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MEDICAL SERVICES POLICY MANUAL,SECTION K M-400 Willful Withholding of Information M 400 Willful Withholding of Information

M-400 Willful Withholding of Information

MS Manual 01/01/14 Willful withholding of information is the deliberate misrepresentation or intentional concealment of information for the purposeof obtaining eligibility. Intentional concealment of information that affects eligibility must be clearly indicated. Overpayments resulting from “willful withholding” may be subject to prosecution for fraud. “Willful” withholding of information includes: • Willful misstatements, oral or written, made by a recipient in response to oral or written questions from the agency concerning the recipient’s income, resources, or other circumstances that may affect eligibility. Such misstatements may include understatements of amounts of income or resources and omission of information regarding income and resources. • Willful failure by the recipient to report changes in income, resources, or other circumstances that may affect eligibility if the agency has clearly notified the recipient of his obligation to report such changes. • When a client signs the application/review form, he certifies that he understands that failure to fulfill his obligation to provide correct, complete information and to keep the agency informed of changes may be considered willful withholding of information and permit the agency to recover any overpayments. • Willful failure by the recipient to report receipt of a payment (keying error and/or system error) which the recipient knew represented an overpayment.