17 Program Integrity, 2605(b)(10)

17.1 Fraud Reporting Mechanisms a. Describe all mechanisms available to the public for reporting cases of suspected waste, fraud, and abuse. Select all that apply. Online Fraud Reporting Dedicated Fraud Reporting Hotline Report directly to local agency/district office or Grant recipient office Report to State Inspector General or Attorney General Forms and procedures in place for local agencies/district offices and vendors to report fraud, waste, and abuse Other - Describe: Other - Describe: Section 37.70.107 of the ARM (Administrative Rules of Montana) states: 37.70.107 REFERRALS TO THE DPHHS OFFICE OF INSPECTOR GENERAL PROGRAM COMPLIANCE BUREAU The Department of Public Health and Human Services (DPHHS), Office of Inspector General, Program Compliance Bureau has the power a investigate matters relating to Low Income Home Energy Assistance including, but not limited to, applications, awards of benefits, and informati relating to an application; 1. determine, based on the evidence gathered, whether an overpayment of benefits has occurred; and 2. whether the overpayment was due to: 3. . a false or misleading statement or a misrepresentation, concealment, or withholding of facts; or 1. . any other action intended to mislead, misrepresent, conceal, or withhold facts. 2. Local contractors may make reports of possible overpayments or fraud to the Department of Public Health and Human Services (DPHHS), Intergovernmental Human Services Bureau (IHSB), P.O. Box 202956, Helena, MT 59620. IHSB will review cases referred prior to referral to the D of Inspector General, Program Compliance Bureau. 37.70.110 FRAUD/TRANSFER OF RESOURCES (1) Whoever knowingly obtains by means of a willfully false statement, representation, o impersonation or other fraudulent device low income energy assistance to which he is not entitled is guilty of theft as provided in 45-6-301, MCA a ineligible for assistance for the entire current heating season. (2) If an individual appears to have received assistance fraudulently, the local contractor must report all facts of the matter to the Intergovern Human Service Bureau (IHSB) to determine if the case should be referred to the department's Office of Inspector General, Program Compliance Bu The PCB may refer the matter to the Department of Justice or the county attorney of the county in which the person resides for further action. b. Describe strategies in place for advertising the above-referenced resources. Select all that apply Printed outreach materials Posted in local administering agencies offices. Addressed on LIHEAP application Website Other - Describe: 17.2. Identification Documentation Requirements a. Indicate which of the following forms of identification are required or requested to be collected from LIHEAP applicants or their household members. Collected from Whom? Type of Identification Collected Applicant Only All Adults in Household All Household Members Required Required Required Social Security Card is photocopied and retained Requested Requested Requested Required Required Required Social Security Number (Without actual Card) Requested Requested Requested Required Required Required Government-issued identification card (i.e.: driver's license, state ID, Tribal ID, passport, etc.) Requested Requested Requested Other Applicant Only Required Applicant Only Requested All Adults in Household Required All Adults in Household Requested All Household Members Required All Household Members Requested 1 17.3. Citizenship/Legal Residency Verification What are your procedures for ensuring LIHEAP recipients are U.S. citizens or qualified non-citizens who are eligible to receive LIHEAP benefits? Select all that apply. Clients sign an attestation of citizenship or U.S. Citizen or Qualified Non-Citizen Client's submission of certain Social Security Administration cards is accepted as proof of U.S. Citizen or Qualified Non-Citizen. Non-Citizens must provide documentation of immigration status Citizens must provide a copy of their birth certificate, naturalization papers, or passport Non-Citizens are verified through the SAVE system Tribal members are verified through Tribal enrollment records/Tribal ID card Other - Describe: The State of Montana has an interface with the Social Security Administration to verify Social Security Numbers. Providing verification and documentation: Including social security number, proof of U.S. citizenship, proof of lawful permanent residency, or qualified alien status for all household members, as well as photo identification for all household if not previously provided. Photo ID's for all household members or birth certificates for household members under 18 years of age are no longer required, if the agency has verified the SSN. A non-citizen who has lawfully entered the U.S. with the intent of establishing permanent residency is commonly known to have a "green card". Officially such a person is called a "lawful permanent resident (LPR)". Individuals of households who refuse to submit social security numbers, proof of citizenship, proof of lawful permanent residency, or qualified alien status will be deemed ineligible members of the household. See the Naturalization Eligibility Worksheet Instructions (Form M-480) at: https://www.uscis.gov. A voter's registration card is not acceptable verification for proof of citizenship when citizenship is questionable since an individual is not required to verify citizenship to register to vote. Marriage to a U.S. citizen has no effect on the ineligible member's eligibility for LIHEAP. A person does not automatically