Wisconsin Legislature: 226,29

(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.

226,14 Section 14. 49.49 (1) (b) of the statutes is repealed.

226,15 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.

226,16 Section 16. 49.49 (2) (title) and (2) (a) (title) of the statutes are repealed.

226,17 Section 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.

226,18 Section 18. 49.49 (2) (b) (title) of the statutes is repealed.

226,19 Section 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.

226,20 Section 20. 49.49 (2) (c) (title) of the statutes is repealed.

226,21 Section 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.

226,22 Section 22. 49.49 (3) (title) of the statutes is repealed.

226,23 Section 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.

226,24 Section 24. 49.49 (3m) (title) of the statutes is repealed.

226,25 Section 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 Section 26. 49.49 (3m) (b) of the statutes is repealed.

226,27 Section 27. 49.49 (3p) (title) of the statutes is amended to read:

49.49 (3p) (title) Other prohibited provider charges.

226,28 Section 28. 49.49 (4) (title) of the statutes is repealed.

226,29 Section 29 . 49.49 (4) (a) and (b) of the statutes are consolidated, renumbered 946.91 (6) and amended to read:

946.91 (6) No person Whoever, in connection with the medical assistance program Medical Assistance when the cost of the services provided to the patient is paid for in whole or in part by the state, may knowingly and willfully charge, solicit, accept or receive intentionally charges, solicits, accepts, or receives, in addition to any amount otherwise required to be paid under a medical assistance program Medical Assistance, any gift, money, donation, or other consideration, other than a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to the patient, as a precondition of admitting a patient to a hospital, skilled nursing facility, or intermediate care facility, or as a requirement for the patient's continued stay in such a facility. (b) 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.

226,30 Section 30. 49.49 (5) of the statutes is amended to read:

49.49 (5) County collection. Any county may retain 15% 15 percent of state medical assistance Medical Assistance funds that are recovered due to the efforts of a county employee or officer or, if the county initiates action by the department of justice, due to the efforts of the department of justice under s. 49.495 49.846. This subsection applies only to recovery of medical assistance that was provided as a result of fraudulent activity by a recipient or by a provider.

226,31 Section 31. 49.49 (7) (d) of the statutes is amended to read:

49.49 (7) (d) A commission's imposition of an assessment described under par. (b), a member's payment of the assessment as described under par. (c), and acceptance of the payment by the commission do not constitute conduct prohibited under sub. (4) s. 946.91 (6) or prohibited under s. DHS 106.04 (3), Wis. Adm. Code, in effect on May 26, 2010. It is the intent of the legislature to create a mechanism whereby 2 or more political subdivisions may share in the operation, use, and funding of a nursing home or intermediate care facility without violating 42 USC 1320a-7b (d) or 42 USC 1396a (a) (25) (C).

226,32 Section 32. 49.495 (title) of the statutes is renumbered 49.846 (title).

226,33 Section 33. 49.495 of the statutes is renumbered 49.846 (2) and amended to read:

49.846 (2) The department of justice or the district attorney may institute, manage, control, and direct, in the proper county, any prosecution for violation of criminal laws affecting the medical a public assistance program, including but not limited to laws in this chapter, chs. 939 to 951 relating to medical assistance contained in this subchapter Medical Assistance, Wisconsin Works, the food stamp program, or any other public assistance program, and laws affecting the health, safety, and welfare of public assistance program recipients of medical assistance. For this purpose the department of justice shall have and exercise all powers conferred upon district attorneys in such cases. The If a prosecution under this section involves a person holding a license granted by the medical examining board or an interested affiliated credentialing board, the department of justice or district attorney shall notify the medical examining board or the interested affiliated credentialing board of any such the prosecution of a person holding a license granted by the board or affiliated credentialing board.

226,34 Section 34. 49.688 (9) (a) of the statutes is amended to read:

49.688 (9) (a) The department shall promulgate rules relating to prohibitions on fraud that are substantially similar to applicable provisions under s. 49.49 (1) (a) 946.91 (2).

226,35 Section 35. 49.795 (title) and (1) (intro.) of the statutes are renumbered 946.92 (title) and (1) (intro.).

226,36 Section 36 . 49.795 (1) (a), (b), (c), (d) and (e) of the statutes are renumbered 946.92 (1) (a), (b), (c), (d) and (e), and 946.92 (1) (b), (c) and (d), as renumbered, are amended to read:

946.92 (1) (b) "Food" means items which that may be purchased using food coupons stamp program benefits under 7 USC 2012 (g) and 2016 (b).

(d) "Supplier" means a retail grocery store or other person authorized by the federal department of agriculture to accept food coupons stamp program benefits in exchange for food under the food stamp program.

226,37 Section 37. 49.795 (1) (cm) of the statutes is repealed.

226,38 Section 38 . 49.795 (2) to (6) of the statutes are renumbered 946.92 (2) (a) to (f), and 946.92 (2) (c), (d), (e) and (f), as renumbered, are amended to read:

946.92 (2) (c) No person may knowingly issue food coupons stamp program benefits to a person who is not an eligible person or knowingly issue food coupons stamp program benefits to an eligible person in excess of the amount for which the person's household is eligible.

(d) No eligible person may knowingly transfer food coupons stamp program benefits except to purchase food from a supplier or knowingly obtain or use food coupons stamp program benefits for which the person's household is not eligible.

(e) No supplier may knowingly obtain food coupons stamp program benefits except as payment for food or knowingly obtain food coupons stamp program benefits from a person who is not an eligible person.

(f) No unauthorized person may knowingly obtain, possess, transfer, or use food coupons stamp program benefits.

226,39 Section 39. 49.795 (7) of the statutes is repealed.

