Your Commitment to Protecting Our Members
Federal and state laws require My Choice Wisconsin and its providers to protect the privacy of our members. We are committed to sharing only necessary information with others who have the legal right and the need to know.
Remember the following when it comes to member privacy, personally identifiable information (PII), and protected health information (PHI):
- 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.
- 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 or home address, in an email unless the information is encrypted. See our Contact Us page for instructions on email encryption.
- Personal concern or curiosity about an “interesting” situation are not sufficient reasons to access or share member information.
Certain providers may be asked to sign a Business Associate Agreement if federal and state laws do not typically apply to them. 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 My Choice Wisconsin.
If you believe a member’s information has been improperly accessed or shared, please report the privacy issue to our Privacy Officer in the following ways:
Call the My Choice Wisconsin hotline:
Toll-free (833) 253-3465
Send a letter to:
My Choice Wisconsin
Attn: Privacy Officer
10201 West Innovation Drive, Suite 100
Wauwatosa WI 53226
My Choice Wisconsin relies on our contracted delegated vendors and providers to help us meet the needs of our membership according to The Centers for Medicare and Medicaid Services’ (CMS) Medicare Advantage/Medicare Prescription Drug Plan (Part D) program requirements. These individuals and organizations are considered First Tier, Downstream, and Related Entities (“FDRs”). FDRs are individuals or entities to which My Choice Wisconsin has delegated administrative or health care service functions under our Medicare Advantage contract with CMS. These contractors are an integral part of the My Choice Medicare Advantage program and have specific responsibilities under Medicare guidelines. The purpose of the FDR Compliance Guide is to assist FDRs in understanding and meeting their compliance obligations under My Choice Wisconsin’s Compliance Program.
Complete your required DSNP Model of Care training video and Compliance guide and attestation:
Fraud, Waste & Abuse Provider Training
Medicare and Medicaid require My Choice Wisconsin and our providers to have programs in place to prevent, detect, and investigate Fraud, Waste & Abuse (FWA).
If you are a My Choice Wisconsin provider, you are required to review this training annually. Topics covered include definitions, examples of FWA, your role, and reporting compliance concerns.
As a Provider You Are Obligated to Report
If you suspect any instance of fraud, waste or abuse, you have an obligation to report it. You can contact My Choice Wisconsin in the following ways:
- Call the My Choice Wisconsin hotline:
Toll-free at (833) 253-3465 or locally at (608) 245-3576
You can also report suspected fraud, waste or abuse to State and Federal agencies.
- Wisconsin Department of Health Services, Office of Inspector General fraud hotline at (877) 865-3432 or visit https://www.dhs.wisconsin.gov/fraud/index.htm
- Centers for Medicare and Medicaid Services has several ways to report fraud by visiting https://www.cms.gov/About-CMS/Components/CPI/CPIReportingFraud