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MS 0880 (1) Volume 1 – General Administration MS 0880 – R. 3/1/22 – OMTL-592 General Procedures for a Suspected Fraud Claim A preliminary determination of suspected fraud is made after review of the information available to the worker regarding the circumstances of the claim and the individual’s statements regarding the reason(s) for the claim. The supervisor must agree with the findings of the worker referring the case(s) to the Office of Inspector General (OIG) for possible prosecution. Use criteria in MS 0910 to refer a case to OIG. A. Fraud is suspected when an individual: 1. Makes a false or misleading statement in order to receive benefits; 2. Misrepresents, conceals, or withholds factual information in order to receive benefits; 3. Commits a violation of the Food and Nutrition Act relating to the use, presentation, transfer, acquisition, receipt, or possession of Supplemental Nutrition Assistance Program (SNAP) benefits. Specifically prohibited is: a. Purchasing a controlled substance using SNAP benefits; b. Purchasing firearms, ammunition, or explosives using SNAP benefits; c. Buying or selling SNAP benefits on or after August 22, 1996; and d. Making a false statement on or after August 22, 1996, pertaining to identity or residence in order to receive duplicate benefits. 4. Permits an individual other than those listed on the Kentucky Health Card to obtain health care benefits; 5. Misuses a Medicaid-covered service, such as medical transportation, for a non-medical purpose; or 6. Misuses supportive service payments. B. [Suspected fraudulent SNAP claims are established on the Benefit Recovery Module as a Suspected Intentional Program Violation (SIPV). After the claim has been established as SIPV, a change in status must be completed within 90 days. If the claim is not referred to OIG, pursue the Intentional Program Violation (IPV) by sending form FS-80, Notice of SNAP Suspected Intentional Program Violation, and form FS-80A, Voluntary Waiver of SNAP Administrative Disqualification Hearing, to the recipient for signature. If form FS-80A is not returned, is returned unsigned, or without a date, submit a request for an Administrative Disqualification Hearing (ADH) within three calendar days. See MS 1070 for ADH procedures.] C. A SNAP claim is not considered fraud unless: