Provider Compliance & Privacy

Member Privacy at Care Wisconsin

Federal and state laws require Care Wisconsin and all of our providers to protect the privacy of our members. We are committed to only sharing information with others who have the legal right and the need to know.

If the federal and state laws do not typically apply to you, Care Wisconsin will require you to sign a Business Associate Agreement. This agreement explains how you are allowed to use and disclose our members’ information, as well as your responsibilities to protect that information and report any improper use or disclosure to Care Wisconsin.

  • When you must discuss member information, services, or care, remember to do so in a private place
  • Unless it is an emergency situation, avoid discussing members in public areas, like hallways, elevators, cafeterias, or other common areas
  • Do not use a member’s name or other identifying information, like date of birth of home address, in an email unless the information is encrypted

Personal concern or curiosity about an “interesting case” are not sufficient reasons to access or share member information. Information that you hear, see, and learn regarding our members is confidential and not to be shared with friends or family unless they have the legal right and need to know.

Fraud, Waste & Abuse

Medicare and Medicaid require Care Wisconsin and our providers to have programs in place to prevent, detect, and investigate Fraud, Waste & Abuse (FWA). This training on FWA is designed for Care Wisconsin’s providers. Topics covered include definitions, examples of FWA, your role, and reporting compliance concerns. For assistance, you can call Care Wisconsin’s Compliance Hotline toll-free at (833) 253-3465 or locally at (608) 245-3576.

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