Section 49.197. Fraud investigation and reduction and error reduction.

 

(1m)   Fraud investigation. From the appropriations under s. 20.437 (2) (dz) , (kx) , (L) , (mc) , (md) , (me) , and (nL) , the department shall establish a program to investigate suspected fraudulent activity on the part of recipients of aid to families with dependent children under s. 49.19 , on the part of participants in the Wisconsin Works program under ss. 49.141 to 49.161 , and, if the department of health services contracts with the department under sub. (5) , on the part of recipients of medical assistance under subch. IV , food stamp benefits under the food stamp program under 7 USC 2011 to 2036 , supplemental security income payments under s. 49.77 , payments for the support of children of supplemental security income recipients under s. 49.775 , and health care benefits under the Badger Care health care program under s. 49.665 . The department's activities under this subsection may include, but are not limited to, comparisons of information provided to the department by an applicant and information provided by the applicant to other federal, state, and local agencies, development of an advisory welfare investigation prosecution standard, and provision of funds to county departments under ss. 46.215 , 46.22 , and 46.23 or multicounty consortia, as defined in s. 49.78 (1) (br) , and to Wisconsin Works agencies to encourage activities to detect fraud. The department shall cooperate with district attorneys regarding fraud prosecutions.

(2)   Incentive program for local fraud detection.

(a) In this subsection:

1. “County department" means a county department under s. 46.22 or 46.23 .

2. “Subsidy program" means the child care subsidy program under s. 49.155 .

3. “Tribal governing body" means an elected governing body of a federally recognized American Indian tribe.

(b)

1. Subject to subd. 2. , the department shall by rule establish an incentive program that, using moneys from the allocation under s. 49.175 (1) (p) , rewards county departments, Wisconsin Works agencies, and tribal governing bodies that administer the subsidy program for identifying fraud in the subsidy program. The rules shall specify that a county department, Wisconsin Works agency, or tribal governing body shall receive, for identifying fraudulent activity under the subsidy program on the part of a child care provider, an amount equal to the average monthly subsidy payment per child during the prior fiscal year, multiplied by the number of children participating in the subsidy program for whom the provider provides care, multiplied by 1.5 months. A county department, Wisconsin Works agency, or tribal governing body may use payments received under this subsection for any purpose for which moneys under the Temporary Assistance for Needy Families block grant program may be used under federal law.

2. No later than January 1, 2012, the department shall submit its plan for the incentive program to the cochairpersons of the joint committee on finance for review by the committee. If the cochairpersons of the committee do not notify the department that the committee has scheduled a meeting for the purpose of reviewing the proposed plan within 14 working days after the date of the department's submittal, the department shall promulgate the rules for the incentive program in accordance with its proposed plan. If, within 14 working days after the date of the department's submittal, the cochairpersons of the committee notify the department that the committee has scheduled a meeting for the purpose of reviewing the proposed plan, the department may not promulgate the rules for the incentive program unless the committee approves the proposed plan. If the committee modifies and approves the proposed plan, the department may promulgate the rules for the incentive program only as modified by the committee.

(3)   State error reduction activities. The department shall conduct activities to reduce payment errors in Wisconsin Works under ss. 49.141 to 49.161 and, if the department of health services contracts with the department under sub. (5) , the Medical Assistance program under subch. IV , the food stamp program under 7 USC 2011 to 2036 , the supplemental security income payments program under s. 49.77 , the program providing payments for the support of children of supplemental security income recipients under s. 49.775 , and the Badger Care health care program under s. 49.665 .

(4)   County and tribal error reduction. If the department of health services contracts with the department under sub. (5) , the department shall provide funds from the appropriation under s. 20.437 (2) (kx) to counties, multicounty consortia, as defined in s. 49.78 (1) (br) , and governing bodies of federally recognized American Indian tribes administering Medical Assistance under subch. IV , the food stamp program under 7 USC 2011 to 2036 , the supplemental security income payments program under s. 49.77 , the program providing payments for the support of children of supplemental security income recipients under s. 49.775 , and the Badger Care health care program under s. 49.665 to offset administrative costs of reducing payment errors in those programs.

