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Wisconsin Department of Children and Families Wisconsin Works (W-2) Manual |
13.4.1.1 Intentional Program Violation Determination and Notification
13.4.1.1.1 Intentional Program Violation Determination
13.4.1.1.2 Determining the Date of an Intentional Program Violation
13.4.1.1.3 Intentional Program Violation Notification
13.4.1.2 Intentional Program Violation Penalties
13.4.1.3 Imposing an Intentional Program Violation Penalty
13.4.1.4 Overpayment Recoupment for Intentional Program Violations
13.4.1.5 Additional Intentional Program Violation Enforcement Actions
13.4.1.6 Dispute Resolution Process
A W-2 IPV means that an individual did any of the following for the purpose of establishing, using, maintaining, increasing, receiving, transferring or trafficking W-2 payments and services including a JAL:
1. Intentionally made a false or misleading statement;
2. Intentionally misrepresented or withheld facts; or
3. Intentionally committed any act that constitutes a violation of state or federal law.
To determine whether to impose an IPV penalty for W-2 applicants, JAL applicants, or W-2 participants, the IPV must have been committed on or after November 1, 2012. An applicant does not have to receive payments or services prior to the agency imposing an IPV penalty.
The following are examples of IPVs:
· Concealing or intentionally not reporting unearned income or assets;
· Failing to report employment;
· Failing to report household composition change (including minor children);
· Failing to disclose/report non-Wisconsin residency;
· Submitting documentation that has been forged or tampered with;
· Submitting false information; or
· Using a JAL for other than an approved purpose.
Reminder: Prior to entering an IPV, the W-2 agency must enter all required fraud information in BRITS. (See 13.1.5)
Within seven working days of receiving a fraud investigation report, the W-2 agency must:
1. Determine if an IPV has occurred;
2. Determine whether an IPV penalty can be applied based on the November 1, 2012 effective date of Wis. Stat. s. 49.151(2); and
3. Notify the individual that he or she has committed an IPV.
If the outcome of a fraud investigation confirms that an individual has committed a fraudulent act, the W-2 agency must ensure that the fraudulent act meets the definition of an IPV. (See 13.4.1) It is likely that if the investigation concluded that an act was, in fact, fraudulent, then it will also be an IPV.
If the W-2 agency discovers that more than one act of fraud occurs at the same time, i.e., at application, at eligibility review, or during a change report, then the W-2 agency must impose only one IPV penalty. The agency can only impose subsequent IPV penalties after the individual has completed an IPV penalty period, re-enrolled in the W-2 program, and then violated program rules again. For example, after an individual has completed a 6-month penalty period for a first IPV, re-enrolls in the W-2 program, and then violates the program rules again, the agency can consider imposing a second IPV penalty. The same is true for imposing a third IPV penalty; an individual has to serve the 12-month penalty period for the second IPV, re-enroll in W-2, and then violate the program rules for the third time.
EXAMPLE: Louis applies for W-2 in June 2013 and is determined eligible and placed in a Community Service Job. The following month, the agency discovers that Louis did not report a savings account with a balance of $5,000. The agency imposes an IPV and Louis is disqualified from W-2 for six months. In March 2014, the agency discovers that Louis did not report his part-time employment that began in May 2013. The agency may not impose a second IPV since Louis had not re-applied for W-2 and violated program rules again.
In cases where the applicant is eligible for a JAL for an approved loan reason and uses the JAL funds for another reason that still meets a discreet financial crisis, an IPV is not applicable.
EXAMPLE: Joan applies for a JAL for auto repairs. Based on the information she provided on the application, the W-2 agency approves it and issues a check on June 11, 2013. On June 12, 2013, Joan’s son Matthew went to the dental office after complaining of a toothache. After the exam, the dentist recommends an emergency root canal procedure. Joan does not have dental insurance and has to pay up-front for this procedure. She uses the JAL to cover this cost, as she does not have any other financial options. The agency determines that the emergency root canal procedure was a discreet financial crisis and does not impose an IPV.
All IPV determinations must be reviewed and approved by a supervisor or a supervisor’s designee to ensure uniform application of IPV policy within each W-2 agency.
The date of intentional program violation is the date that the individual committed the fraudulent act.
