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MS 0920

(1)

Volume 1 – General Administration MS 0920 – R. 8/1/26 – OMTL-703 Fraud Hotline Referrals

A. The Office of Inspector General (OIG) maintains a toll-free hotline, 1-800-372- 2970, to report suspected fraud.

1. When a caller contacts the local office regarding fraud for any program, provide the toll-free hotline number.

2. Use this number to report alleged Medicaid (MA) vendor fraud.

3. Use this number to report alleged employee fraud.

4. If an individual indicates they are unable to leave a message when they call the fraud hotline, take the information and email OIG.

B. OIG screens complaints and sends valid hotline referrals via email to the designated contact for each region within the Department of Community Based Services (DCBS). The DCBS contact is required to respond within 20 calendar days with the outcome of the complaint.

[When a hotline referral is received:

1. Scan a copy of the hotline referral to the Electronic Case File (ECF). If there is an individual name and number listed as the complainant, attempt to contact and obtain any supporting documentation from them. Attempt to contact the household to discuss the allegation. Do not reveal the complainant's information. Review the case to determine if incorrect benefits were issued. Verify any necessary information and secure substantiating documentation. Document thoroughly in case comments any action taken pertaining to the referral.]

2. If the hotline referral is determined to involve suspected trafficking allegations, refer to MS 1020, Trafficking and Retailer Fraud.

3. If a change becomes known to the agency through a hotline referral, enter the change on the Integrated Eligibility and Enrollment System (IEES). IEES will generate a Request for Information (RFI) requesting verification of the change. When the requested verification is returned, enter the verification in IEES and allow the system to process the change. If the verification is not returned, IEES will act on the change according to policy in Volume 2 MS 6750 and MS 6760, as appropriate.

Example: It is reported that a non-custodial parent (NCP) is in the home with income. Enter the information on IEES and allow the case to pend for verification of household composition and income.

4. If sufficient information is not provided to enter the change on the system, select the Unclear Information button on the Case Summary screen and send the RFI notice requesting the specific verification needed to process the change. Document the case thoroughly as to why the question was utilized and what is requested on the RFI. Allow the household 10 days from the date the RFI is mailed to provide the verification. If the mandatory