reglab/statecodes huggingface dataset:
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-106 - Application for Assistance; Determination of Eligibility; Assignment of Benefits; Resources and Income Allowances Defined for Institutionalized Spouse.

42-4-106. Application for assistance; determination of eligibility; assignment of benefits; resources and income allowances defined for institutionalized spouse.
(a) Any Wyoming resident may apply for medical assistance under this chapter by filing an application by telephone, by mail, in person at the eligibility customer service center in Cheyenne, on the eligibility internet site or at a department of family services field office located in the county in which the individual resides. A determination of eligibility for medical assistance shall be based upon the application. Medical assistance shall be provided on behalf of a qualified applicant with reasonable promptness.
(b) Upon signing an application for medical assistance under this chapter, an applicant assigns to the department any right to medical support or payment for medical expenses from any other person on his behalf or on behalf of any relative for whom application is made. The assignment is effective upon a determination of eligibility. Application for medical assistance shall contain an explanation of the assignment provided under this subsection.
(c) In determining the eligibility of an institutionalized spouse for medical assistance under this chapter, the resources of the noninstitutionalized spouse shall not be considered available to the institutionalized spouse to the extent the amount of his resources does not exceed the maximum authorized by the Medicare Catastrophic Coverage Act of 1988, P.L. 100-360. For purposes of determining the amount of an institutionalized spouse's monthly income to be applied towards payment of institutional care costs, the maximum amount of allowance authorized by the Medicare Catastrophic Coverage Act of 1988, P.L. 100-360 shall be deducted from his monthly income.
(d) In any assistance program under this chapter for which income is the criterion or one (1) of the criteria for assistance payments, compensation received for a veteran's service connected disability shall not be counted in determining income if that compensation on an annual basis is not more than the poverty level for the applicant as determined by the federal office of management and budget.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-107 - Uniform Application Throughout State; Discrimination Prohibited; Pilot Projects Authorized.

42-4-107. Uniform application throughout state; discrimination prohibited; pilot projects authorized.
(a) This chapter and the state plan for medical assistance and services developed under W.S. 42-4-104(a)(ii) shall be uniformly applied within all political subdivisions of the state.
(b) The provision of medical assistance to any applicant or qualified recipient shall not be denied or delayed and the administration of this chapter shall not otherwise discriminate against any applicant or recipient on the basis of race, creed, color, national origin, sex or mental or physical handicap.
(c) Notwithstanding any other provision of this act, the department, in providing services and supplies authorized by this act, may conduct pilot projects pertaining to some or all categorically eligible individuals.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-108 - Administrative Hearings.

42-4-108. Administrative hearings.
In accordance with the Wyoming Administrative Procedure Act, the department shall provide opportunity for a hearing to any individual denied medical assistance under this chapter or otherwise aggrieved by the administration of this chapter.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-109 - Renumbered and Repealed.

42-4-109. Renumbered and Repealed.
(a) Renumbered as 42-4-207(a) by Laws 1994, ch. 73, 2.
(b) Renumbered as 42-4-207(b) by Laws 1994, ch. 73, 2.
(c) Repealed by Laws 1994, ch. 73, 3.
(d) Renumbered as 42-4-207(f) by Laws 1994, ch. 73, 2.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-110 - Charges for Inpatient Hospital Services.

42-4-110. Charges for inpatient hospital services.
A cost deduction, cost sharing or other similar charge shall not be imposed upon any recipient of medical assistance for inpatient hospital services provided on his behalf pursuant to this chapter.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-111 - Providing or Obtaining Assistance by Misrepresentation; Penalties.

42-4-111. Providing or obtaining assistance by misrepresentation; penalties.
(a) Repealed by Laws 2019, ch. 96, 3.
(b) Repealed by Laws 2019, ch. 96, 3.
(c) No person shall knowingly make a false statement or misrepresentation or knowingly fail to disclose a material fact in obtaining medical assistance under this chapter. A person violating this subsection is guilty of a misdemeanor punishable by imprisonment for not more than six (6) months, a fine of not more than seven hundred fifty dollars ($750.00), or both.
(d) Repealed by Laws 2019, ch. 96, 3.
(e) Repealed by Laws 2019, ch. 96, 3.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-112 - Confidentiality of Records; Penalty for Disclosure; Authorized Disclosure.

