Office of Inspector General (OIG)

The Office of the Inspector General (OIG) is charged with protecting the taxpayers of Wisconsin by preventing and detecting waste, fraud, and abuse of public assistance programs such as Medicaid, FoodShare, and FamilyCare. The Department’s Office of the Inspector General (OIG) was established by Governor Walker in October 2011.  Led by Inspector General Alan White, the OIG consolidates all Department of Health Services program integrity, audit and fraud investigation activities within one office. Staff within the OIG work closely with other state and local partners in identifying misuses of public assistance funds, and where appropriate, forward fraud cases to federal, state and local officials for prosecution.

Programs & Services within the Office of Inspector General

Report Fraud

The OIG encourages the public to report any fraudulent use of public assistance dollars through its fraud hotline, 1-877-865-3432, or on this web page. The OIG monitors these contacts and reports monthly on the results of these public contacts.

Monthly Outcome Measures 

Every month the OIG measures a number of key statistics, including projected cost avoidance and overpayments established.

Monitor and audit providers who participate in Wisconsin Medicaid

The OIG is responsible for the prevention and detection of provider fraud, waste and abuse in Wisconsin’s Medicaid program. These responsibilities are carried out by the Medical and Program Audit Review Sections which are responsible for auditing Medicaid providers to ensure compliance with Medicaid rules and regulations; reviewing, monitoring, and researching provider billing to detect and identify potential fraud, waste, and abuse; investigating allegations of fraud, waste, and abuse; providing education and technical assistance to the provider community through the audit activities; and recommending new policies, or changes to existing policies, that promote and protect the Medicaid program.

 

Monitor, investigate and refer recipient fraud and retailer fraud allegations

The Fraud Investigation, Recovery and Enforcement Section in the OIG 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).

Oversee and enforce the prior authorization policies of the state’s Medical Assistance program

As one of the most comprehensive Medicaid programs in the country, the OIG is responsible to assure that services paid for by Wisconsin Medicaid are medically necessary and provided in a cost-effective manner. This is completed by requiring certain services and products to be reviewed through the prior authorization process before payment can be made for them.

Perform independent, objective assurance and consulting engagements for DHS programs and operations 

The Internal Audit Section within the OIG performs independent, objective assurance and consulting activities designed to add value and improve the Department’s operations. It helps the Department accomplish its objectives by bringing a systematic, disciplined approach to evaluate the effectiveness of risk management, internal control, and governance processes. Internal Audit does not assume any operational or program responsibility.

Collaborate with other states and the federal government to detect and avoid issuing duplicate benefits

OIG uses the Public Assistance Reporting Information System (PARIS), which is a federal database matching recipients of public assistance from across the nation to determine if they may be receiving duplicate benefits in two or more states. OIG PARIS staff verifies this information and when we confirm an individual received duplicate benefits we then determine any overpayment amount and may disqualify the individual from the program according to policy.

Work closely with partners and other states to identify misuse of public assistance funds

Staff within the OIG work closely with other state and local partners in identifying misuses of public assistance funds, and where appropriate, forward fraud cases to federal, state and local officials for prosecution

Office of the Inspector General
1 West Wilson Street
P.O. Box 309
Madison, WI 53707-0309
(608) 266-2521
 

Return to List of Divisions

Last Revised: December 5, 2014