112-1          DEFINITION OF FRAUD

Fraud is defined as "an intentional action, inaction, or statement made by an individual for the purposes of obtaining benefits to which he or she is not entitled." To act with intent to defraud means to act willfully, and with the specific intent to deceive or cheat.

Public assistance fraud is frequently referred to as an Intentional Program Violation or IPVIntentional Program Violation. An IPVIntentional Program Violation may occur with or without a benefit overpayment due to fraud.

112-1 A.      SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM

An intentional program violation in the SNAPSupplemental Nutrition Assistance Program occurs when a client takes an action for the purposes of qualifying for SNAPSupplemental Nutrition Assistance Program, or for increasing or preventing a reduction in the amount of SNAPSupplemental Nutrition Assistance Program, including ending benefits. This includes:

• Trading or selling SNAPSupplemental Nutrition Assistance Program benefits;
• Using or possessing improperly obtained SNAPSupplemental Nutrition Assistance Program benefits;
• Concealing information to obtain benefits to which they are not entitled;
• Using SNAPSupplemental Nutrition Assistance Program benefits to purchase items that are not eligible, such as cigarettes or alcohol;
• Making a false or misleading statement to the agency, either orally or in writing, to obtain benefits to which they are not entitled; and
• Failing to report, as required, changes in income, household composition, or other factors of eligibility in order to obtain benefits to which they are not entitled.

112-1 B.      CASH ASSISTANCE PROGRAMS

An intentional program violation in the cash assistance programs occurs when a client takes an action for the purpose of establishing or maintaining a family's eligibility for Alaska Temporary Assistance or Adult Public Assistance benefits, or for increasing or preventing a reduction in the amount of cash benefits, including ending benefits. This includes:

• Concealing information;
• Making a false or misleading statement to the agency, either orally or in writing; and
• Failing to report, as required, changes in income, resources, or any other factors of eligibility.

Example:

An IPVIntentional Program Violation may result from intentionally failing to report when a child leaves the Alaska Temporary Assistance unit.

112-1 C.      MEDICAID PROGRAMS

An intentional program violation in the Medicaid Program occurs when a client takes an action for the purpose of establishing or maintaining an individual or family's eligibility for Medicaid benefits, including ending benefits. This includes:

• Concealing information;
• Making a false or misleading statement to the agency, either orally or in writing;
• Failing to report, as required, changes in income, resources, or any other factor's of eligibility.

Note:

The Fraud Control Unit generally does not address alleged Medicaid provider fraud.

112-1 D.      HEATING ASSISTANCE PROGRAM

Types of vendor fraud include:

• Vendors who do not credit the entire HAPHeating Assistance Program grant to the client's account(s);

• Vendors who discriminate, either in cost of goods supplied or the services provided, against the household receiving HAPHeating Assistance Program;

• Vendors who knowingly dispense HAPHeating Assistance Program purchased fuel to a client who they know is selling, sharing, or trading their HAPHeating Assistance Program purchased fuel.

• Vendors who fail to follow the conditions regarding the allowable uses for HAPHeating Assistance Program funds, how to apply HAPHeating Assistance Program payments to clients' accounts, and when to refund money back to HAPHeating Assistance Program for clients' who have closed their account. These conditions are covered in each vendors' signed Heating Assistance Vendor Agreement.

Client fraud is committed when:

• An applicant intentionally makes false statements, misrepresents facts, or misrepresent situations to get benefits a household is not eligible to receive.

• Clients do not report all income received by their household.

• Applicants misrepresent the number of people in their household.

• Applicants misrepresent the type of dwelling they live in, total square footage, and/or the number of heated bedrooms in their home.

• Clients sell, barter, give away, or share fuel paid for with HAPHeating Assistance Program benefits.