DHS Beefs Up Fraud Prevention Efforts

Gov. Walker has directed the Wisconsin Department of Health Services (DHS) to evaluate and implement six strategies strengthening the state’s public assistance programs by increasing fraud prevention and giving DHS access to more information that it can use to verify individuals and families are eligible for public assistance benefits.

Gov. Walker’s six strategies for increasing fraud prevention and detection include:

  • Strategy One: Pilot a front-end verification project at Milwaukee Enrollment Services (MilES) to review all applications in which an applicant indicates a household member is self-employed to determine if any additional proof is needed before the case is fully processed.
  • Strategy Two: Develop an Error Prone Profile module for the Department’s public assistance eligibility determination, CARES, that will identify at the time of application cases that need further verification or additional investigation before the case can be fully processed. Wisconsin’s SeniorCare Program has an Error Prone Profile established that has been successful in flagging cases that need additional review.
  • Strategy Three: Require all BadgerCare Plus and FoodShare members and applicants, who indicate they have self-employment income, to submit their tax returns for income verification or sign IRS form 4506-T that will give the Department permission to request a transcript of the individual or family’s tax return to verify the income the individual or family reported to the IRS. Current program guidelines do not require self-employed applicants or members to submit a tax return for a business, if it has been established for less than six months. Implementing this option would require self-employed applicants or members to submit tax returns at application, renewal, or when there has been a significant change in circumstances, regardless of how long the business has been established.
  • Strategy Four: Evaluate and implement additional data exchanges to maximize the information that individuals provide to all State agencies. The Department would evaluate connecting the Department’s public assistance eligibility determination system, CARES, to databases maintained by the Register of Deeds, Department of Revenue, Department of Workforce Development, Department of Veterans Affairs, Department of Transportation, Department of Financial Institutions, Department of Administration, and the Department of Natural Resources.
  • Strategy Five: Create a Recipient Fraud and Abuse Prevention Task Force to include the Department of Health Services, Department of Children and Families, Wisconsin Department of Justice and other state, federal, and local representatives. The structure of this task force would be similar to the Health Care Fraud Task Force that is convened by the United States Attorneys and the Nursing Home Fraud and Abuse Task Force.
  • Strategy Six: Require an asset test – property, liquid assets, and vehicles – for FoodShare applicants and members. The Department will not be able to require the asset test for BadgerCare Plus members because under federal rules related to the Affordable Care Act, states cannot test the assets of non-elderly, non-disabled Medicaid members.

While DHS will evaluate additional options for fraud detection and prevention as it moves forward with implementing these strategies and works to comply with requirements of the federal Affordable Care Act.

DHS will provide an update quarterly about its progress in implementing Governor Walker’s recommendations in the Department’s Quarterly Report to the Joint Committee on Finance.

Additional information about the Department of Health Services Office of the Inspector General, including monthly data about the OIG’s success in tracking and preventing waste, fraud, and abuse is available at: www.dhs.wisconsin.gov/fraud/index.htm

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