12-007 WILLFULLY WITHHELD INFORMATION

When evidence reasonably establishes a client willfully withheld information regarding a third-party resource that resulted in an overpayment of Medicaid expenditures, the case must be referred to the Special Investigation Unit (SIU). Once a case has been referred to SIU, no further action shall be taken with regard to the prosecution of the suspected fraud, except in accordance with instructions or approval by SIU. However, normal case actions must be completed, which include applying the appropriate sanction.