become a lawful permanent resident or a U.S. citizen by marrying a U.S. citizen. The marriage has no effect on the person's LIHEAP eligibility. To Verify Lawful Entry into the United States as a "Qualified Alien" Certificate of Naturalization (DHS Forms N-550 or N-570). Certification of U.S. Citizenship (DHS Forms N-560 or N-561). Certification of Birth Abroad of a U.S. Citizen (Form FS-240 or FS-545). U.S. Citizen Identification Card (Form I-197) Alien Registration Receipt Card (Form I-551) Arrival-Departure Record (Form I-94) Temporary Resident Card (Form I-688) Or other proof of Qualified Alien status as provided by the Department of Homeland Security. Verification must be requested and provided. Note: Some of the above forms (e.g. Arrival- Departure Record (Form I-94)) may prove lawful entry but do not prove intent to establish permanent residency. See the U.S. Citizenship and Immigration Services website at: https://www. uscis.gov. Current and future benefits will be denied to any persons and households who refuse to submit social security numbers; proof of U.S. citizenship; proof of status as a qualified alien as defined in 8 U.S.C. 1641(b); or whose social security numbers, proof of residency or citizenship cannot be verified. 17.4. Income Verification What methods does your agency utilize to verify household income? Select all that apply. Require documentation of income for all adult household members Pay stubs Social Security award letters Bank statements Tax statements Zero-income statements Unemployment Insurance letters Other - Describe: Other - Describe: It is the responsibility of the applicant to provide verification of earned income and unearned income. EARNED INCOME: Verification Information Generally Available From the Applicant or Recipient: Pay stubs Pay envelopes Employee W-2 forms Income tax returns-state/federal Self-employment bookkeeping records or the most recently filed income tax return (within the last 12-18 months) Sales and expenditure records Verification Information From Other Sources Employer's wage/payroll records State form for clearance of earnings for employment Employment Security Office Occupation Tax Agency State Income Tax Bureau - Department of Revenue (DOR) Tax statements-Federal/State CHIMES inquiry (SNAP Database) MUSE (Wage and UI Inquiry) State Compensation Insurance Fund UNEARNED INCOME: Verification Information Generally Available From the Applicant or Recipient RSDI Benefit Check RSDI Award Letter Correspondence on SSA Benefits Educational grant or scholarship award letter Unemployment compensation award letter Pension award notice Veteran's Administration award letter Correspondence on benefits Income tax record -state and federal Railroad retirement award letter Social Security & Supplementary Security Income (SSI) award letter Worker's compensation benefits award notice Verification Information From Other Sources Utilities subsidy payments (Section 8) Social Security District Office Bureau of Employment Security - Unemployment Compensation Section Employer's Records Union Records Worker's Compensation Records Veteran's Administration Lawyer's Records Insurance Company Records Lodge, Club, or Fraternal Organization Records Personal income tax records Railroad retirement board records United Mine Workers Union (Black Lung Benefits) Social Security Administration Records College and University Financial Aid Records Bureau of Indian Affairs Records Indian Tribal Business Council Records County Clerk of the Court Records Child Support Enforcement Agency Records Financial Institution Records Personal Records of Contributions Money orders Personal Checks Statement from person making the contribution Income tax return In addition, any economic impact payments from the Internal Revenue Service (IRS) will not be counted as income. Computer data matches: Income information matched against state computer system (e.g., SNAP, TANF) Proof of unemployment benefits verified with state Department of Labor Social Security income verified with SSA Utilize state directory of new hires Other - Describe: b. Describe any exceptions to the above policies. 17.5 Identification Verification Describe what methods are used to verify the authenticity of identification documents provided by clients or household members. Select all that apply Verify SSNs with Social Security Administration Match SSNs with death records from Social Security Administration or state agency Match SSNs with state eligibility/case management system (e.g., SNAP, TANF) Match with state Department of Labor system Match with state and/or federal corrections system Match with state child support system Verification using private software (e.g., The Work Number) In-person certification by staff (for tribal Grant recipients only) Match SSN/Tribal ID number with tribal database or enrollment records (for tribal Grant recipients only) Other - Describe: 17.6. Protection of Privacy and Confidentiality Describe the financial and operating controls in place to protect client information against improper use or disclosure. Select all that apply. Policy in place prohibiting release of information without written consent Grant recipient LIHEAP database includes privacy/confidentiality safeguards Employee training on confidentiality for: Grant recipient employees Local agencies/district offices Employees must sign confidentiality agreement Grant recipient employees Local agencies/district offices Physical files are stored in a secure location Electronic files are protected in a secure location. Other - Describe: Applicants' and Recipients' personally identifiable information (PII) is not sent by email. All communication with PII is sent through Montana's Secure File Transfer Service. 