42-4-112. Confidentiality of records; penalty for disclosure; authorized disclosure.
(a) Any application, information and record obtained, compiled and maintained for an applicant or qualified recipient of medical assistance under this chapter is confidential and shall not be disclosed or used for any purpose other than the administration of this chapter.
(b) A violation of subsection (a) of this section is a misdemeanor.
(c) Notwithstanding subsection (a) of this section and any other provision of law to the contrary, and for purposes of ensuring any medical assistance under this act does not duplicate any benefit payment made by another state agency, insurer, group health plan, third party administrator, health maintenance organization or similar entity, the department may upon request of the state agency, insurer or similar entity, disclose information limited to a recipient's name, social security number, amount of payment, charge for services, date of services and services rendered relating to medical assistance payments made under this act. A state agency, insurer, group health plan, health maintenance organization or similar entity shall, upon request of the department, disclose the same limited information to the department. Information received under this subsection shall be used only for the purpose authorized by this subsection and shall otherwise be confidential and the state agency, insurer, group health plan, health maintenance organization or other recipient entity shall be subject to the confidentiality restrictions imposed by law upon information received to the extent required of the department. Any violation of this subsection is a misdemeanor punishable by imprisonment for not more than six (6) months, a fine of not more than seven hundred fifty dollars ($750.00), or both.
(d) Prior to receipt of any payment under this act, the department shall require an applicant for or recipient of assistance under this act to sign a waiver authorizing the release of information limited to assistance payment information to state agencies, insurers, group health plans, third party administrators, health maintenance organizations or similar entities for purposes specified by subsection (c) of this section.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-113 - Eligibility Criteria; Irrevocable Burial Trusts.

42-4-113. Eligibility criteria; irrevocable burial trusts.
(a) The department shall not consider as assets available to an applicant seeking medical assistance the corpus of a Medicaid qualifying trust:
(i) That is irrevocable;
(ii) In which the trustee and trustor retain no discretion with respect to distributions to the applicant;
(iii) In which the income from the trust shall be transferred to the applicant at least annually;
(iv) In which the trust corpus shall not exceed five thousand dollars ($5,000.00); and
(v) In which the trust corpus is specifically and irrevocably designated, assigned, or pledged for payment of the applicant's burial expenses.
(b) If any of the trust corpus remains after payment of burial expenses, that remainder shall be transferred to the department to be used in the medical assistance program.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-114 - Cooperative Agreements Authorized.

42-4-114. Cooperative agreements authorized.
The department may enter into a cooperative agreement and may contract with private attorneys to provide legal services and legal representation necessary to assist the department in enforcing its right to reimbursement created under article 2 of this chapter. The department and its contract attorneys shall have an unconditional right to intervene in any action by or on behalf of a recipient or former recipient against any third party who may be legally liable to reimburse any medical assistance provided under the Wyoming Medicaid program. If no action has been brought, the department and its contract attorneys may initiate and prosecute an independent action on behalf of the department against any third party that may be liable to the person to whom the care was furnished. If the department elects not to contract with private attorneys to provide legal services and representation under this section, the attorney general, or an appropriate county attorney, shall provide the legal services and representation.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-115 - Work Incentives Improvement Option; Purchase of Services; Eligibility Criteria; Definition.

42-4-115. Work incentives improvement option; purchase of services; eligibility criteria; definition.
(a) The department may amend the state plan for medical assistance and services developed under W.S. 42-4-104(a)(ii) to allow individuals with countable income not to exceed three hundred percent (300%) of the supplemental security income level to receive services authorized under W.S. 42-4-103(a), provided that:
(i) Repealed by Laws 2002, Ch. 31, 2.
(ii) Repealed By Laws 2002, Ch. 31, 2.
(iii) The individual is eligible to buy into the Wyoming Medical Assistance and Services Act under the federal Ticket to Work and Work Incentive Improvement Act of 1999 and subsequent similar federal enactments and the federal government is not restricted from paying its proportionate share of the individual's eligible medical expenses;
(iv) Provided that the individual's earnings do not exceed the level specified in section 201(a)(3) of the Federal Ticket to Work and Work Incentive Improvement Act of 1999; and
(v) The individual pays to the department a premium of seven and one-half percent (7.5%) of his total gross earnings from work and seven and one-half percent (7.5%) of his unearned income in excess of six hundred dollars ($600.00) per year, provided that:
(A) The total paid in premiums under this section does not exceed the yearly premium as calculated pursuant to W.S. 42-4-116; and
(B) The individual is not liable for more than the full premium calculated pursuant to W.S. 42-4-116.
(b) If the federal government does not allow a state plan amendment containing the expense limitations provided in paragraphs (a)(i) and (ii) of this section or provisions with similar fiscal effects, the state plan amendment authorized by this section shall not be implemented without specific legislative authorization.
(c) With respect to the premium received pursuant to subsection (a) of this section, the department shall deduct and forward to the federal government any amount owed under federal regulations. Any overpaid premium shall be refunded to the individual and the balance shall be deposited in the general fund. The sum of all amounts deposited under this section shall be reported in the biennial budget submissions to the joint appropriations interim committee as premium earned to offset the expenses of the program.
(d) Repealed by Laws 2015, ch. 54, 2.
(e) Repealed by Laws 2002, Ch. 31, 2.
(f) Repealed By Laws 2002, Ch. 31, 2.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-116 - Premium Calculation.

