Chapter 946

946.90 History History: 2013 a. 226 ss. 2, 7, 9, 51, 52, 53; Stats. 2013 s. 946.90.

946.91 946.91 Medical Assistance fraud.

946.91(1) (1) In this section:

946.91(1)(a) (a) “Facility” means a nursing home or a community-based residential facility that is licensed under s. 50.03 and that is certified by the department of health services as a provider of aid under Medical Assistance.

946.91(1)(b) (b) “Medical Assistance” means the program providing aid under subch. IV of ch. 49, except ss. 49.468 and 49.471.

946.91(1)(c) (c) “Provider” means a person, corporation, limited liability company, partnership, incorporated business, or professional association, and any agent or employee thereof, who provides services under Medical Assistance.

946.91(2) (2) Whoever does any of the following is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000:

946.91(2)(a) (a) Intentionally makes or causes to be made any false statement or representation of a material fact in any application for any Medical Assistance benefit or payment.

946.91(2)(b) (b) Intentionally makes or causes to be made any false statement or representation of a material fact for use in determining eligibility for any Medical Assistance benefit or payment.

946.91(2)(c) (c) Having knowledge of the occurrence of any event affecting the initial or continued eligibility for any Medical Assistance benefit or payment or the initial or continued eligibility for any such benefit or payment of any other individual in whose behalf he or she has applied for or is receiving such benefit or payment, conceals or fails to disclose such event with an intent to fraudulently secure such benefit or payment either in a greater amount or quantity than is due or when no such benefit or payment is authorized.

946.91(2)(d) (d) Having applied to receive any Medical Assistance benefit or payment for the use and benefit of another and having received it, knowingly and willfully converts the benefit or payment or any part thereof to a use that is not for the benefit of such other person.

946.91(3) (3) 

946.91(3)(a) (a) Whoever solicits or receives, directly, indirectly, overtly, or covertly, money, goods, services, or any other thing of value in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under Medical Assistance, or in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which payment may be made in whole or in part under Medical Assistance, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.

946.91(3)(b) (b) Whoever offers or provides, directly, indirectly, overtly, or covertly, money, goods, services, or any other thing of value to any person to induce such person to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which payment may be made in whole or in part under Medical Assistance, or to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service or item for which payment may be made in whole or in part under Medical Assistance, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.

946.91(3)(c) (c) This subsection does not apply to any of the following:

946.91(3)(c)1. 1. A discount or other reduction in price obtained by a provider of services or other entity under chs. 46 to 51 and 58 if the reduction in price is properly disclosed and appropriately reflected in the costs claimed or charges made by the provider or entity under Medical Assistance.

946.91(3)(c)2. 2. An amount paid by an employer to an employee who has a bona fide employment relationship with such employer for employment in the provision of covered items or services.

946.91(3)(c)3. 3. Any payment made for sharing of cost savings under s. 49.45 (26g).

946.91(4) (4) Whoever knowingly and willfully makes or causes to be made, or induces or seeks to induce the making of, any false statement or representation of a material fact with respect to the conditions or operation of any institution or facility in order that such institution or facility may qualify either upon initial certification or upon recertification as a hospital, skilled nursing facility, intermediate care facility, or home health agency is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.

946.91(5) (5) Whoever knowingly imposes upon a Medical Assistance recipient charges in addition to payments received for services under ss. 49.45 to 49.471 or knowingly imposes direct charges upon a recipient in lieu of obtaining payment under ss. 49.45 to 49.471 is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000. This subsection does not apply under any of the following circumstances:

946.91(5)(a) (a) Benefits or services are not provided under s. 49.46 (2) or 49.471 (11) and the Medical Assistance recipient is advised of this fact prior to receiving the service.

946.91(5)(b) (b) An applicant is determined to be eligible retroactively under s. 49.46 (1) (b), 49.47 (4) (d), or 49.471, a provider bills the applicant directly for services and benefits rendered during the retroactive period, the provider, upon notification of the applicant’s retroactive eligibility, submits a claim for payment under s. 49.45 for covered services or benefits rendered to the recipient during the retroactive period, and the provider reimburses the recipient or other person who has made prior payment to the provider for services provided to the recipient during the retroactive eligibility period, by the amount of the prior payment made upon receipt of payment under s. 49.45.

946.91(5)(c) (c) Benefits or services are provided for which recipient copayment, coinsurance, or deductible is required under s. 49.45 (18), not to exceed maximum amounts allowable under 42 CFR 447.53 to 447.58, or for which recipient copayment or coinsurance is required under s. 49.471 (11).

946.91(6) (6) Whoever, in connection with Medical Assistance when the cost of the services provided to the patient is paid for in whole or in part by the state, intentionally charges, solicits, accepts, or receives, in addition to any amount otherwise required to be paid under Medical Assistance, any gift, money, donation, or other consideration, other than a charitable, religious, or philanthropic contribution from an organization or from a person unrelated to the patient, as a precondition of admitting a patient to a hospital, skilled nursing facility, or intermediate care facility, or as a requirement for the patient’s continued stay in such a facility is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.