226,40 Section 40. 49.795 (8) (a), (b) and (c) of the statutes are repealed.

226,41 Section 41. 49.795 (8) (d) 1. of the statutes is renumbered 946.92 (3) (b) and amended to read:

946.92 (3) (b) In addition to the penalties applicable under par. (a), (b) or (c), the court shall suspend a person who violates this section sub. (2) from participation in the food stamp program as follows:

1. For a first offense conviction under this section, for not less than one year. The court may extend the suspension by and not more than 18 months 2 years and 6 months.

2. For a 2nd offense conviction under this section, for not less than 2 years. The court may extend the suspension by and not more than 18 months 3 years and 6 months.

3. For a 3rd offense conviction under this section, permanently.

226,42 Section 42. 49.795 (8) (d) 1m. of the statutes is renumbered 946.92 (3) (c) and amended to read:

946.92 (3) (c) In addition to the penalties applicable under par. (a), (b) or (c), a court shall permanently suspend from the food stamp program a person who has been convicted of an offense under 7 USC 2024 (b) or (c) involving an item covered by 7 USC 2024 (b) or (c) having a value of $500 or more.

226,43 Section 43. 49.795 (8) (d) 2. of the statutes is renumbered 49.796 and amended to read:

49.796 Food stamp reinstatement. The A person may apply to the a multicounty consortium, as defined in s. 49.78 (1) (br), or the a federally recognized American Indian tribal governing body or, if the person is a supplier, as defined in s. 946.92 (1) (d), to the federal department of agriculture for reinstatement of benefits following the a period of suspension imposed under s. 946.92, if the suspension is not permanent.

226,44 Section 44. 49.795 (8) (e) and (f) of the statutes are renumbered 946.92 (3) (d) and (e) and amended to read:

946.92 (3) (d) 1. If a court finds that a person traded violated sub. (2) by trading a controlled substance, as defined in s. 961.01 (4), for food coupons stamp program benefits, the court shall suspend the person from participation in the food stamp program as follows:

a. Upon the first such finding a first conviction, for 2 years.

b. Upon the a 2nd such finding conviction, permanently.

2. If a court finds that a person traded violated sub. (2) by trading firearms, ammunition, or explosives for food coupons stamp program benefits, the court shall suspend the person permanently from participation in the food stamp program.

(e) Notwithstanding par. (d) pars. (b) and (c), in addition to the penalties applicable under par. (a), (b) or (c), the court shall suspend from the food stamp program for a period of 10 years a person who violates sub. (2) by fraudulently misstates misstating or misrepresents misrepresenting his or her identity or place of residence for the purpose of receiving multiple benefits simultaneously under the food stamp program.

226,45 Section 45. 49.797 (2) (a) of the statutes is amended to read:

49.797 (2) (a) Notwithstanding s. 46.028 and except as provided in par. (b) and sub. (8), the department shall administer a statewide program to deliver food stamp benefits to recipients of food stamp benefits by an electronic benefit transfer system. All suppliers, as defined in s. 49.795 946.92 (1) (d), may participate in the delivery of food stamp benefits under the electronic benefit transfer system. The department shall explore methods by which nontraditional retailers, such as farmers' markets, may participate in the delivery of food stamp benefits under the electronic benefit transfer system.

226,46 Section 46. 49.835 of the statutes is created to read:

49.835 Statements in applications. A person who makes a statement in a written application for any aid or benefit provided under this chapter is considered to have made an admission as to the existence, correctness, or validity of any fact stated. Such a statement is prima facie evidence against the person who made it in any complaint, information, or indictment, or in any action brought for enforcement of any provision of this chapter.

226,47 Section 47. 49.846 (1) of the statutes is created to read:

49.846 (1) In this section, "public assistance program" means any program administered by the department of health services or the department of children and families under this chapter under which the department administering the program provides services, benefits, or other assistance to individuals or families.

226,48 Section 48. 49.95 of the statutes is repealed.

226,49 Section 49. 59.54 (23) of the statutes is amended to read:

59.54 (23) Public assistance; false representation. The board may enact and enforce an ordinance to prohibit conduct that is the same as or similar to conduct that is prohibited by s. 49.95 (1) 946.93 (2) and provide a forfeiture for a violation of the ordinance.

226,50 Section 50. 940.11 (2) of the statutes is amended to read:

940.11 (2) Whoever hides or buries a corpse, with intent to conceal a crime or avoid apprehension, prosecution, or conviction for a crime or notwithstanding s. 49.141 (7), 49.49 (1), or 49.795 946.90 (2) or (3), 946.91 (2), 946.92, or 946.93 (2) or (3) with intent to collect benefits under one of those sections the assistance program for families with dependent children administered under ss. 49.141 to 49.161, the Medical Assistance program administered under subch. IV of ch. 49, or the food stamp program, as defined in s. 49.79 (1) (c), is guilty of a Class G felony.

226,51 Section 51 . 946.90 (title) of the statutes is created to read:

946.90 (title) Wisconsin Works fraud.

226,52 Section 52. 946.90 (1) of the statutes is created to read:

946.90 (1) In this section:

(a) "Provider" means a Wisconsin Works agency, a person that contracts with a Wisconsin Works agency to provide services to a participant in Wisconsin Works, or a person that provides child care for reimbursement under s. 49.155.

(b) "Wisconsin Works" means the assistance program for families with dependent children administered under ss. 49.141 to 49.161.

226,53 Section 53 . 946.90 (2) of the statutes is created to read:

946.90 (2) Whoever does any of the following is guilty of a Class A misdemeanor:

(a) Intentionally makes or causes to be made any false statement or representation of a material fact in any application for or receipt of any Wisconsin Works benefit or payment.