1) (b), 49.49 (2) (title) and (2) (a) (title), 49.49 (2) (b) (title), 49.49 (2) (c) (title), 49.49 (3) (title), 49.49 (3m) (title), 49.49 (3m) (b), 49.49 (4) (title), 49.795 (1) (cm), 49.795 (7), 49.795 (8) (a), (b) and (c) and 49.95; to renumber 49.495 (title) and 49.795 (title) and (1) (intro.); to renumber and amend 49.141 (7) (a), 49.141 (9) (a) to (c), 49.141 (10) (a), 49.49 (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 (3m) (a), 49.495, 49.795 (1) (a), (b), (c), (d) and (e), 49.795 (2) to (6), 49.795 (8) (d) 1., 49.795 (8) (d) 1m., 49.795 (8) (d) 2. and 49.795 (8) (e) and (f); to consolidate, renumber and amend 49.49 (4) (a) and (b); to amend 49.141 (7) (c) (intro.) and 1., 49.141 (8), 49.32 (8), 49.45 (2) (b) 7. (intro.) and a., and (11), 49.49 (3p) (title), 49.49 (5), 49.49 (7) (d), 49.688 (9) (a), 49.797 (2) (a), 59.54 (23) and 940.11 (2); to repeal and recreate 49.141 (7) (title); and to create 49.835, 49.846 (1), 946.90 (title), 946.90 (1), 946.90 (2), 946.91 (title), (1) and (2) (intro.), 946.92 (3) (a) and 946.93 of the statutes; relating to: applications for public assistance programs, offenses in public assistance programs, granting rule-making authority, and providing a penalty.
The people of the state of Wisconsin, represented in senate and assembly, do enact as follows:
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1. 49.141 (7) (title) of the statutes is repealed and recreated to read:
49.141 (7) (title) Suspensions.
226,2
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2
. 49.141 (7) (a) of the statutes is renumbered 946.90 (3) and amended to read:
946.90 (3) A person who is convicted of violating sub. (6) in connection with the Whoever violates sub. (2) by furnishing by that person of items or services for which payment is or may be made under Wisconsin works Works is guilty of a Class H felony.
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3. 49.141 (7) (b) of the statutes is repealed.
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4. 49.141 (7) (c) (intro.) and 1. of the statutes are amended to read:
49.141 (7) (c) (intro.) Except as provided in par. (d), in addition to the penalties applicable under par. (a) or (b) s. 946.90 (2) or (3), a person shall be suspended from participating in Wisconsin works Works for a period of 10 years, beginning on the date of conviction, if the person is convicted in a federal or state court for any of the following:
1. Violating sub. (6) (a) or s. 946.90 (2) (a) with respect to his or her identity or place of residence for the purpose of receiving simultaneously from this state and at least one other state assistance funded by a block grant under Title I of the Federal Personal Responsibility and Work Opportunity Reconciliation Act of 1996.
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5. 49.141 (8) of the statutes is amended to read:
49.141 (8) Damages. If a person is convicted under sub. (6) s. 946.90 (2) or (3), the state has a cause of action for relief against the person in an amount equal to 3 times the amount of actual damages sustained as a result of any excess payments made in connection with the offense for which the conviction was obtained. Proof by the state of a conviction under sub. (6) s. 946.90 (2) or (3) is conclusive proof in a civil action of the state's right to damages and the only issue in controversy shall be the amount, if any, of the actual damages sustained. Actual damages consist of the total amount of excess payments, any part of which is paid with state funds. In a civil action under this subsection, the state may elect to file a motion in expedition of the action. Upon receipt of the motion, the presiding judge shall expedite the action.
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6. 49.141 (9) (title) of the statutes is repealed.
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7. 49.141 (9) (a) to (c) of the statutes are renumbered 946.90 (4) (a) to (c), and 946.90 (4) (a), (b) and (c) 1., as renumbered, are amended to read:
946.90 (4) (a) Whoever solicits or receives any remuneration in cash or in-kind money, goods, services, or any other thing of value, in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under Wisconsin works Works, or in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under Wisconsin works Works, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.
(b) Whoever offers or pays any remuneration in cash or in-kind provides money, goods, services, or any other thing of value to any person to induce the person to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under Wisconsin works Works, or to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service or item for which payment may be made in whole or in part under any provision of Wisconsin works Works, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.