42-4-116. Premium calculation.
(a) The calculation of premium for services under W.S. 42-4-115 shall be as follows:
(i) Determine the total expenses of the Medicaid program for the most recent state fiscal year and the total number of clients in the Medicaid program served in that period;
(ii) Deduct from the totals in paragraph (i) of this subsection the clients over the age of sixty-five (65) years and the expenses associated with those clients;
(iii) Divide the resulting expenses calculated pursuant to paragraph (ii) of this subsection by the clients remaining after the deduction pursuant to paragraph (ii) of this subsection. The result is the basic annual premium;
(iv) Add to the basic premium a risk factor of fifty percent (50%) of the basic premium to recover additional costs incurred by the population eligible to be served pursuant to W.S. 42-4-115; and
(v) The premium shall be the sum of the basic annual premium calculated pursuant to paragraph (iii) of this subsection and the risk factor calculated pursuant to paragraph (iv) of this subsection.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-117 - End Stage Renal Dialysis Program; Rulemaking; Funding.

42-4-117. End stage renal dialysis program; rulemaking; funding.
(a) Effective July 1, 2001, the department shall expand coverage for services authorized under W.S. 42-4-103(a)(xxiii) for qualified individuals in need of end stage renal dialysis to the extent funding is available.
(b) The department shall by rule and regulation establish reasonable limits on services and supplies authorized under this section, including establishing eligibility criteria for receipt of services. In establishing eligibility criteria, the department shall consider financial ability of the individual or his family to contribute to the services, severity of the illness, the critical need for the services and the ability of the program to meet the needs of the individual.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-122 - Cooperation With Paternity Determination.

42-4-122. Cooperation with paternity determination.
(a) Except as otherwise provided in subsection (b) of this section, as a condition of eligibility, or continuing eligibility, for medical assistance under this chapter, a person who receives medical assistance shall cooperate in good faith with the department to:
(i) Establish the paternity of a child, including any proceeding to adjudicate parentage that is held pursuant to W.S. 14-2-801 through 14-2-823;
(ii) Obtain a child support obligation payment or other payments or property to which the state may have a claim, including recovery of birth costs paid by medical assistance pursuant to W.S. 14-2-1001 through 14-2-1008.
(b) The following persons are not required to cooperate with the department pursuant to subsection (a) of this section:
(i) A person who is pregnant, or who has been pregnant within the preceding sixty (60) days;
(ii) A person who has good cause to not cooperate with the department, as determined by rule promulgated pursuant to W.S. 14-2-1008;
(iii) A woman who has been pregnant within the preceding twelve (12) months. This paragraph is repealed effective March 31, 2027.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 1 - In General › Section 42-4-124 - Clubhouse Rehabilitation Services.

42-4-124. Clubhouse rehabilitation services.
(a) The director of the department shall include reimbursement for clubhouse rehabilitation services within the Medicaid program.
(b) Within the limits of available funding, the department may enter into contracts with certified clubhouse providers for clubhouse rehabilitation services.
(c) On or before September 1, 2019 the department shall report to the joint labor, health and social services interim committee on information, findings and recommendations related to clubhouse rehabilitation services including information to facilitate implementation of Medicaid contracts to be entered into pursuant to this section.
(d) As used in this section, "clubhouse" means a community-based psychosocial rehabilitation program that:
(i) Has members of the program, with staff assistance, engaged in operating all aspects of the clubhouse, including food service, clerical, reception, janitorial and other member services such as employment training, housing assistance and educational support; and
(ii) Is designed to alleviate a member's emotional or behavior problems with the goal of transitioning the member to a less restrictive level of care, reintegrating the member into the community and increasing social connectedness beyond a clinical or employment setting.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 2 - Medicaid Benefit Recovery › Section 42-4-201 - Action Against Third Party; Notice; Subrogation.

