13.3.2  Referrals for Fraud Investigation

13.3.2.1  Identifying Potential Fraud
13.3.2.2  Timeliness of Fraud Investigation
13.3.2.3  Sources for Fraud Investigation

The steps the W-2Wisconsin Works agency must take to initiate and process a fraud investigation referral are as follows:

1.             Assess whether the case meets the agency’s fraud referral criteria established in the agency’s standard operating procedures;

2.             Review the allegations contained in the investigation referral;

3.             Conduct the investigation in accordance with the agency’s standard operating procedures to substantiate the allegations of fraud;

4.             Provide specific information regarding the investigation in BRITSBenefit Recovery and Investigation Tracking System (see 13.1.5); and

5.             Initiate the processes for prosecution of fraud cases, applying an IPVIntentional Program Violation, and calculating and collecting fraudulent overpayments.

13.3.2.1 Identifying Potential Fraud

Potential fraud may be identified by various sources, including:

·        W-2Wisconsin Works agency staff;

·        IMIncome Maintenance agency staff;

·        Other agency staff (Child Welfare, Child Support, Child Care);

·        FIREFraud Investigation, Recovery, and Enforcement staff;

·        FDIUFraud Detection and Investigation Unit;

·        W-2 Fraud and Child Care Anti-Fraud Task Forces;

·        Program Integrity Unit;

·        Complaints from the general public; and

·        Anonymous tips from the general public.

Potential fraud may also be identified using various tools:

·        Error-prone profiles;

·        Periodic case audits;

·        Shared information on automated systems (CWWCARES Worker Web, CARES, WWPWisconsin Work Programs, and Data Exchanges);

·        Case worker alerts (W-2 and IM);

·        Automated reporting systems (WebI); and

·        PARISPublic Assistance Reporting Information Systems interstate matches.

W-2 agencies should establish networks with local agencies to promote communication of fraud referrals. Fraud committed by an individual in one program may be simultaneously occurring in another program.

13.3.2.2 Timeliness of Fraud Investigation

The W-2Wisconsin Works agency must conduct fraud investigations within 90 calendar days from the date the referral was created in BRITS. If a fraud investigation is expected to exceed 90 days, the W-2 agency’s fraud representative must record an extension due date in BRITS and provide an explanation.

When a W-2 agency designates fraud investigation activities to a third party, the W-2 agency is responsible for establishing procedures for requesting investigation extensions including the criteria for approval or denial.

13.3.2.3 Sources for Fraud Investigation

To determine the appropriate fraud investigation source(s) to verify the correctness of an allegation that prompted a fraud referral, see 13.2.3.2.

History: Release 19-01; Release 18-02.