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4610.20.10 IDENTIFICATION OF POSSIBLE FRAUD

A suspected fraud task must be created if an eligibility worker observes signs of possible fraudulent activity such as: • Questionable information being provided that cannot be successfully verified; • Expenses exceeding income that cannot be explained/verified; • Reluctance to provide needed information about income and/or resources; • Unexplained and continued refusal to have certain pertinent references or relatives contacted; or • Complaints or remarks of other persons.

Pending fraud investigations should never be discussed with the client. 4610.20.15 INVESTIGATION OF POSSIBLE FRAUD

The investigation must be conducted in such manner that: • The legal rights of the AG are preserved; • The privacy of the home is not invaded without consent; • Search and seizure are not committed; • The AG's right to due process of law is protected; • The right to legal counsel is not obstructed; and • Confidential information is used only for the administration of assistance.

If the result of the investigation indicates a basis for suspected fraud, the period of time during which it is believed that the AG fraudulently obtained assistance is to be made a part of the record.

The fraud tracking system is to be used to record all investigations for all programs. All suspected fraud tasks, and benefits recovery referrals that result in suspected fraud, and referrals to the Bureau of Investigation must be entered in the fraud tracking system as well. Fraud tracking system cases must be maintained as case activity takes place. 4610.20.20 EVIDENCE USED TO SUBSTANTIATE FRAUD

Evidence to prove intent to fraud and the allegations regarding the specific fraud must be gathered and presented to support the case and use in calculating a possible over- issuance amount. Evidence for intent can include such things as: • Signed application; • Rights and responsibilities; • Interim contact form; • Change form; • Other verified instances of changes that affected eligibility.

To support the particular allegations of fraud a worker should include such things as (but not limited to): • Verifications of income or resources from the source of the income or resource;