42-4-201. Action against third party; notice; subrogation.
(a) If a person who is or becomes an applicant or recipient for medical assistance under this chapter receives an injury under circumstances creating a legal liability in some third party, the applicant or recipient shall not be deprived of any medical assistance for which he is entitled under this chapter. He may also pursue his remedy at law against the third party. If the applicant or recipient recovers from the third party in any manner, including judgment, compromise, settlement or release, the state is entitled to be reimbursed for all payments made, or to be made, on behalf of the applicant or recipient under this chapter.
(b) The department shall be served by certified mail, return receipt requested, with a copy of the complaint within seven (7) days of its filing in any suit initiated pursuant to subsection (a) of this section. Any attorney who knowingly fails to serve the complaint on the department shall be reported to the state board of professional responsibility for the Wyoming state bar. The department shall be notified in writing by certified mail return receipt requested of any judgment, compromise, settlement or release entered into by any person who has been an applicant for or recipient of medical assistance under this chapter after the date of injury. If there is a settlement, compromise or release entered into by the parties the attorney general representing the director shall be made a party in all negotiations for settlement, compromise or release. The department, for purposes of facilitating compromise and settlement, may in a proper case authorize acceptance by the state of less than the state's claim for reimbursement under this section for all current and future assistance under this chapter. Any reimbursement right created pursuant to this article shall remain in effect until the state is paid the amount authorized under this section. In addition the person paying the settlement remains liable to the state's reimbursement right unless the state through the attorney general signs the release prior to payment of an agreed settlement.
(c) If the injury causes death of the recipient, the rights and remedies in this section inure to, and the obligations are binding upon the personal representative of the deceased recipient for the benefit of his dependents.
(d) Repealed By Laws 2002, Ch. 39, 2.
(e) If, after notice is provided in accordance with this section, the department states in writing that it will neither file an independent action nor intervene in an existing action as allowed by W.S. 42-4-114, the department's reimbursement right shall be reduced by not more than thirty-three percent (33%) for attorney's fees together with the amount of its proportionate share of costs. If the department does not provide this written statement, its right to reimbursement shall not be reduced by any share of the recipient's attorney's fees or costs.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 2 - Medicaid Benefit Recovery › Section 42-4-203 - Settlement Between Recipient and Tortfeasor or Insurer; Lien Not Discharged; Exceptions.

42-4-203. Settlement between recipient and tortfeasor or insurer; lien not discharged; exceptions.
(a) No settlement made by and between the applicant or recipient and the tortfeasor or insurer shall discharge the right to reimbursement created pursuant to this article, against any money due or owing by such tortfeasor or insurer to the applicant or recipient or relieve the tortfeasor or insurer from liability by reason of the right to reimbursement unless the settlement also provides for the payment and discharge of the right to reimbursement and the attorney general has signed a written release as provided by W.S. 42-4-201(b).
(i) Repealed By Laws 2002, Ch. 39, 2.
(ii) Repealed By Laws 2002, Ch. 39, 2.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 2 - Medicaid Benefit Recovery › Section 42-4-205 - Insurance Policy Termination Notification Requirement.

42-4-205. Insurance policy termination notification requirement.
(a) With respect to cases for which there is an assignment in effect pursuant to W.S. 42-4-204:
(i) The department, upon receipt of the health coverage information, shall notify the obligor's insuring entity that the department shall be notified thirty (30) days prior to discontinuance of coverage;
(ii) Entities providing health insurance as defined in title 26 and health maintenance organizations and prepaid health clinics as defined in W.S. 26-34-102 shall upon request by the department, provide a list of insureds residing in the state and any records and information as necessary to accomplish the purpose of this section, unless the requirement results in an unreasonable burden;
(iii) The department and the insurance commissioner appointed pursuant to W.S. 26-2-102 shall enter into a cooperative agreement for requesting and obtaining information necessary to effect the purpose and objectives of this section;
(iv) The department shall only request information from the entity providing health insurance necessary to determine whether health insurance, as defined pursuant to title 26 or those health services provided pursuant to W.S. 26-34-102, are discontinued;
(v) The department, in consultation with the department of insurance, shall promulgate rules for the development and administration of the cooperative agreement. The rules shall include the following:
(A) A method for identifying those entities subject to furnishing information under the cooperative agreement;
(B) A method for furnishing requested information; and
(C) Procedures for requesting exemption from the cooperative agreement based on an unreasonable burden to the reporting entity.
(vi) If the department notifies the insurer that it has made payments to the provider, payment of benefits or notices of denial issued by the insurer shall be made directly to the department.
(b) Upon the department receiving notice from the obligor's insuring entity that the coverage is discontinued due to cancellation for any reasons, the department shall retain that information for use in enforcing any court order requiring the obligor to provide health insurance to the individuals stated in the court order.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 2 - Medicaid Benefit Recovery › Section 42-4-208 - Recovery for Cost of Health Care.

