13.3.1  Fraud Investigation

The primary goal of a fraud investigation is to determine the correctness of an allegation that an applicant or recipient of W-2 payments and services, including employment position payments and JALs, intended to misrepresent his or her eligibility criteria or committed any act that constitutes an IPV.

In most suspected fraud cases referred to an investigator by the W-2 agency:

·        A benefit overpayment is suspected and the agency has reason to believe the overpayment is the result of misrepresentation of program eligibility requirements. The misrepresentation of program eligibility or fraudulent activity may be the result of:

o       False or misleading statements of circumstances,

o       Failure to report a change in circumstances,

o       Concealed or withheld facts, or

o       Violation of a program regulation or State statute relating to program benefits.

·        The benefit(s) would not have been provided, but for the false representation.

·        The conduct of the applicant or recipient indicates the misrepresentation or fraudulent use of the benefit was done with knowledge and intent.



History: There are no previous versions of this policy.