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MEDICAL SERVICES POLICY MANUAL,SECTION N N-100 Fraud Investigation N 140 Review of Case

Referrals from DHS sources in which an overpayment has not been established are referred to the Fraud Investigations Unit via DHS-1700.

N-140 Review of Case MS Manual 01/01/14 When a referral is made to the Fraud Investigations Unit, the circumstances will be reviewed to determine if the case warrants investigation toward criminal prosecution. If one or more of the following facts are present, the case will not be referred for prosecution: • Total amount of the overpayment resulting from the alleged fraud is $200 or less; • Age/education of the suspect is not conducive to proving criminal intent; • Statute of limitations has run on all evidence referred; • Recipient is permanently residing out of state. If one or more of the following facts are present, the decision to investigate lies with the Director of Fraud Investigations: • Fraud not evident in referred material; • Fraud resulted from failure to report child support payments;

N-150 Case Accepted for Investigation MS Manual 01/01/14 The following procedures will be completed for reports of suspected fraud that warrant criminal prosecution: 1. The case documentation and any other pertinent information concerning the suspected recipient will be reviewed and printed from the system. DHS Offices, Sections and Units must release any requested information to the Fraud Investigations Unit. Original documents will be retained by the Fraud Investigation Unit for evidence, and copies of those documents will be indexed in the electronic case record or furnished to the document source.