(c) 1. A discount or other reduction in price obtained by a provider of services or other entity under chs. 46 to 51 and 58 if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity under Wisconsin works Works.
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8. 49.141 (10) (title) and (b) of the statutes are repealed.
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9
. 49.141 (10) (a) of the statutes is renumbered 946.90 (5) and amended to read:
946.90 (5) A provider may not who knowingly impose imposes upon a recipient participant in Wisconsin Works charges in addition to payments received by the provider for services under Wisconsin works
Works or knowingly impose imposes direct charges upon a recipient participant in Wisconsin Works in lieu of obtaining payment under Wisconsin works unless Works is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000. This subsection does not apply if benefits or services are not provided under Wisconsin works Works and the recipient Wisconsin Works participant is advised of this fact prior to receiving the service.
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10. 49.32 (8) of the statutes is amended to read:
49.32
(8) Periodic earnings check by department. The department shall make a periodic check of the amounts earned by recipients of aid to families with dependent children under s. 49.19 and by participants under Wisconsin works under ss. 49.141 to 49.161 through a check of the amounts credited to the recipient's social security number. The department shall make an investigation into any discrepancy between the amounts credited to a social security number and amounts reported as income on the declaration application and take appropriate action under s.
49.95 946.93 when warranted. The department shall use the state wage reporting system under
1985 Wisconsin Act 17, section
65 (1), when the system is implemented, to make periodic earnings checks.
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11. 49.45 (2) (b) 7. (intro.) and a., and (11) of the statutes are amended to read:
49.45 (2) (b) 7. (intro.) Require, as a condition of certification under par. (a) 11., all providers of a specific service that is among those enumerated under s. 49.46 (2), 49.47 (6) (a), or 49.471 (11), as specified in this subdivision, to file with the department a surety bond issued by a surety company licensed to do business in this state. Providers subject to this subdivision provide those services specified under s. 49.46 (2), 49.47 (6) (a), or 49.471 (11) for which providers have demonstrated significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a), or (4m) (a) or 946.91 (2), (3) (a) or (b), (4), (5), or (6), to require recovery under par. (a) 10., or to need additional sanctions under par. (a) 13. The surety bond shall be payable to the department in an amount that the department determines is reasonable in view of amounts of former recoveries against providers of the specific service and the department's costs to pursue those recoveries. The department shall promulgate rules to implement this subdivision that specify all of the following:
a. Services under medical assistance Medical Assistance for which providers have demonstrated significant potential to violate s. 49.49 (1) (a), (2) (a) or (b), (3), (3m) (a), (3p), (4) (a), or (4m) (a) or 946.91 (2), (3) (a) or (b), (4), (5), or (6), to require recovery under par. (a) 10., or to need additional sanctions under par. (a) 13.
(11) Penalty. Any person who receives or assists another in receiving assistance under this section, to which the recipient is not entitled, shall be subject to the penalties under s. 49.95 ss. 946.91 and 946.93.
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12. 49.49 (1) (title) and (a) (intro.) of the statutes are repealed.
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13. 49.49 (1) (a) 1. to 4. of the statutes are renumbered 946.91 (2) (a) to (d) and amended to read:
946.91 (2) (a) Knowingly and willfully make Intentionally makes or cause causes to be made any false statement or representation of a material fact in any application for any Medical Assistance benefit or payment.
(b) Knowingly and willfully make Intentionally makes or cause causes to be made any false statement or representation of a material fact for use in determining rights to such eligibility for any Medical Assistance benefit or payment.
(c) Having knowledge of the occurrence of any event affecting the initial or continued right to eligibility for any such Medical Assistance benefit or payment or the initial or continued right to eligibility for any such benefit or payment of any other individual in whose behalf he or she has applied for or is receiving such benefit or payment, conceal conceals or fail fails to disclose such event with an intent to fraudulently to secure such benefit or payment either in a greater amount or quantity than is due or when no such benefit or payment is authorized.
(d) Having made application applied to receive any such Medical Assistance benefit or payment for the use and benefit of another and having received it, knowingly and willfully convert such converts the benefit or payment or any part thereof to a use other than for the use and that is not for the benefit of such other person.
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14. 49.49 (1) (b) of the statutes is repealed.
