Fraud: Identification and Prevention

Casey Wheeler

Fraud Specialist

Fraud is not a victimless crime. Fraud violates all of the taxpayers who support state and federal long-term care programs. We all have the responsibility to look for fraud and protect the integrity of the programs and people we serve.

What is fraud?

Fraud is the wrongful or deceptive intention to make financial or personal gain. With the pressures in today’s society, some people feel that the only way they can make ends meet is to commit an act of fraud. They rationalize their intentions by thinking that they deserve this money and that their actions do not hurt anybody. Once they see an opportunity to commit fraud, they take it. Unfortunately, a single act of fraud often leads to additional violations.  Fraud’s short-term benefits bring serious long-term consequences, including felony charges, large fines and restitution.

What is the most common form of fraud we see?

The most common fraud we currently see is billing for hours that are not worked. How does this work?

• The program participant makes a deal with one of their employees.
• The employee records more hours than they actually worked (if worked at all).
• The employee gives the participant the money resulting from the extra hours being billed.

Sometimes participants think their allocation is their money. It is not. The allocation reflects the amount of services that the participant is able to receive within that given total.

What can we do to prevent fraud?

There are many ways we can help program participants understand fraud.  Within IRIS, the state of Wisconsin’s self-directed care program, care consultants meet with their assigned participants and complete a participant education form. Once the participant has gone over the material and understands it, they sign the form so all parties can be on the same page.

As a financial management services provider, we educate participants about fraud.  Resources like this info-graphic give participants the information and knowledge to successfully self-direct their services.

Looking out for fraud and reporting suspected activity protects people receiving care, supports those providing care, and strengthens the integrity of long-term care programs.

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Participant Liaisons in Long-Term Care Programs

Julie Peterson

Participant Liaison

I come from a caregiving background. In 2010, I began working for two participants in IRIS, the state of Wisconsin’s self-directed long-term care program. During that time, I saw the positive impact IRIS has on their lives. I could see how the program could be improved, too. To bring about these improvements, I joined the iLIFE staff as a participant liaison.

What is a participant liaison? What does a participant liaison do?

Participant liaisons are responsible for serving consumers in the IRIS program. Liaisons work in specific service areas, which for me is northwest Wisconsin.

From my office in Rice Lake, I am available to participants in my region, along with their caregivers, consultants and vendors. They call or email me, and I work with them to get the help and information they need to navigate the IRIS program.

Working in a regional office allows me to see things from the viewpoint of our clients. I meet consumers face-to-face, understand their issues, and develop personal relationships. It is an effective way to improve customer service and educate consumers on self-direction.

When someone contacts me for help, I work as quickly as I can to resolve the issue. I also take note of other things that may need attention. This includes:

• verifying participant and caregiver contact information
• updating participant caregiver lists
• answering budget questions
• educating consumers about program guidelines

I truly consider it a privilege to serve IRIS consumers as a participant liaison. It is a rewarding role that helps consumers, and makes a great self-directed program even better.

Learn more about iLIFE

Read about the Wisconsin IRIS program