Wisconsin In-Network Transportation Provider Checklist

presenting a preponderance of the evidence rather than meeting the higher burden ofproof that applies in criminal cases. The False Claims Act allows private individuals tobring “qui tam” actions for violations of the False Claims Act.Employee Protection• If any employee has knowledge or information that any such activity may have takenplace, the employee should notify his or her supervisor or other management official.Transportation providers must have a system in place for reporting potential violations,and such information may be reported anonymously. Federal and state law as well asLogistiCare policy prohibit any retaliation or retribution against any person who reportssuspected violations of these laws to law enforcement officials or who file lawsuits onbehalf of the government. Anyone who believes that he or she has been the subject toany such retaliation or retribution should also report this to their supervisor or otherappropriate person, as provider by their employer’s policy covering such matters.Program Fraud Civil Remedies Act of 1986The Program Fraud Civil Remedies Act of 1986 (“PFCRA”) authorizes federal agencies such asthe Department of Health and Human Services to investigate and assess penalties for thesubmission of false claims to the agency. The conduct prohibited by the PFCRA is similar tothat prohibited by the False Claims Act. For example, a person may be liable under the PFCRAfor making, presenting, or submitting, or causing to be made, presented, or submitted, a claimthat the person knows or has reason to know:• is false, fictitious, or fraudulent;• includes or is supported by any written statement that:• omits a material fact;• is false, fictitious, or fraudulent as a result of such omission; and• include such material fact; or• is for payment for the provision of property or services which the person has not providedas claimed.If a government agency suspects that a false claim has been submitted, it can appoint aninvestigating official to review the matter. The investigating official may issue a subpoena tofurther investigate, or may refer the matter to the Department of Justice for proceedings underthe False Claims Act. If, based on the investigating official’s report, an agency concludes thatfurther action is warranted, it may issue a complaint regarding the false claim. A hearingfollowing the detailed due process procedures set forth in the regulations implementing thePFCRA would be held.State False Claims ActsWisconsin NET ProgramVersion: March 25 2011Page 38