42-4-208. Recovery for cost of health care.
(a) The department, to the extent necessary to reimburse its costs, shall be entitled to recover from any parent who:
(i) Is required by court or administrative order to provide coverage of the cost of health services to a child eligible for medical assistance under this act; and
(ii) Has received payment from a third party for the costs of such services but has not used the payments to reimburse either the other parent or guardian of the child or the provider of the services.
(b) The department shall be entitled to enforce any judgment entered pursuant to this section by garnishment or any other available statutory remedy.
(c) Claims for current and past due child support shall take priority over claims made under this section.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 3 - False Medicaid Claims › Section 42-4-302 - Definitions.

42-4-302. Definitions.
(a) As used in this act:
(i) "Claim" means any request or demand under the Medicaid program, whether under a contract or otherwise, for money, property or services that:
(A) Is presented to an officer, employee or agent of the state or a political subdivision of the state; or
(B) Is made to a contractor, grantee or other recipient, if the money or property is to be spent or used on the state's behalf or to advance a state program or interest, and if the state provides or has provided any portion of the money or property requested or demanded.
(ii) "Material statement" means a statement that affects the payment or receipt of money or property;
(iii) "This act" means W.S. 42-4-301 through 42-4-306.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 3 - False Medicaid Claims › Section 42-4-303 - Acts Subjecting Person to Treble Damages; Costs and Civil Penalties; Exceptions.

42-4-303. Acts subjecting person to treble damages; costs and civil penalties; exceptions.
(a) Except as provided in subsection (c) of this section, any person who commits any of the following acts in relation to the Wyoming Medicaid program shall be liable to the state for three (3) times the amount of damages which the state sustains because of the act of that person. A person who commits any of the following acts shall also be liable to the state for the costs of a civil action brought to recover any penalties or damages provided in this subsection, and shall be liable to the state for a civil penalty of not less than one thousand dollars ($1,000.00) and not more than ten thousand dollars ($10,000.00) for each violation:
(i) Knowingly presents or causes to be presented a false or fraudulent claim for payment or approval;
(ii) Knowingly makes, uses or causes to be made or used, a false record or statement material to a false or fraudulent claim;
(iii) Is a beneficiary of an inadvertent submission of a false claim to any employee, officer or agent of the state or a political subdivision of the state, or to any contractor, grantee or other recipient of state funds or funds of any political subdivision of the state, who subsequently discovers the falsity of the claim and fails to disclose the false claim and make satisfactory arrangements for repayment to the state or affected political subdivision within ninety (90) days after discovery of the false claim;
(iv) Conspires to commit a violation of paragraph (i), (ii) or (iii) of this subsection.
(b) Notwithstanding subsection (a) of this section, the court may assess not more than two (2) times the amount of damages which the state sustains because of the act in violation of subsection (a) of this section, and no civil penalty, if the court finds all of the following:
(i) The person committing the violation furnished officials of the state who are responsible for investigating false claims violations with all information known to that person about the violation within forty-five (45) days after the information is requested; and
(ii) The person has substantially cooperated with any investigation by the state.
(c) The provisions of subsections (a) and (b) of this section shall not apply to a recipient as defined by W.S. 42-1-101(a)(v). Any recipient who knowingly:
(i) Presents or causes to be presented a false or fraudulent claim shall be liable to the state for the amount of damages which the state sustains because of the claim and shall be liable for a civil penalty of not more than one thousand dollars ($1,000.00);
(ii) Violates paragraph (i) of this subsection a second or subsequent time shall be liable to the state for three (3) times the amount of damages which the state sustains because of the claim and shall be liable for a civil penalty of not more than one thousand dollars ($1,000.00).
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 3 - False Medicaid Claims › Section 42-4-304 - Investigations and Prosecutions; Powers of Prosecuting Authority; Remedies for Retaliation; Venue; No Private Right of Action.

