Department of Health Services Logo

 

Wisconsin Department of Health Services

Report Fraud

Office of the Inspector General

Outcome Measures

Monitor and Audit Providers

Recipient and Retailer Fraud

Prior Authorization

Internal Audit

Public Assistance Reporting Information System

Resources for State and Local Partners

Monitor, investigate and refer recipient fraud and retailer fraud allegations

The Office of the Inspector General is responsible for the prevention and detection of recipient fraud, waste and abuse in Wisconsin's public assistance programs, including Medicaid, FoodShare, the Women, Infants and Children (WIC) supplemental food program and the state supplement to Supplemental Security Income (SSI).

Types of recipient and retailer fraud and abuse can include:

  • Card Sharing
  • Trafficking of benefits for ineligible items or cash
  • Unreported income
  • Not reporting household changes like incarceration, changes in household composition or moving out of state
  • Receiving benefits in more than one state at the same time
  • Filing a false application for a DHS-funded assistance program such as Medicaid, BadgerCare Plus, WIC or FoodShare

Fraud Investigation, Recovery and Enforcement Section

The Fraud Investigation, Recovery and Enforcement Section in the Office of the Inspector General is responsible for monitoring, investigating and referring allegations of recipient and retailer fraud in Department of Health Services programs, including BadgerCare, Wisconsin Medicaid, FoodShare and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).

The Fraud Investigation, Recovery and Enforcement Section employs a number of strategies to detect fraud and abuse, including

  • Reviewing recipient data for out-of-state usage
  • Participating in the Public Assistance Reporting Information System (PARIS)
  • Investigating fraud allegations received from our hotline and other sources
  • Monitoring the number of replacement cards issued to each recipient
  • Monitoring social media sites for advertisement of FoodShare cards or benefits for sale
  • Matching with available public information databases such as Social Security, Unemployment benefits, State wage records and prisoner data
  • Conducting monitoring visits, audits and undercover investigations of retailers

The Trafficking Enforcement and Audit Unit is responsible for investigating QUEST and ForwardHealth card trafficking, benefit recovery for cases investigated by the OIG, identifying and taking action on cases that may be receiving benefits in Wisconsin and at least one other state, and developing a FoodShare Program retailer fraud operation.

The Investigation and Technical Assistance Unit is responsible for investigating recipient fraud, providing technical assistance to our local agency partners on fraud, developing client and general public educational material and acting as a special operations team as needed.

The WIC Vendor and Integrity Unit is responsible for recipient and retailer program integrity for the WIC Program.

Resources for state and local partners that work with the OIG

Office of the Inspector General Outcome Measures

Last Revised: November 25, 2013