Fraud Prevention
The purpose of the Fraud Investigator is to prevent, identify, and reduce public assistance fraud, waste and, abuse by ensuring benefits and services are received by eligible individuals and in the correct amount. Smyth County Department of Social Services has a Certified Welfare Fraud Investigator who investigates allegations of all public assistance fraud with the exception of non-money payment Medicaid cases.
Functions of the Fraud Investigator:
Receiving fraud allegation/referral for investigations; agency workers and community members make referrals to fraud investigator. Fraud investigator then accepts/rejects referrals. Fraud investigator sets up fraud case files, and then reviews all case files associated with individual active during time of allegation. Fraud investigator gathers, documents, and analyzes evidence needed to prove or disprove the allegation. Fraud investigator then interviews witnesses, and then determines intent to commit fraud, client misunderstanding, or agency error. Fraud investigator then refers cases for prosecution or beginning Administrative Disqualification Hearing (ADH) process, depending on Commonwealth Attorney (CA) agreement.
Fraud investigator calculates overpayments, establishes claim/overpayment in appropriate system(s), and initiates collection action based on program guidance, depending on the agency. Eligibility/Child Care/Service staff is notified of any required case action, such as disqualification. Fraud investigator reports SNAP disqualifications to Electronic Disqualified Recipient Subsystem (eDRS) within required timeframes. Fraud investigator sends appropriate client notices.
For court cases: Referring case to CA, having warrant issued for arrest, as appropriate, testifying before Grand Jury or in General District Court, testifying in Circuit Court, and attending sentencing hearing.
For ADHs: Sending Notice of Intentional Program Violation (IPV) and Waiver of ADH, referring case for ADH if waiver not received within 10 days, and presenting case at the ADH.
In the past 5 years Smyth County DSS Fraud has collected a total of $398,262.65 in payments, conducted 1,779 investigations, and had 62 court convictions.
(Data as of 3/31/2015)
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Functions of the Fraud Investigator:
Receiving fraud allegation/referral for investigations; agency workers and community members make referrals to fraud investigator. Fraud investigator then accepts/rejects referrals. Fraud investigator sets up fraud case files, and then reviews all case files associated with individual active during time of allegation. Fraud investigator gathers, documents, and analyzes evidence needed to prove or disprove the allegation. Fraud investigator then interviews witnesses, and then determines intent to commit fraud, client misunderstanding, or agency error. Fraud investigator then refers cases for prosecution or beginning Administrative Disqualification Hearing (ADH) process, depending on Commonwealth Attorney (CA) agreement.
Fraud investigator calculates overpayments, establishes claim/overpayment in appropriate system(s), and initiates collection action based on program guidance, depending on the agency. Eligibility/Child Care/Service staff is notified of any required case action, such as disqualification. Fraud investigator reports SNAP disqualifications to Electronic Disqualified Recipient Subsystem (eDRS) within required timeframes. Fraud investigator sends appropriate client notices.
For court cases: Referring case to CA, having warrant issued for arrest, as appropriate, testifying before Grand Jury or in General District Court, testifying in Circuit Court, and attending sentencing hearing.
For ADHs: Sending Notice of Intentional Program Violation (IPV) and Waiver of ADH, referring case for ADH if waiver not received within 10 days, and presenting case at the ADH.
In the past 5 years Smyth County DSS Fraud has collected a total of $398,262.65 in payments, conducted 1,779 investigations, and had 62 court convictions.
(Data as of 3/31/2015)
Back to the Programs List