If the fraudulent act is committed prior to November 1, 2012, the agency must not impose an IPV. If the fraudulent act resulted in an overpayment, however, the W-2 agency must still process the overpayment.
If it is discovered, through a data exchange or other third-party verified source, that a participant received or retained income while receiving W-2 that would have made them financially ineligible for W-2 and did not report it, the overpayment must start the day the income was received.
EXAMPLE 1: Marquita submits an altered Medical Examination & Capacity form on October 3, 2012 claiming that she can only participate five hours per week. Based on this altered form, her FEP places her in a W-2 T placement with limited activities assigned. The following year, her FEP learns that Marquita altered the form she submitted on October 3, 2012 by changing 15 hours to 5 hours. The fraudulent act (submitting falsified information) was committed prior to November 1, 2012. The W-2 agency must not apply an IPV penalty.
EXAMPLE 2: When the W-2 agency determines Lisa’s initial W-2 eligibility on December 17, 2012, Lisa does not list Tony, her son’s father, as part of her household. In February 2013, Lisa reports that Tony is living with her. The W-2 agency subsequently determines that Tony has been living with Lisa since August 24, 2011 and that Tony works full-time making them financially ineligible for W-2. The W-2 agency will apply an IPV because the fraudulent act occurred after November 1, 2012. The date of the fraudulent act is December 17, 2012. The agency must apply an IPV penalty.
EXAMPLE 3: Judy was found eligible for a W-2 T placement in February 2014. Through a third party data exchange, Judy’s FEP finds out that Judy received $10,000 as an inheritance on June 12, 2014. When Judy’s FEP contacts Judy, Judy states that she spent the money by September 1, 2014. Judy would have been over the asset limit for the calendar months of July and August. Since Judy did not report the change in income timely, her overpayment period starts the day she received the inheritance, June 12, and ends the day before she was again eligible, August 31. If Judy had reported the income timely, there would not have been an overpayment.
EXAMPLE 4: Suki was found eligible for a CSJ placement in April 2016. On May 15, 2016, Suki receives a $5,000 legal settlement. Suki calls her FEP to report the change on May 16, 2016. Suki’s FEP advises her to pay ahead on her rent, electric bill, and other utilities to help stabilize her living situation. At a follow-up appointment in July 2016, Suki’s FEP asks if she still has any settlement money remaining. Suki says she still has $2,600, and plans on keeping it. Suki’s FEP advises Suki that her case will close at the end of July since it will be her second month of being over assets. Suki agrees, and Suki’s FEP closes her case on July 31, 2016. There is no overpayment as Suki reported the income timely, and Suki’s FEP closed her case timely. If Suki had not reported the income, Suki’s overpayment would have started on May 15 and ended when her case closed.
The W-2 agency must notify an individual in writing that he or she committed an IPV by generating the IPVI letter from CWW. The letter informs the individual:
1. He or she has been determined to have committed an IPV;
2. The date(s) of the fraudulent act;
3. The fraudulent act that resulted in the IPV penalty; and
4. He or she has seven working days to provide any additional information regarding the IPV.
The W-2 agency must allow seven working days for the individual to rectify the IPV.
· If the individual submits additional information related to the IPV within the seven working day timeframe, the W-2 agency must review the additional information and decide if the IPV determination should be overturned.
· If the IPV is overturned, the agency must delete the IPV and must notify the individual that he or she will not receive an IPV penalty. If the IPV is not overturned, the W-2 agency must impose the IPV.
The period of ineligibility begins the first day of the month after the seven working day timeframe. CWW will generate a Notice of Eligibility to the ineligible individual.
EXAMPLE: On May 28, 2013, the W-2 agency receives a fraud investigation report on Mary’s case. The Fraud Coordinator reviews the report on June 6, 2013 and determines that the fraudulent act was intentional. On that day, the W-2 agency enters the IPV and generates an IPV notification letter (IPVI) to Mary, giving her until June 17, 2013 to provide any additional information regarding the IPV. On June 18, 2013, the agency imposes the IPV penalty because Mary did not submit new information. This is Mary’s first IPV. Mary will be ineligible for W-2 for six months beginning July 1, 2013, and ending December 31, 2013.