17.7. Verifying the Authenticity What policies are in place for verifying vendor authenticity? Select all that apply. All vendors must register with the State/Tribe. All vendors must supply a valid SSN or TIN/W-9 form Vendors are verified through energy bills provided by the household Grant recipient and/or local agencies/district offices perform physical monitoring of vendors Other - Describe and note any exceptions to policies above: LIHEAP payments will only be sent to authorized fuel vendors who have a signed contract agreement with the State of Montana. 17.8. Benefits Policy - Gas and Electric Utilities What policies are in place to protect against fraud when making benefit payments to gas and electric utilities on behalf of clients? Select all that apply. Applicants required to submit proof of physical residency Applicants must submit current utility bill Data exchange with utilities that verifies: Account ownership Consumption Balances Payment history Account is properly credited with benefit Other - Describe: Centralized computer system/database tracks payments to all utilities Centralized computer system automatically generates benefit level Separation of duties between intake and payment approval Payments coordinated among other energy assistance programs to avoid duplication of payments Payments to utilities and invoices from utilities are reviewed for accuracy Computer databases are periodically reviewed to verify accuracy and timeliness of payments made to utilities Direct payment to households are made in limited cases only Procedures are in place to require prompt refunds from utilities in cases of account closure Vendor agreements specify requirements selected above, and provide enforcement mechanism Other - Describe: 17.9. Benefits Policy - Bulk Fuel Vendors What procedures are in place for averting fraud and improper payments when dealing with bulk fuel suppliers of heating oil, propane, wood, and other bulk fuel vendors? Select all that apply. Vendors are checked against an approved vendors list Centralized computer system/database is used to track payments to all vendors Clients are relied on for reports of non-delivery or partial delivery Two-party checks are issued naming client and vendor Direct payment to households are made in limited cases only Vendors are only paid once they provide a delivery receipt signed by the client Conduct monitoring of bulk fuel vendors Bulk fuel vendors are required to submit reports to the grant recipient. Vendor agreements specify requirements selected above, and provide enforcement mechanism Other - Describe: 17.10. Investigations and Prosecutions Describe the Grant recipients procedures for investigating and prosecuting reports of fraud, and any sanctions placed on clients, staff, or vendors found to have committed fraud. Select all that apply. Refer to state Inspector General Refer to local prosecutor or state Attorney General Refer to US DHHS Inspector General (including referral to OIG hotline) Local agencies/district offices or Grant recipient conduct investigation of fraud complaints from public Grant recipient attempts collection of improper payments. If so, describe the recoupment process OVERPAYMENTS Current and future program year payments of Low Income Home Energy Assistance will be reduced the full amount of prior overpayments, unless the administrative cost would exceed the amount of overpayment. Additionally, cases in which the recipient willfully made false statements or withheld information causing overpayment are to be referred to IHSB for determination as to whether the case should be referred to the DPHHS Office of Inspector General, Program Compliance Bureau for determination of fraud as provided in the Administrative Rules of Montana 37.70.110. Cases of fraud at the client, vendor and employee level: Complete the LIHEAP Investigative Referral Form (See attached) 1. Field Monitor will evaluate and determine if a referral to the Office of Inspector General Program Compliance Bureau is appropriate. 2. If referred, the Office of Inspector General Program Compliance Bureau will review the case. 3. . If additional information is needed the Program Compliance Bureau will work directly with the subgrantee. 1. . Once investigation is complete the findings will be reported to the Field Monitor to either drop or pursue the case. 2. When it is discovered that the local contractor caused an overpayment of LIHEAP or weatherization services, at the sole discretion of the department the local contractor may be required to repay the entire overpayment to the department, rather than the overpayment being withheld from the recipient's future payments. Over payments are recouped in the following ways: Lump sum payment 1. Installment payments (A repayment agreement will be sent.) 2. Reduction of future LIHEAP benefits to repay entire unpaid balance. 3. A letter and with the fair hearing language will be sent to the recipient explaining the overpayment. 4. Clients found to have committed fraud are banned from LIHEAP assistance. For how long is a household banned? Contracts with local agencies require that employees found to have committed fraud are reprimanded and/or terminated Vendors found to have committed fraud may no longer participate in LIHEAP Other - Describe: If any of the above questions require further explanation or clarification that could not be made in the fields provided, attach a document with said explanation here.