42-4-304. Investigations and prosecutions; powers of prosecuting authority; remedies for retaliation; venue; no private right of action.
(a) The Medicaid fraud control unit created by W.S. 42-4-403 or a district attorney may investigate alleged violations of W.S. 42-4-303(a) and (c). If the Medicaid fraud control unit or district attorney finds that a person has violated or is violating W.S. 42-4-303(a) or (c), the unit or district attorney may bring a civil action under this section against that person.
(b) Any employee, contractor or agent of a person being investigated for a violation of W.S. 42-4-303(a) shall be entitled to recover all economic damages suffered if that employee, contractor or agent is discharged, demoted, suspended, threatened, harassed or in any other manner retaliated against in the terms and conditions of employment because of lawful acts taken in good faith by the employee or others in an action reported, filed or investigated under this act. An action by an employee, contractor or agent under this subsection shall not be brought more than three (3) years after the date when the retaliation occurred. A person may bring an action in the appropriate district court for the relief provided in this subsection. This subsection shall not otherwise be construed to create a private cause of action for violations of this act and is limited to the remedies expressly created by this subsection related to employment retaliation.
(c) Except as provided in subsection (b) of this section, any action under this act may be brought in the district court of any county in which the defendant, or any of them, resides. If the defendant is not a resident of the state of Wyoming, the action shall be brought in the first judicial district court in Laramie County.
(d) Except as provided in subsection (b) of this section, nothing in this act shall be construed to create a private cause of action.
(e) The remedies provided in this act are separate from and additional to any remedies available under the State Government Fraud Reduction Act.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 3 - False Medicaid Claims › Section 42-4-305 - Limitation of Actions; Retroactivity; Burden of Proof.

42-4-305. Limitation of actions; retroactivity; burden of proof.
(a) A civil action under W.S. 42-4-304(a) shall not be brought more than six (6) years after the date on which the violation was committed or more than three (3) years after the date when facts material to the right of action are known or reasonably should have been known by the official of the state charged with responsibility to act in the circumstances, whichever occurs last, provided that in no event shall a civil action be brought more than seven (7) years after the date on which the violation is committed.
(b) In any action brought under W.S. 42-4-304(a), the state shall be required to prove all essential elements of the cause of action, including damages, by clear and convincing evidence.
(c) Notwithstanding any other provision of law, a guilty verdict rendered in a criminal proceeding charging false statements or fraud is admissible in any civil action which involves the same transaction as in the criminal proceeding and which is brought under W.S. 42-4-304.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 3 - False Medicaid Claims › Section 42-4-306 - Remedies Under Other Laws; Liberality of Construction; Joint and Several Liability.

42-4-306. Remedies under other laws; liberality of construction; joint and several liability.
(a) The provisions of this act are not exclusive, and the remedies provided for in this act shall be in addition to any other remedies provided for in any other law or available under common law.
(b) Liability pursuant to this act is joint and several for any violation done by two (2) or more persons.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-402 - Definitions.

42-4-402. Definitions.
(a) As used in this act:
(i) "Claim" means as defined in W.S. 42-4-302(a)(i);
(ii) "Provider" means a person who furnishes services or supplies for which payment is claimed under Medicaid;
(iii) "Record" means information in physical or electronic form relating to:
(A) The treatment or care of any patient;
(B) A service or supply provided to a Medicaid recipient;
(C) Rates paid for a service or supply;
(D) Any other information required to be kept by rule of the Medicaid program.
(iv) "Unit" means the Medicaid fraud control unit created by this act to investigate and prosecute fraud, waste, abuse, bribery, kickback and related cases under Medicaid;
(v) "This act" means W.S. 42-4-401 through 42-4-412.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-403 - Medicaid Fraud Control Unit Created; Duties.

42-4-403. Medicaid fraud control unit created; duties.
(a) The Medicaid fraud control unit is recognized and continued in existence within the office of the attorney general. The unit shall conduct a statewide program for investigating and prosecuting violations of all applicable state laws pertaining to fraud in the administration of the Medicaid program and the provision of services or supplies, or the activities of providers of services or supplies, under the state Medicaid plan. The unit may also conduct criminal investigations and prosecutions relating to patient abuse, neglect, exploitation and other violations of law, if the violation is primarily connected to Medicaid.
(b) The office of the attorney general shall employ attorneys, auditors, agents and other personnel which are necessary to carry out the duties specified in this act in an effective and efficient manner. Agents employed under this subsection shall have the qualifications and powers of an agent under W.S. 9-1-611(b)(i).
(c) The unit may file criminal charges without consultation with another person or entity outside the office of the attorney general. Before the filing of criminal charges under this act, the unit may consult with the district attorney of the judicial district in which the prosecution would take place. If the district attorney, after consultation, concurs with the decision to file criminal charges, the unit may refer the case to the district attorney. A district attorney may request that the unit assign an attorney to assist with prosecution under this act.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-404 - Access to Records.

