Program Integrity

Program Integrity is the process of preventing and investigating fraud and abuse. Western Wisconsin Cares is committed to operational initiatives designed to prevent, detect and correct instances of fraud and abuse.

Fraud is intentionally falsifying information or acting to deceive Medicare/Medicaid/Western Wisconsin Cares.

Abuse is when good business practices are not followed resulting in unnecessary costs or improper payments.

Examples of Fraud or Abuse:

  • Billing Medicare, Medicaid, or WWC for services or equipment that were not provided.
  • Using someone else’s Medicare/Medicaid card or number.
  • Intentionally giving false or inaccurate information to receive services someone is not eligible for.
  • A service provider asking a member to sign timesheets that are not accurate.
  • Paying a worker for services they did not complete.
  • Selling equipment WWC purchased and then requesting replacement.
  • A member giving their disposable medical supplies to someone else then requesting additional supplies.

What Can You Do To Protect Yourself?

Keep your personal information safe.

  • Medicare/Medicaid Cards
  • Social Security Cards
  • Financial documents or cards

Ask Questions

  • Review all bills and know what is billed and why.
  • Report providers who falsify information.

Know Your Resources

  • Your Western Wisconsin Cares team (nurse and care manager).
  • Western Wisconsin Cares’ Member Rights Specialist.
  • Local law enforcement.
  • Fraud and abuse hotlines.
  • Aging and Disability Resource Centers.

Fraud and Abuse Hotlines

  • MEDICARE 1-800-447-8477 TTY: 1-800-377-4950
  • WISCONSIN MEDICAID 1-877-865-3432
  • SENIOR MEDICARE PATROL  1-800-488-2596 EXT 317
  • IDENTITY THEFT 1-877-438-438  TTY 1-866-653-4261

Aging and Disability Resource Centers (ADRC)

  • ADRC of WESTERN WI (Serving Jackson, La Crosse, Monroe, and Vernon Counties) 1-800-500-3910
  • ADRC of TREMPEALEAU CO. 1-800-273-2001
  • ADRC OF CLARK, PEPIN BUFFALO CO 1-866-578-2372