113-8          FRAUD REFERRALS

The QAQuality Assurance Reviewer may recommend referral to the Fraud Unit.  During the review process, if the QAQuality Assurance Reviewer finds that the recipient of benefits or a childcare provider receiving subsidy willfully and intentionally provided false information or verifications to the caseworker, the QAQuality Assurance Reviewer marks the "Fraud Referral Recommended” on the Q-Form.

Caseworkers will consider fraud referral recommendations during the discussion of the case.  In some cases, caseworkers might recommend the fraud referral.  If the CAPS Corrective Action Planning Spreadsheets agrees a fraud referral is warranted, the staff will complete and submit the Fraud Allegation Report form online at https://fcm.i-sight.com/external/dhsscase/new. The staff will need to complete all of the required fields, which include the client's first and last name, phone number, and allegation details. Any supporting document can be uploaded by using "Add File" on the form. Once all the fields are completed, select the Submit button.

If during the QA Quality Assessment review process the household fails or refuses to cooperate and the reviewer is not able to complete the review, the reviewer may submit a Fraud Allegation Report online to the Fraud Unit. This could occur if the reviewer has discovered the client misrepresented circumstances such as undisclosed income, resources, household composition, or provided false information or verification to the QA Quality Assessment reviewer.

Note:  

An overpayment claim is not sent to the Claims Unit if the caseworker or a QA Quality Assessment Reviewer submits a Fraud Referral.