42-4-404. Access to records.
(a) Notwithstanding any other provision of law, the unit shall have full access to all records held by a provider or by another person or entity acting on the provider's behalf, if the unit determines that such information is material to its duties under this act. A provider, or another person or entity acting on the provider's behalf, shall promptly comply with a request from the unit for access to records.
(b) The unit shall avoid disclosure of personally identifiable information concerning any patient received in the course of an investigation, except as authorized by this section. The unit may transmit personally identifiable information to authorized persons, consistent with federal law, including governmental entities responsible for oversight of the health care system, benefit programs or the regulation of health care facilities or health care providers. The unit may also disclose information under this section as otherwise permitted or required by law.
(c) No provider or other person or entity holding records required to be made available to the unit under this section may refuse to provide access on the basis that release would violate any right of privacy, privilege against disclosure or use or any other grounds for nondisclosure.
(d) Nothing in this section shall be interpreted to limit the authority of the unit to use other legal processes to conduct investigations and prosecutions authorized by this act or other provisions of law.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-405 - Reporting to Unit.

42-4-405. Reporting to unit.
The department of health, department of family services, health care licensing boards, state agencies and the agents, contractors and subcontractors of these entities shall refer to the unit all cases where reasonable cause likely exists that fraud, waste, abuse, bribery or kickbacks relating to Medicaid has occurred, is occurring or will occur, as well as suspected cases of patient abuse, neglect or exploitation under Medicaid.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-406 - Fraud and False Statements; Criminal Penalty.

42-4-406. Fraud and false statements; criminal penalty.
(a) In relation to the delivery of or payment for services or supplies under Medicaid, a person shall not knowingly, in whole or in part:
(i) Make or cause to be made a false or fraudulent claim;
(ii) Deliberately conceal a material fact;
(iii) Make or cause to be made a false statement or misrepresentation which will be used by another person;
(iv) Execute a scheme or artifice to commit fraud.
(b) A person who violates subsection (a) of this section is guilty of:
(i) A misdemeanor punishable by imprisonment of not more than six (6) months, a fine of not more than seven hundred fifty dollars ($750.00), or both, if the amount of the claims for services or supplies under Medicaid is less than one thousand dollars ($1,000.00); or
(ii) A felony punishable by imprisonment for not more than ten (10) years, a fine of not more than ten thousand dollars ($10,000.00), or both, if the amount of the claims for services or supplies under Medicaid is one thousand dollars ($1,000.00) or more.
(c) The department of health shall ensure that the following documents contain a statement, under penalty of perjury and signed by the responsible provider, that all matters stated therein are true and accurate:
(i) An application to become a Medicaid provider;
(ii) All reports stating income or expenses upon which rates of payment by the department of health may be based; and
(iii) Each invoice for payment of a service or supply provided to a person eligible for Medicaid.
(d) A person commits perjury if the person signs or submits, or causes to be signed or submitted a statement under subsection (c) of this section, knowing that the application, report or invoice contains information that is false, in whole or in part. Perjury under this subsection shall be punished as specified in W.S. 6-5-301(b).
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-407 - Kickbacks, Bribes, Undisclosed Payments, Referral Fees and Illegal Copayments; Criminal Penalty; Exception.

42-4-407. Kickbacks, bribes, undisclosed payments, referral fees and illegal copayments; criminal penalty; exception.
(a) A person shall not knowingly, in whole or in part:
(i) Act on behalf of a provider to purchase or lease a service or supply for which payment may be made, in whole or in part, under Medicaid and then solicit or accept anything of additional value in connection with the purchase or lease;
(ii) Sell or lease to a provider a service or supply for which payment may be made, in whole or in part, under Medicaid, and offer, transfer or pay anything of additional value in connection with the sale or lease;
(iii) Refer an individual to a provider for the provision of a service or supply for which payment may be made, in whole or in part, under Medicaid, and solicit or accept anything of value in connection with the referral;
(iv) Act on behalf of a provider to charge, solicit, accept or receive anything of value in addition to the amount payable for a service or supply under Medicaid.
(b) A violation of subsection (a) of this section is a felony punishable by imprisonment of not more than five (5) years, a fine of not more than ten thousand dollars ($10,000.00), or both.
(c) A person does not commit a violation of paragraph (a)(i) or (ii) of this section in cases where the additional value transferred is a refund or discount made in the ordinary course of business and is reflected by the records of the person within a reasonable period of time after the transfer of value.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-408 - Failure to Maintain Records; Destruction of Records; Penalty.

