F. INFORMATION SYSTEMS AVAILABLE TO ASSIST IN FRAUD PREVENTION

 

General

The Health and Human Services Agency (HHSA) has developed a network that is designed to provide access to various information systems, allowing for review of current and historical data, either case or person specific. These systems are to be used to verify information. When there is conflicting information, use of the appropriate information systems is required.

 

 

Information Systems

Some of the Information Systems that are accessible for on-line inquiry purposes include:

·       Social Services Systems Index

·       Assessor/Secured Property

·       DMV Clearance

·       Warrant Inquiry

·       General Relief Lien

·       Jail Clearance/Probation Clearance

·       Revenue and Recovery Access

·       Recorder’s Files (RESS/REP1)

·       Marshal Clearance (MA09/MA10)

·       Medi-Cal Eligibility Data System (MEDS)

·       Income and Eligibility Verification System (IEVS)

·       Systematic Alien Verification for Entitlement 

 

 

FRC Staff Responsibility

FRC Managers

 

Are responsible for ensuring Family Resource Center (FRC) staff are aware of and utilize all automated information systems appropriate in the eligibility determination process.

 

SHSS

 

Are responsible for reviewing the usage of the automated information systems with the HSS to ensure they utilize the information available.

 

HSS’s  

 

Are responsible for utilizing automated information systems.

 

 

Nationwide Prisoner Match

The Nationwide Prisoner Match (NPM) compares information from federal, state, or local correction or detention facilities throughout the nation via the Social Security Administration’s Prisoner Update Program System (SSA PUPS) with the California Medi-Cal Eligibility File (MMEF), to determine if individuals incarcerated over 30 days are currently receiving public assistance.  From this data match, the California Department of Social Services (CDSS) Fraud Bureau transmits abstract match information to the County’s Public Assistance Fraud (PAF).   The information received is only a potential fraud indicator.  PAF will forward the abstract match information to the HHSA for appropriate action.

 

The Human Services Specialist (HSS) will take the following steps upon receipt of the NPM abstract:

 

Step

Action

1

Review the case to determine if the person listed on the abstract is the same person in the case.

2

Determine if the person was receiving aid during the period of incarceration.

3

Take appropriate case action based on existing regulations for each specific program.

4

Narrate and complete 16-77 HHSA noting action taken as a result of the NPM.  If no action is necessary, indicate the reason in detail on the 16-77 HHSA.

5

Send one copy of 16-77 HHSA with proof of action taken to the Corrective Action Supervisor (CAS) and file the other copy along with the abstract under the “Overpayment” tab in the case.

6

For Medi-Cal overpayments, follow procedures as stated in Medi-Cal Program Guide Article 16.

Note:  Do not refer to OSU.

7

For CAPI overpayments, follow procedures as stated in CAPI Program Guide section 99-109.

8

For CalWORKs, Food Stamp, and General Relief overpayments/ overissuances:

If…

Then…

The total willful

overpayment/overissuance

is  $99 or less

HSS will process as

appropriate per existing

regulations for each

program.

The total willful

overpayment/overissuance

is over $99 and under

$1500

Initiate a referral to OSU.

The period of the offense identifies a willful

overpayment or

overissuance of $1,500 or more

Initiate a referral to PAF via FRTS.

 

Note:  Do not initiate a referral to OSU for administrative error overpayments resulting from a lack of timely notice of action to the client. 

 

Fleeing Felon Match

The following steps and actions will be used to review information provided by the statewide Fleeing Felon Match for possible ineligibility.

 

PAF action:

Step

Action

1

Review all CDSS Fleeing Felon Matches

2

Process the matches through a team of District Attorney Investigators (DAIs) and Investigative Specialists (ISs).

3

Clear criminal history systems to determine if individual’s match is valid.

4

Clear each warrant’s information and status with the issuing agency for wanted persons residing in San Diego County.

5

On misdemeanor warrants, document the information found on the yellow PAF Fleeing Felon Match Correspondences form (FLEEFELN1), retain the bottom white copy and forward the form to the HSS of record for action.

6

On active felony warrants, document the information found on the yellow Fleeing Felon Match Correspondences form, attach a copy of the booking slip to verify the recipient has been arrested, forward the form to the HSS of record for action and retain the bottom white copy.

 

HSS action:

Step

Action

1

Review the information provided on the yellow PAF Fleeing Felon Match Correspondences form.

2

Take appropriate case action based on existing regulations.

3

Forward response to PAF within 20 calendar days from receipt by:

o       Fully completing Section 2 of the yellow PAF Fleeing Felon Match Correspondences form; and

o       Returning the top yellow copy to PAF; and

o       Filing the goldenrod case copy under the Overpayment tab. 

 

PAF will review the HSS response on the PAF Fleeing Felon Match Correspondence form, and initiate a referral on FRTS to PAF Investigations, when the period of offense identifies an overpayment of $1,500 or more.