946.91 History History: 2013 a. 226 ss. 13, 17, 19, 21, 23, 25, 29, 54; Stats. 2013 s. 946.91; 2015 a. 195; 2017 a. 279.

946.92 946.92 Food stamp offenses.

946.92(1) (1) In this section:

946.92(1)(a) (a) “Eligible person” means a member of a household certified as eligible for the food stamp program or a person authorized to represent a certified household under 7 USC 2020 (e) (7).

946.92(1)(b) (b) “Food” means items that may be purchased using food stamp program benefits under 7 USC 2016 (b).

946.92(1)(c) (c) “Food stamp program” means the federal food stamp program under 7 USC 2011 to 2036a.

946.92(1)(d) (d) “Supplier” means a retail grocery store or other person authorized by the federal department of agriculture to accept food stamp program benefits in exchange for food under the food stamp program.

946.92(1)(dm) (dm) “Traffic food stamp program benefits” means to do any of the following:

946.92(1)(dm)1. 1. Buy, sell, steal, or otherwise accomplish the exchange of, directly, indirectly, in collusion with others, or individually, food stamp program benefits issued and accessed through the electronic benefit transfer program under s. 49.797, or by manual voucher and signature, for cash or other consideration that is not food.

946.92(1)(dm)2. 2. Exchange firearms, ammunition, explosives, or controlled substances, as defined in 21 USC 802, for food stamp program benefits.

946.92(1)(dm)3. 3. Use food stamp program benefits to purchase food that includes a container deposit for the sole purpose of discarding the container contents and returning the container for a cash refund of the deposit.

946.92(1)(dm)4. 4. Resell food purchased with food stamp program benefits for the purpose of obtaining cash or other consideration that is not food.

946.92(1)(dm)5. 5. Purchase, for cash or other consideration that is not food, food that was previously purchased from a supplier using food stamp program benefits.

946.92(1)(dm)6. 6. Any other action that is trafficking under 7 USC 2011 to 2036a.

946.92(1)(e) (e) “Unauthorized person” means a person who is not one of the following:

946.92(1)(e)1. 1. An employee or officer of the federal government, the state, a county, a multicounty consortium, or a federally recognized American Indian tribe acting in the course of official duties in connection with the food stamp program.

946.92(1)(e)2. 2. A person acting in the course of duties under a contract with the federal government, the state, a county, a multicounty consortium, or a federally recognized American Indian tribe in connection with the food stamp program.

946.92(1)(e)3. 3. An eligible person.

946.92(1)(e)4. 4. A supplier.

946.92(1)(e)5. 5. A person authorized to redeem food coupons under 7 USC 2019.

946.92(2) (2) 

946.92(2)(a) (a) No person may misstate or conceal facts in a food stamp program application or report of income, assets or household circumstances with intent to secure or continue to receive food stamp program benefits.

946.92(2)(b) (b) No person may knowingly fail to report changes in income, assets or other facts as required under 7 USC 2015 (c) (1) or regulations issued under that provision.

946.92(2)(c) (c) No person may knowingly issue food stamp program benefits to a person who is not an eligible person or knowingly issue food stamp program benefits to an eligible person in excess of the amount for which the person’s household is eligible.

946.92(2)(d) (d) No eligible person may knowingly transfer food stamp program benefits except to purchase food from a supplier or knowingly obtain or use food stamp program benefits for which the person’s household is not eligible.

946.92(2)(e) (e) No supplier may knowingly obtain food stamp program benefits except as payment for food or knowingly obtain food stamp program benefits from a person who is not an eligible person.

946.92(2)(f) (f) No unauthorized person may knowingly obtain, possess, transfer, or use food stamp program benefits.

946.92(2)(g) (g) No person may knowingly traffic food stamp program benefits.

946.92(3) (3) 

946.92(3)(a) (a) Whoever violates sub. (2) is subject to the following penalties:

946.92(3)(a)1. 1. If the value of the food stamp program benefits does not exceed $100, a Class B misdemeanor.

946.92(3)(a)2. 2. Except as provided in subd. 3., if the value of the food stamp program benefits exceeds $100, but is less than $5,000, a Class I felony.

946.92(3)(a)3. 3. If the value of the food stamp program benefits exceeds $100, but is less than $5,000, and the person has a prior conviction under this section, a Class H felony.

946.92(3)(a)4. 4. If the value of the food stamp program benefits is $5,000 or more, a Class G felony.

946.92(3)(b) (b) In addition to the penalties applicable under par. (a), the court shall suspend a person who violates sub. (2) from participation in the food stamp program as follows:

946.92(3)(b)1. 1. For a first conviction under this section, for not less than one year and not more than 2 years and 6 months.