(5)   Contracts for medical assistance, food stamps, supplemental security income, and caretaker supplement. Notwithstanding s. 49.845 (1) and (2) , the department of health services may contract with the department to investigate suspected fraudulent activity on the part of recipients of medical assistance under subch. IV , food stamp benefits under the food stamp program under 7 USC 2011 to 2036 , supplemental security income payments under s. 49.77 , payments for the support of children of supplemental security income recipients under s. 49.775 , and health care benefits under the Badger Care health care program under s. 49.665 and to conduct activities to reduce payment errors in the Medical Assistance program under subch. IV , the food stamp program under 7 USC 2011 to 2036 , the supplemental security income payments program under s. 49.77 , the program providing payments for the support of children of supplemental security income recipients under s. 49.775 , and the Badger Care health care program under s. 49.665 , as provided in this section.

(6)   Reporting of suspected fraudulent activity.

(a)

1. If any employee of the department, a county, or a tribal governing body reasonably suspects that fraudulent activity as described in sub. (1m) or (2) (b) has occurred or is occurring, the employee shall immediately report the facts and circumstances contributing to that suspicion to the employee's immediate supervisor.

2. An immediate supervisor who receives a report under subd. 1. shall immediately evaluate the report to determine whether there is reason to suspect that the fraudulent activity has occurred or is occurring. If the immediate supervisor determines that there is reason to suspect that the fraudulent activity has occurred or is occurring, the immediate supervisor shall immediately report the facts and circumstances contributing to that suspicion to the unit of the department that is responsible for investigating suspected fraudulent activity under sub. (1m) . If the immediate supervisor is an employee of the department or of a county having a population of 145,000 or more, the immediate supervisor shall also immediately report those facts and circumstances to the sheriff.

3. Except as provided in subd. 2. , an immediate supervisor who receives a report under subd. 1. shall keep the identity of the reporter confidential. A sheriff or unit of the department that receives a report under subd. 2. shall keep the identity of the employee reporting under subd. 1. and the immediate supervisor reporting under subd. 2. confidential until the sheriff or unit determines that the report merits further investigation. If the sheriff or unit conducts a full investigation, the sheriff or unit shall keep the identity of that employee and immediate supervisor confidential if it is reasonably possible to do so. Any person who fails to report as required in subd. 1. or 2. may be required to forfeit not more than $1,000.

(b) Any person participating in good faith in the making of a report under par. (a) 1. or 2. or in initiating, participating in, or testifying in, any action or proceeding in which fraudulent activity as described in sub. (1m) or (2) (b) is alleged shall have immunity from any liability, civil or criminal, that results by reason of the action. For the purpose of any proceeding, civil or criminal, the good faith of any person reporting under par. (a) 1. or 2. shall be presumed.

(c) The department, a county, a tribal governing body, or an employee of the department, a county, or a tribal governing body may not take disciplinary action against, or threaten to take disciplinary action against, any person because the person in good faith reported any information under par. (a) 1. or 2. or initiated, participated in, or testified in, any action or proceeding in which fraudulent activity described in sub. (1m) or (2) (b) was alleged or because the department, county, tribal governing body, or employee believes that the person in good faith reported any information under par. (a) 1. or 2. or initiated, participated in, or testified in, such an action or proceeding.

(d) Any person who is subjected to disciplinary action, or who is threatened with disciplinary action, in violation of par. (c) may file a complaint with the department of workforce development under s. 106.54 (9) . If that department finds that a violation of par. (c) has been committed, that department may take such action under s. 111.39 as will effectuate the purpose of this section. Section 111.322 (2m) applies to a disciplinary action arising in connection with any proceeding under this paragraph.

1985 a. 29 , 176 ; 1987 a. 27 , 413 ; 1989 a. 31 ; 1991 a. 39 ; 1995 a. 27 , 289 ; 1997 a. 27 , 35 ; 2001 a. 16 ; 2005 a. 25 ; 2007 a. 20 ss. 1465 to 1466 , 9121 (6) (a) ; 2009 a. 28 , 76 ; 2011 a. 32 .