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The Medicaid Fraud Control and Elder Abuse Unit (MFCEAU) within the Wisconsin Department of Justice is a 75% federally-funded unit with statewide authority that investigates and prosecutes Medicaid provider fraud as well as abuse, neglect, and financial misappropriation of patients in nursing homes and other board and care facilities.
The MFCEAU is comprised of Assistant Attorneys General, sworn and non-sworn investigators, analysts, and support staff who work together to develop investigations and prosecute cases.
The MFCEAU works regularly with federal, state, and local law enforcement agencies to combat fraud, protect our most vulnerable citizens, and save taxpayer dollars. The MFCEAU has the resources and expertise to assist with county and local law enforcement investigations and District Attorney prosecutions.
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- A doctor billing Medicaid for X-rays, tests, and other procedures that were never performed, or falsifying a patient’s diagnosis to justify unnecessary tests
- A pharmacist giving a Medicaid customer a generic drug and billing instead for the name brand version of the medication
- A home health agency billing Medicaid for care not given, billing while the patient was in the hospital or after the patient had died, or inflating how much care a patient needs
- An orthodontist billing Medicaid for braces that were never applied
- Selling Medicaid prescriptions or access to prescription drugs for the purpose of abuse or misuse
- Falsely inflating reimbursement rates for large institutions such as nursing homes, hospitals, or clinics by falsifying financial reports on which the rates are set
- Cheating patients by demanding cash payments on the side for services insured by Medicaid
- Billing for services not rendered or “upcoding” by billing Medicaid for more expensive procedures than those that are actually performed
- Overbilling for services paid by the hour—such as private duty nursing—by submitting false time records
- Billing for board and care when an Adult Family Home resident has eloped or been hospitalized
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The Wisconsin MFCEAU receives referrals from a variety of local, state, and federal agencies, including local law enforcement agencies, District Attorney Offices, the Wisconsin Department of Health Services, the Wisconsin Department of Safety and Professional Services, and the United States Department of Health and Human Services.
You may report suspected Medicaid provider fraud by sending a detailed email to WIMedicaidFraud@doj.state.wi.us or calling the statewide hotline number at 1-800-488-3780.
Medicaid Fraud Control Basics
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The MFCEAU investigates Medicaid provider fraud. You may report suspected Medicaid provider fraud by sending a detailed email to WIMedicaidFraud@doj.state.wi.us or calling the statewide hotline number at 1-800-488-3780
The MFCEAU only pursues Medicaid recipient fraud when the fraud was committed in collusion with a Medicaid provider who was also defrauding the program.
“Medicaid providers” are the doctors, dentists, and other health care professionals who provide services to people who receive Medicaid.
“Medicaid recipients” are the people who receive Medicaid benefits. Medicaid recipients can also defraud Medicaid by misrepresenting their household size and income to falsely claim eligibility for Medicaid benefits, for example.
The Wisconsin Department of Health Services, Office of the Inspector General (DHS) and local district attorneys have jurisdiction to prosecute Medicaid recipients who have defrauded Medicaid, whether the fraud was coordinated with the Medicaid provider or not.
Allegations of Medicaid recipient fraud can be reported to DHS’s Report Fraud website or its Public Assistance Fraud hotline number, 1-877-865-3432.
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The MFCEAU's jurisdiction is limited to allegations of patient abuse, neglect, or financial misappropriation. The patient must be a resident of a health care facility or board and care facility (ex: nursing home, assisted living, adult family home, etc.)
To report allegations that meet this definition, send a detailed email to WIMedicaidFraud@doj.state.wi.us or call the Wisconsin Elder Abuse Hotline: 1-833-586-0107
For all other complaints:
- To report abuse in a nursing home or other long term care facility, contact the Department of Health Services, Division of Quality Assurance
- To report abuse of an adult at risk (age 18 to 59), call your county helpline
- To report abuse of an elder (age 60 plus), call your county helpline or the Wisconsin Elder Abuse Hotline: 1-833-586-0107
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Wisconsin Medicaid is a joint federal and state program that provides health care coverage, long-term care, and other health care services to over one million poor, disabled, and elderly Wisconsin residents. There are many types of Medicaid programs. Each program has different requirements, such as age and income qualifications, that must be met before a person becomes eligible for the program. BadgerCare is an example of a large Wisconsin Medicaid program.
On the other hand, Medicare is a federally funded health insurance program for individuals age 65 or older, individuals under age 65 with certain disabilities, and individuals of all ages with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a kidney transplant). The MFCEAU has jurisdiction to investigate Medicare fraud only with the consent of the Office of the Inspector General of the United States Department of Health and Human Services and only if the case as a whole is primarily related to Medicaid. To report Medicare fraud, click here