42-4-408. Failure to maintain records; destruction of records; penalty.
(a) A person, after submitting a claim or receiving a payment for a service or supply under Medicaid, shall not knowingly fail to maintain records required under Medicaid, including records that fully disclose the nature of the services or supplies provided to a recipient.
(b) A person who violates subsection (a) of this section is guilty of:
(i) A misdemeanor punishable by imprisonment for not more than thirty (30) days, a fine of not more than seven hundred fifty dollars ($750.00), or both, if:
(A) The claims for which records were not maintained are less than twenty-five percent (25%) of the Medicaid claims submitted by the provider in any consecutive three (3) month period; and
(B) The amount of the claims for which records were not maintained is five thousand dollars ($5,000.00) or more.
(ii) A misdemeanor punishable by imprisonment for not more than six (6) months, a fine of not more than one thousand dollars ($1,000.00), or both, if:
(A) The claims for which records were not maintained are twenty-five percent (25%) or more of the Medicaid claims submitted by the provider in any consecutive three (3) month period; and
(B) The amount of the claims for which records were not maintained is five thousand dollars ($5,000.00) or more.
(iii) A felony punishable by imprisonment for not more than five (5) years, a fine of not more than ten thousand dollars ($10,000.00), or both, if:
(A) The person intended to defraud Medicaid and the claims for which records were not maintained are twenty-five percent (25%) or more of the Medicaid claims submitted by the provider in any consecutive three (3) month period; and
(B) The amount of the claims for which records were not maintained is five thousand dollars ($5,000.00) or more.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-409 - Aggregation of Claims in Certain Cases.

42-4-409. Aggregation of claims in certain cases.
The amount of claims relating to violations of this act through a common scheme, or based on the same transaction or occurrence, may be aggregated to determine the level of penalty under this act, whether or not the claims were made as part of the same claim under Medicaid.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-410 - Suspension or Exclusion as Provider.

42-4-410. Suspension or exclusion as provider.
(a) The department of health or the department of family services may suspend or exclude a provider from providing services and supplies under Medicaid if:
(i) The department determines that the provider has committed an offense under this act or the Wyoming Medicaid False Claims Act, whether or not a criminal prosecution is brought under this act or any civil action is brought under the Wyoming Medicaid False Claims Act; or
(ii) A provider fails to provide the unit with access to records pursuant to W.S. 42-4-404(a).
(b) Any term of suspension or exclusion under this section, which may be permanent, shall be determined by the department of health or the department of family services.
(c) The department of health and the department of family services may adopt rules necessary to implement this section.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-411 - Provisions of Act Not Exclusive Remedies.

42-4-411. Provisions of act not exclusive remedies.
The provisions of this act shall not be exclusive and do not preclude the use of any other criminal or civil remedy as authorized by law.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 4 - Medical Assistance and Services › Article 4 - Medicaid Fraud Control › Section 42-4-412 - Rules.

42-4-412. Rules.
The attorney general, in consultation with the department of health, may adopt rules to implement W.S. 42-4-401 through 42-4-409 and 42-4-411.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 5 - Family Planning and Birth Control › Section 42-5-101 - Provision of Information and Services; Refusal to Accept.

42-5-101. Provision of information and services; refusal to accept.
(a) The department of health may provide and pay for family planning and birth control information and services including interviews with trained personnel, distribution of literature, referral to a licensed physician for consultation, examination, tests, medical treatment and prescription and to the extent prescribed, the distribution of rhythm charts, drugs, medical preparation, contraceptive devices and similar products, to any person who may benefit from this information and these services. Information and services shall be provided in a language understood by the recipient.
(b) Any medical service shall be performed by a licensed physician.
(c) The right to receive public assistance and social services or any other public benefit shall not be affected by a refusal to accept family planning and birth control services. Each person offered family planning and birth control services shall be advised of this subsection both orally and in writing.
(d) Any person may refuse to accept the duty of offering family planning and birth control services to the extent the duty is contrary to his personal or religious beliefs. The refusal shall not be grounds for:
(i) Any disciplinary action;
(ii) Dismissal;
(iii) Any departmental transfer;
(iv) Any other discrimination in employment;
(v) Suspension from employment; or
(vi) Any loss in pay or other benefits.
2023 Wyoming Statutes › Title 42 - Welfare › Chapter 5 - Family Planning and Birth Control › Section 42-5-102 - Statutory Interpretation.

42-5-102. Statutory interpretation.
(a) Nothing in W.S. 42-5-101 shall be interpreted to:
(i) Interfere with a person's religious beliefs;
(ii) In any way abridge the right to accept or refuse family planning and birth control services;
(iii) Impose practices offensive to a person's moral standards; or
(iv) Restrict self-determination in the procreation of children.