Wisconsin Administrative Code › Department of Health Services › DHS 101-109 - Medical Assistance › Chapter DHS 108 - General Administration › Section DHS 108.03 - County responsibilities

Current through June 24, 2024
(1) DETERMINATION
				OF ELIGIBILITY. Agencies shall be responsible for determination of eligibility
				for MA. These determinations shall comply with standards for eligibility found
				in ss. 49.46 (1),
				49.47 (4), and
				49.665 (4),
				Stats., and ch. DHS 103.
(2)
				INFORMING RECIPIENTS OF RIGHTS AND DUTIES. Agencies shall inform recipients of
				the recipients' rights and duties under the program, including those rights
				enumerated in s.
				DHS
				106.04(3).
(3) RECOVERY OF INCORRECT PAYMENTS.
(a) Agencies shall begin recovery action, as
				provided by statute for civil liabilities, on behalf of the department against
				any MA recipient to whom or on whose behalf an incorrect payment was
				made.
(b) The incorrect payment
				shall have resulted from a misstatement or omission of fact by the person
				supplying information during an application for MA benefits, or failure by the
				recipient, or any other person responsible for giving information on the
				recipient's behalf, to report income or assets in an amount which would affect
				the recipient's eligibility for benefits.
(c) The amount of recovery may not exceed the
				amount of the MA benefits incorrectly provided.
(d) Records of payment for the period of
				ineligibility, provided to the agency by the MA fiscal agent, shall be evidence
				of the amounts paid on behalf of the recipient.
(e) The agency shall notify the recipient or
				the recipient's representative of the period of ineligibility and the amounts
				incorrectly paid, and shall request arrangement of repayment within a specified
				period of time.
(f) If the effort
				to recover incorrect payments under par. (e) is not successful, the agency
				shall refer cases of possible recovery to the district attorney or corporation
				counsel for investigation and the district attorney or corporation counsel may
				bring whatever action may be appropriate for prosecution for fraud or
				collection under civil liability statutes. Judgments obtained in these actions
				shall be filed as liens against property in any county in which the recipient
				is known to possess assets, if not satisfied at the time the judgment or order
				for restitution is rendered. Execution may be taken on the judgments as
				otherwise provided in statute.
(g)
				The agency may seek recovery through an order for restitution by the court of
				jurisdiction in which the recipient or former recipient is being prosecuted for
				fraud.
(h) The agency's decision
				concerning ineligibility and amounts owed may be appealed pursuant to ch. HA 3.
				During the appeal process the agency may take no further recovery actions
				pending a decision. Benefits shall be continued pending the decision on the
				appeal. When the hearing decision is subsequently adverse to the client the
				benefits paid pending a decision on the appeal shall be collectable as
				incorrect payments.
(i) The agency
				shall immediately deposit monies collected under this subsection to a
				designated bank account. The collection shall be reported to the department in
				the manner and on forms designated by the department within 30 days following
				the end of the month in which the collection is made, and shall be transmitted
				to the state in accordance with departmental instructions.