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West Virginia Income Maintenance Manual Chapter 11
West Virginia Income Maintenance Manual
Page 41 Chapter 11 Benefit Repayment
APPENDIX C: INVESTIGATIONS AND FRAUD MANAGEMENT (IFM) REFERRALS When and Where to Make a Referral – Make Referral to Only One Unit FRONT-END FRAUD (FEFU) REFERRALS Referrals to FEFU are only made for applicants and recipients. REFERRAL PROCESS: • Print ACCH Screen(s) in the eligibility system • Describe questionable eligibility factors • Forward to FEFU Worker in your county EXAMPLES OF APPROPRIATE REFERRALS: • You receive a complaint that an unreported household member resides in the house and is working. • Client reports newborn child to be added to case. You suspect that the ABSENT PARENT is in the home and working. • Client applies for assistance claiming ZERO income, no work history, and NO Assets. He/she has excessive expenses and recently paid rent receipts and is seen driving away in a new model vehicle. Refer to FEFU and they will have a response within 10 working days since this is an application. REPAYMENT INVESTIGATOR (RI) REFERRALS Referrals to RIs are to be made for Cash Assistance and SNAP cases due to Agency, Unintentional Program Violation (UPV) and Intentional Program Violation (IPV) errors of less than $500. REFERRAL PROCESS: • Complete BVRP Screen in the eligibility system EXAMPLES OF APPROPRIATE REFERRALS: • Client begins works on January 20 but does not report income until March 1. • Client reports her children is out of the home in February, however, the Worker does not take action until May. This is an agency error referred to the RI for repayment.
CRIMINAL INVESTIGATOR (CI) REFERRALS Referrals to CIs are made when a client INTENTIONALLY withheld information affecting eligibility for Cash Assistance, SNAP, Medicaid, Emergency Assistance, Child Care, and/or LIEAP, and the total overpayment exceeds $500. REFERRAL PROCESS: • Complete IFM-1. Include all information regarding the unreported information • Mail completed IFM-1 to Investigations and Fraud Management (IFM) headquarters in Charleston EXAMPLES OF APPROPRIATE REFERRALS: • Client admits spouse is and has been in household. Take corrective action and complete IFM-1. • It is discovered the client has been employed for months and not reporting it to the Agency. Take corrective action and complete IFM-1 to Investigator. DO NOT REFER – if the client is over 70 years old, the fraud occurred 2 or more years ago, or the client is terminally ill or not capable of understanding policy. Administrative Claims must still be established and are referred to the RI. DO NOT DISCUSS FRAUD OR REPAYMENT WITH THE CLIENT OR THREATEN WITH CRIMINAL PROSECUTION.