946.92(3)(b)2. 2. For a 2nd conviction under this section, for not less than 2 years and not more than 3 years and 6 months.

946.92(3)(b)3. 3. For a 3rd conviction under this section, permanently.

946.92(3)(c) (c) In addition to the penalties applicable under par. (a), a court shall permanently suspend from the food stamp program a person who has been convicted of an offense under 7 USC 2024 (b) or (c) involving an item covered by 7 USC 2024 (b) or (c) having a value of $500 or more.

946.92(3)(d) (d)

946.92(3)(d)1. 1. If a person violated sub. (2) by trading a controlled substance, as defined in s. 961.01 (4), for food stamp program benefits, the court shall suspend the person from participation in the food stamp program as follows:

946.92(3)(d)1.a. a. Upon a first conviction, for 2 years.

946.92(3)(d)1.b. b. Upon a 2nd conviction, permanently.

946.92(3)(d)2. 2. If a person violated sub. (2) by trading firearms, ammunition, or explosives for food stamp program benefits, the court shall suspend the person permanently from participation in the food stamp program.

946.92(3)(e) (e) Notwithstanding pars. (b) and (c), in addition to the penalties applicable under par. (a), the court shall suspend from the food stamp program for a period of 10 years a person who violates sub. (2) by fraudulently misstating or misrepresenting his or her identity or place of residence for the purpose of receiving multiple benefits simultaneously under the food stamp program.

946.92 History History: 2013 a. 226 ss. 35, 36, 38, 41, 42, 44, 55; Stats. 2013 s. 946.92; 2015 a. 195 s. 82.

946.93 946.93 Public assistance fraud.

946.93(1) (1) In this section, “public assistance” means any aid, benefit, or services provided under ch. 49.

946.93(2) (2) Whoever intentionally makes or causes to be made any false statement or representation of material fact in any application for or receipt of public assistance is guilty of a Class A misdemeanor.

946.93(3) (3) No person may do any of the following:

946.93(3)(a) (a) Having knowledge of an event affecting the initial or continued eligibility for public assistance, conceal or fail to disclose that event with an intent to fraudulently secure public assistance, including payment either in a greater amount or quantity than is due or when no such benefit or payment is authorized.

946.93(3)(b) (b) Receive any income or assets and fail to notify the public assistance agency within 10 days after receiving the income or assets, unless a different time period is required under the applicable public assistance program.

946.93(3)(c) (c) Fail to notify the public assistance agency within 10 days of any change in circumstances for which notification by the recipient must be provided under law, unless a different time period is required under the applicable public assistance program.

946.93(3)(d) (d) Receive a voucher under a public assistance program for goods or services and use the funding granted under the voucher for purposes that are not authorized by the public assistance agency.

946.93(3)(e) (e) Whoever violates par. (a), (b), (c), or (d) is subject to the following penalties:

946.93(3)(e)1. 1. If the value of the payment or benefit does not exceed $300, a Class B forfeiture.

946.93(3)(e)2. 2. If the value of the payment or benefit is more than $300 but does not exceed $1,000, a Class B misdemeanor.

946.93(3)(e)3. 3. If the value of the payment or benefit is more than $1,000 but does not exceed $2,000, a Class A misdemeanor.

946.93(3)(e)4. 4. If the value of the payment or benefit is more than $2,000 but does not exceed $5,000, a Class I felony.

946.93(3)(e)5. 5. If the value of the payment or benefit is more than $5,000 but does not exceed $10,000, a Class H felony.

946.93(3)(e)6. 6. If the value of the payment or benefit is more than $10,000, a Class G felony.

946.93(4) (4) A person who obtains money, goods, services, or any other thing of value because he or she sends or brings a person to a county department, federally recognized American Indian tribe or band, multicounty consortium, or Wisconsin Works agency for the purpose of obtaining public assistance is guilty of a Class C misdemeanor.

946.93(5) (5) 

946.93(5)(a) (a) Whoever solicits or receives money, goods, services, or any other thing of value in return for referring an individual to a person for the furnishing or arranging for the furnishing of any item or service for which a public assistance payment may be made in whole or in part, or in return for purchasing, leasing, ordering, or arranging for or recommending purchasing, leasing, or ordering any good, facility, service, or item for which public assistance payment may be made in whole or in part, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.

946.93(5)(b) (b) Whoever offers or provides money, goods, services, or any other thing of value to any person to induce the person to refer an individual to a person for the furnishing or arranging for the furnishing of any item or service for which public assistance payment may be made in whole or in part, or to purchase, lease, order, or arrange for or recommend purchasing, leasing, or ordering any good, facility, service, or item for which public assistance payment may be made in whole or in part, is guilty of a Class H felony, except that, notwithstanding the maximum fine specified in s. 939.50 (3) (h), the person may be fined not more than $25,000.