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7 4610.15.15 ESTABLISHMENT AND INVESTIGATION OF POSSIBLE FRAUD Documentation of the applicant's/recipient's apparent ability or inability to understand questions regarding eligibility, especially regarding income and resources, must be entered in the Benefit Recovery notes. It is unlikely that fraud can be established and substantiated if the documentation shows that the individual's mental or physical condition resulted in his inability to understand eligibility requirements and his responsibility to provide information to the DFR. The eligibility worker may suspect fraud exists within an AG. Some clues which may indicate unwarranted receipt of assistance are: · Purchase of items which indicate that more income exists than is known · Living at a higher standard than known income would permit · Unexplained absences or difficulty in seeing the recipient to complete necessary redeterminations · Reluctance to provide needed information about income and/or resources · Unexplained and continued refusal to have certain pertinent references or relatives contacted · Complaints or remarks of other persons. The worker should be alert to any information that can lead to the identification of a case discrepancy. If such information becomes available, the worker should take the action listed in Section 4605.05.05, Caseworker Responsibilities, then enter a referral to the Benefit Recovery unit on the Overpayment Details- Referral Details page Benefit Recovery if appropriate. The worker is responsible for completing all investigations that can be done from the office: By phone, mail, or interview. This includes data matches. Use Subpoena (Form FI0018/State Form 48133) to obtain needed verification when a signed client "Release of Information" is not available or appropriate. If it appears that the investigation cannot be completed by the eligibility worker, a suspected fraud task can be created to the Benefit Recovery Unit who can make a referral to the Bureau of Investigation. 4610.15.20 INVESTIGATION OF POSSIBLE FRAUD If the AG is currently eligible, assistance is not to be discontinued solely because an investigation of suspected fraud is being conducted, nor is the worker to discuss an investigation by the Bureau of Investigation with the client. The DFR is required to pursue suspected fraud. It is the responsibility of the eligibility worker to do the initial investigation and then, if appropriate, create a suspected fraud task for Benefit Recovery. Based on the Benefit Recovery worker and the B of I investigator's findings, and if the case meets the Local Prosecutor's criteria, the individual may be referred for prosecution to the County Prosecutor.