20.930 History
History: 1979 c. 221;
1989 a. 119 s.
1; Stats. 1989 s. 20.930;
1993 a. 490;
1999 a. 9;
2007 a. 1.
20.930 Annotation
This section applies to principal administrative units and whatever agencies assist those units in administration and governance of the unit. Kaye v. Board of Regents,
158 Wis. 2d 664,
463 N.W.2d 398 (Ct. App. 1990).
20.931
20.931
False claims for medical assistance; actions by or on behalf of state. 20.931(1)(b)
(b) "Claim" includes any request or demand for medical assistance made to any officer, employee, or agent of this state.
20.931(1)(c)
(c) "Employer" includes all agencies and authorities.
20.931(1)(d)
(d) "Knowingly" means, with respect to information, having actual knowledge of the information, acting in deliberate ignorance of the truth or falsity of the information, or acting in reckless disregard of the truth or falsity of the information. "Knowingly" does not mean specifically intending to defraud.
20.931(1)(e)
(e) "Proceeds" includes damages, civil penalties, surcharges, payments for costs of compliance, and any other economic benefit realized by this state as a result of an action or settlement of a claim.
20.931(2)
(2) Except as provided in
sub. (3), any person who does any of the following is liable to this state for 3 times the amount of the damages sustained by this state because of the actions of the person, and shall forfeit not less than $5,000 nor more than $10,000 for each violation:
20.931(2)(a)
(a) Knowingly presents or causes to be presented to any officer, employee, or agent of this state a false claim for medical assistance.
20.931(2)(b)
(b) Knowingly makes, uses, or causes to be made or used a false record or statement to obtain approval or payment of a false claim for medical assistance.
20.931(2)(c)
(c) Conspires to defraud this state by obtaining allowance or payment of a false claim for medical assistance, or by knowingly making or using, or causing to be made or used, a false record or statement to conceal, avoid, or decrease an obligation to pay or transmit money or property to the Medical Assistance program.
20.931(2)(g)
(g) Knowingly makes, uses, or causes to be made or used a false record or statement to conceal, avoid, or decrease any obligation to pay or transmit money or property to the Medical Assistance program.
20.931(2)(h)
(h) Is a beneficiary of the submission of a false claim for medical assistance to any officer, employee, or agent of this state, knows that the claim is false, and fails to disclose the false claim to this state within a reasonable time after the person becomes aware that the claim is false.
20.931(3)
(3) The court may assess against a person who violates
sub. (2) not less than 2 nor more than 3 times the amount of the damages sustained by the state because of the acts of the person, and shall not assess any forfeiture, if the court finds all of the following:
20.931(3)(a)
(a) The person who commits the acts furnished the attorney general with all information known to the person about the acts within 30 days after the date on which the person obtained the information.
20.931(3)(b)
(b) The person fully cooperated with any investigation of the acts by this state.
20.931(3)(c)
(c) At the time that the person furnished the attorney general with information concerning the acts, no criminal prosecution or civil or administrative enforcement action had been commenced with respect to any such act, and the person did not have actual knowledge of the existence of any investigation into any such act.
20.931(5)(a)(a) Except as provided in
subs. (10) and
(12), any person may bring a civil action as a qui tam plaintiff against a person who commits an act in violation of
sub. (2) for the person and the state in the name of the state.
20.931(5)(b)
(b) The plaintiff shall serve upon the attorney general a copy of the complaint and documents disclosing substantially all material evidence and information that the person possesses. The plaintiff shall file a copy of the complaint with the court for inspection in camera. Except as provided in
par. (c), the complaint shall remain under seal for a period of 60 days from the date of filing, and shall not be served upon the defendant until the court so orders. Within 60 days from the date of service upon the attorney general of the complaint, evidence, and information under this paragraph, the attorney general may intervene in the action.
20.931(5)(c)
(c) The attorney general may, for good cause shown, move the court for one or more extensions of the period during which a complaint in an action under this subsection remains under seal.
20.931(5)(d)
(d) Before the expiration of the period during which the complaint remains under seal, the attorney general shall do one of the following:
20.931(5)(d)1.
1. Proceed with the action or an alternate remedy under
sub. (10), in which case the action or proceeding under
sub. (10) shall be prosecuted by the state.
20.931(5)(d)2.
2. Notify the court that he or she declines to proceed with the action, in which case the person bringing the action may proceed with the action.
20.931(5)(e)
(e) If a person brings a valid action under this subsection, no person other than the state may intervene or bring a related action while the original action is pending based upon the same facts underlying the pending action.