State of Wisconsin Department of Health Services

Release 24-03 December 18, 2024

View History

20.4 Questionable Items

20.4.1 Questionable Items Introduction

Information is questionable when:

1. There are inconsistencies in the group’s oral or written statements.
2. There are inconsistencies between the group’s claims and collateral contacts, documents, or prior records.
3. The memberA recipient of Medicaid; formerly referred to as a "client." or his or her representative is unsure of the accuracy of his or her own statements.
4. The member has been convicted of Medicaid member fraud or has legally acknowledged his or her guilt of member fraud.
5. The member is a minorA minor is a person less than age 18. who reports that he or she is living alone. This does not apply to minors applying solely for FPOSFamily Planning Only Services.
6. Unclear or vague (i.e., information provided, but not clear).

20.4.2 Tuberculosis

See BadgerCare Plus Handbook, Chapter 43 Tuberculosis-Related Medicaid for appropriate verification items if information provided is questionable.

20.4.3 Farm and Self-Employment Income

See Section 15.6.6 Verification for appropriate verification items if information provided is questionable.

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The information concerning the Medicaid program provided in this handbook release is published in accordance with: Titles XI and XIX of the Social Security Act; Parts 430 through 481 of Title 42 of the Code of Federal Regulations; Chapters 46 and 49 of the Wisconsin Statutes; and Chapters HA 3, DHS 2, 10 and 101 through 109 of the Wisconsin Administrative Code.

Notice: The content within this manual is the sole responsibility of the State of Wisconsin's Department of Health Services (DHS). This site will link to sites outside of DHS where appropriate. DHS is in no way responsible for the content of sites outside of DHS.

Publication Number: P-10030