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Section
15. 49.49 (1) (c) of the statutes is renumbered 49.49 (1d) and amended to read:
49.49 (1d) Damages. If any person is convicted under this subsection s. 946.91 (2), the state shall have a cause of action for relief against such person in an amount 3 times the amount of actual damages sustained as a result of any excess payments made in connection with the offense for which the conviction was obtained. Proof by the state of a conviction under this section s. 946.91 (2) in a civil action shall be conclusive regarding the state's right to damages and the only issue in controversy shall be the amount, if any, of the actual damages sustained. Actual damages shall consist of the total amount of excess payments, any part of which is paid by state funds. In any such civil action the state may elect to file a motion in expedition of the action. Upon receipt of the motion, the presiding judge shall expedite the action.
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16. 49.49 (2) (title) and (2) (a) (title) of the statutes are repealed.
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17
. 49.49 (2) (a) of the statutes is renumbered 946.91 (3) (a) and amended to read:
946.91 (3) (a) Any person who Whoever solicits or receives any remuneration, including any kickback, bribe, or rebate, directly or, indirectly, overtly, or covertly, in cash or in kind, money, goods, services, or any other thing of value in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a medical assistance program Medical Assistance, or in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under a medical assistance program Medical Assistance, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.
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18. 49.49 (2) (b) (title) of the statutes is repealed.
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19
. 49.49 (2) (b) of the statutes is renumbered 946.91 (3) (b) and amended to read:
946.91 (3) (b) Whoever offers or pays any remuneration including any kickback, bribe, or rebate provides, directly or, indirectly, overtly, or covertly, in cash or in kind money, goods, services, or any other thing of value to any person to induce such person to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under a medical assistance program Medical Assistance, or to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service or item for which payment may be made in whole or in part under a medical assistance program Medical Assistance, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.
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20. 49.49 (2) (c) (title) of the statutes is repealed.
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21. 49.49 (2) (c) of the statutes is renumbered 946.91 (3) (c) and amended to read:
946.91 (3) (c) This subsection shall
does not apply to any of the following:
1. A discount or other reduction in price obtained by a provider of services or other entity under chs. 46 to 51 and 58 if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity under a medical assistance program Medical Assistance.
2. Any An amount paid by an employer to an employee who has a bona fide employment relationship with such employer for employment in the provision of covered items or services.
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22. 49.49 (3) (title) of the statutes is repealed.
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23
. 49.49 (3) of the statutes is renumbered 946.91 (4) and amended to read:
946.91 (4) No person may Whoever knowingly and willfully make makes or cause causes to be made, or induce induces or seek seeks to induce the making of, any false statement or representation of a material fact with respect to the conditions or operation of any institution or facility in order that such institution or facility may qualify either upon initial certification or upon recertification as a hospital, skilled nursing facility, intermediate care facility, or home health agency. A person who violates this subsection is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.
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24. 49.49 (3m) (title) of the statutes is repealed.
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25
. 49.49 (3m) (a) of the statutes is renumbered 946.91 (5), and 946.91 (5) (intro.), (a), (b) and (c), as renumbered, are amended to read:
946.91 (5) (intro.) No provider may
Whoever knowingly impose imposes upon a Medical Assistance recipient charges in addition to payments received for services under ss. 49.45 to 49.471 or knowingly impose imposes direct charges upon a recipient in lieu of obtaining payment under ss. 49.45 to 49.471 except under the following conditions is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000. This subsection does not apply under any of the following circumstances:
(a) Benefits or services are not provided under s. 49.46 (2) or 49.471 (11) and the Medical Assistance recipient is advised of this fact prior to receiving the service.
(b) If an An applicant is determined to be eligible retroactively under s. 49.46 (1) (b), 49.47 (4) (d), or 49.471 and, a provider bills the applicant directly for services and benefits rendered during the retroactive period, the provider shall, upon notification of the applicant's retroactive eligibility, submit claims submits a claim for payment under s. 49.45 for covered services or benefits rendered to the recipient during the retroactive period. Upon receipt of payment under s. 49.45, the provider shall reimburse, and the provider reimburses the recipient or other person who has made prior payment to the provider for services provided to the recipient during the retroactive eligibility period, by the amount of the prior payment made upon receipt of payment under s. 49.45.
(c) Benefits or services
are provided for which recipient copayment, coinsurance, or deductible is required under s. 49.45 (18), not to exceed maximum amounts allowable under
42 CFR 447.53 to
447.58, or for which recipient copayment or coinsurance is required under s. 49.471 (11).
226,26
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26. 49.49 (3m) (b) of the statutes is repealed.