Wisconsin Healthcare Fraud/Medicare Fraud Enforcement

Contact Form - Your First Step

In Wisconsin, major healthcare fraud is civilly and criminally prosecuted by the Eastern and Western United States Attorney’s Offices and the State’s own Medicaid Fraud Control Unit.

The federal government often accomplishes this task with the assistance of the Wisconsin Medicaid Fraud Control Unit (MFCU). The MFCU takes the responsibility of stopping fraud very seriously and is often assisted in its efforts by the bravery and actions of whistleblowers.

Modeled after the federal False Claims Act, the Wisconsin False Claims for Medical Assistance Law permits private citizens to bring qui tam actions on behalf of the State of Wisconsin to recover treble damages and civil penalties. Wis. Stat. § 20.931 et seq.

Nolan Auerbach & White represents whistleblowers in federal court only. We will bring cases on behalf of whistleblowers under the Wisconsin qui tam statute as part of an action under the federal False Claims Act. We do so under the Court’s pendent jurisdiction.

The liability provisions of the Wisconsin False Claims for Medical Assistance Law, 388.    Wis. Stat. § 20.931(2), provide liability for any person who:

(a)        Knowingly presents or causes to be presented to any officer, employee, or agent of this state a false claim for medical assistance.

(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.

(c)        conspires to defraud this State by obtaining allowance or payment of 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;

***

(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.

 

Cases completed in Wisconsin that were originally brought in a Wisconsin federal court include:

 

Odyssey HealthCare, Inc. agreed to pay the United States $12.9 million to settle allegations that the company submitted false claims to Medicare. Odyssey HealthCare also entered into a Corporate Integrity Agreement with the Office of Inspector General of the Department of Health and Human Services. The national hospice provider was alleged to have billed Medicare for services provided to patients who were not terminally ill, and therefore ineligible for the Medicare hospice benefit.