If the W-2 agency determines that an individual has committed a W-2 or JAL IPV, the W-2 agency must impose an IPV penalty denying W-2 and JAL to the individual for the following time periods:
1. Six months for the first IPV;
2. One year for the second IPV; and
3. Permanently for the third IPV.
Once a W-2 agency imposes an IPV penalty, the penalty continues uninterrupted for the duration of the ineligibility period unless reversed under the W-2 dispute resolution process (See Chapter 12). The duration of the ineligibility period is never subject to review.
Each IPV determination is subject to the dispute resolution process.
IPV determinations for W-2 (including JALs), Wisconsin Shares (child care) and EA are independent of each other. If an individual is determined to have committed a W-2 or JAL IPV, the penalty applies to both W-2 and JAL. If an individual commits a child care IPV, the penalty applies only to child care. If an individual commits an EA IPV, the penalty applies only to EA.
If a W-2 applicant or participant demonstrates an inability to obtain child care as a result of a child care IPV, the W-2 agency must not grant good cause for all nonparticipation.
EXAMPLE: Cathy applies for W-2 and child care. During the W-2 application process, Cathy states that she and her two children reside in her home. She states that her husband James moved out two months ago and she does not know where he is. The FEP completes the W-2 intake and confirms eligibility. The FEP reviews all W-2 forms with Cathy before she signs them. After the appointment, the FEP’s co-worker approaches her and states that Cathy is her neighbor and that James resides in the home. The FEP calls Cathy and she admits that James is in the home and that she did provide false information. The FEP discusses the situation with the Fraud Coordinator who decides that Cathy committed a W-2 IPV. The Fraud Coordinator notifies child care of the finding and child care makes the IPV determination for that program. The following month, Cathy is not able to pay her rent. She applies for EA and lists herself, her husband, and two children on the EA application. The W-2 IPV does not prevent Cathy from being determined eligible for EA. She may be eligible for EA if she meets all of the non-financial and financial eligibility.
More than one adult in the W-2 Group may be determined to have committed an IPV and can be subject to the penalty. Only the individual determined to have committed an IPV must receive the penalty. An individual ineligible for W-2 due to an IPV penalty is an Included Adult in the W-2 Group for the purpose of financial eligibility; however, the individual is not eligible for a W-2 placement or services or JAL.
In the case of a two-parent household when one parent is ineligible and the second parent has been determined not to be involved in the IPV activity, the second parent may apply for, and may be, eligible for W-2.
If the W-2 case is closed, or if the individual has already received a JAL, an IPV may still be determined and a penalty applied.
(See Operations Memo 13-10 for instructions on entering W-2 and JAL IPVs in CWW)
The W-2 agency must establish all W-2 overpayments claims in the CARES BV Subsystem. CARES automates the collection process by sending the overpayment notice, repayment agreement, and past-due (dunning) notices. CARES also automates recoupment of overpayments from ongoing payments.
Because an individual’s W-2 case will close for an IPV, it is not possible to recoup from ongoing payments. When entering overpayment claims related to IPVs, the agency must use IV as the Error Type on CARES screen BVCL. If a balance still exists when the individual reapplies for, and is found eligible for W-2, CARES will recoup the remaining overpayment from ongoing payments. (See 10.3.3)
Under no circumstances can the W-2 agency recoup JAL payments from W-2 payments, including any JAL payments that occur due to an IPV. When a JAL recipient commits an IPV and receives an IPV penalty, the recipient is still subject to the terms of his or her JAL repayment agreement. (See 17.5)
After the W-2 agency determines that an IPV has occurred, the agency may decide to take additional enforcement action(s). The additional enforcement action(s) include:
1. Refer for possible criminal prosecution. The W-2 agency must communicate with its Corporate Counsel to discuss and establish thresholds and criteria regarding when to refer individuals to local law enforcement or the district attorney for consideration of possible criminal prosecution.
2. Obtain a Disqualification Consent Agreement. If the W-2 agency decides to refer an individual to the District Attorney for prosecution for civil or criminal misrepresentation or fraud, the agency may offer the individual the option to sign a consent agreement with the agency to defer the referral for prosecution. Individuals who choose to sign this waiver still receive an IPV penalty.
Individuals may appeal an IPV determination by requesting a Fact Finding Review (See Chapter 12). A W-2 IPV determination and the establishment of an IPV-related overpayment are considered two separate actions. The individual must appeal each action separately.
History: Release 20-01; Release 18-04; Release 16-01.