63-453    Intentional Program Violation (IPV) Claims Determination

 

Table of Contents

 

Section

Definition: Intentional Program Violation (IPV) Claim

453.1

Public Assistance Fraud Division (PAFD) Responsibility

453.2

Establishment of IPV Claims

453.3

Inadvertent Household Error (IHE) Claims Referral Guidelines

453.4

Administrative Disqualification Hearings

453.5

IPV Disqualification Periods

453.6

IPV Disqualification Procedures

453.7

Timeframes for Imposition of Disqualification Penalties

453.8

Reinstating an IPV Disqualified Individual to CalFresh (Lopez v. Wagner Settlement Agreement)

453.9

 

 

 

63-453.1

Definition: Intentional Program Violation Claim

An Intentional Program Violation (IPV) claim as applied to a CalFresh household member is defined as having intentionally:

·      Made a false or misleading statement, or misrepresented, concealed,  or withheld facts, or

·      Committed any act which constitutes a violation of the Food Stamp Act, CalFresh program regulations or any statute relating to the use, presentation, transfer, acquisition, receipt or possession of CalFresh benefits, trafficking of benefits, or electronic benefit cards or devices that deliver benefits.

Individuals found to have committed an IPV either through an administrative disqualification hearing or by a court of appropriate jurisdiction, or individuals accused of IPV who have signed an Administrative Disqualification Hearing Waiver or a Disqualification Consent Agreement in cases referred for prosecution will be ineligible to receive CalFresh benefits.

 

63-453.2

Public Assistance Fraud Division Responsibility

The County’s Public Assistance Fraud Division (PAFD) is responsible for investigating any case of alleged IPV. 

PAFD may confer with the District Attorney (DA) in establishing criteria for prioritizing cases to be assigned for investigation and prosecution.  In those cases in which it appears that clear and convincing evidence exists to substantiate the allegation of an IPV, PAFD shall file a request for a complaint with the DA’s office as provided in Manual of Policies and Procedures (MPP) Section 20-007.35.

 

63-453.3

Establishment of IPV Claims

In San Diego County, an Intentional Program Violation (IPV) can only be established when:

·      A Court of Law (an administrative disqualification hearing official or a court of appropriate jurisdiction) has determined that a household member or its sponsor has committed an IPV; or

·      An individual accused of IPV has signed either:

o   A Waiver of Rights to an Administrative Disqualification Hearing (ADH), or

o   A Disqualification Consent Agreement.

 

63-453.4

Inadvertent Household Error (IHE) Claims Referral Guidelines

Prior to a determination of an IPV, a suspected fraud claim will be established and handled as an Inadvertent Household Error (IHE) claim.  Refer to 63-452.1and 63-452.4.

The worker will be responsible for obtaining all necessary verifications and computing all overpayments to establish IHE overpayments as explained in 63-452.1, 63-452.4 and 63-452.6-7.

Reminder: When determining the amount of benefits the household should have received, the worker will not apply the twenty (20) percent earned income deduction to the portion of earned income the household failed to report.

An IHE claim will only be referred to PAFD or Administrative Disqualification Hearing (ADH) when meeting the criteria listed below:

  • A CalFresh claim will be referred to PAFD via Fraud Referral Tracking System (FRTS) when the overpayment is:

o  Client caused, and

§  The CalFresh overissuance is $1,500 or more, or

§  A combined CalFresh and CalWORKs overpayment of $1,500 or more; or

o The client failed to report on more than one document, and the County had NO knowledge of this information; or

o  There is a prior IPV, and the current overissuance is $400 or more.

·         A CalFresh claim will be referred for an Administrative Disqualification (ADH) review to the Overpayment Specialist Unit (OSU) when the overpayment is:

o  Client caused, and

o  The overpayment is $251 or greater but less than $1500.

Send ADH referrals via email to HHSA, SDOverpaymentUnit stating in the subject line ‘Request ADH Review’ and include the case name, case number and brief summary in the email.

 

63-453.5

Administrative Disqualification Hearings

The County shall conduct administrative disqualification hearings for individuals accused of IPV in accordance with MPP Division 22 regulations and MPP 63-804.  However, an individual is allowed to waive his/her right to an administrative disqualification hearing.

Those cases warranting prosecution will be referred to the court to establish whether the individual has committed an IPV.

The County has the option of allowing accused individuals to sign Disqualification Consent Agreements for cases of deferred adjudication.  Deferred adjudication applies to the following:

·      Those cases in which a determination of guilt is not obtained from a court due to the accused individual having met the terms of a court order; or

·      Those cases which are not prosecuted due to the accused individual having met the terms of an agreement with the prosecutor.

 

63-453.6

IPV Disqualification Periods

Individuals determined guilty of committing an IPV act in a Court of Law or through an Administrative Disqualification Hearing (ADH) will be disqualified as follows:

OFFENSE

PENALTY

Trading CalFresh benefits for a controlled substance,

If convicted by a Court of Law:

·         Two years for the first conviction.

·         Permanent disqualification for the second conviction.

Trading CalFresh benefits for firearms, ammunition, or explosives,

If convicted by a Court of Law:

·         Permanent disqualification for the first conviction.

Falsifying the identity or place of residence of the individual in order to receive multiple CalFresh benefits simultaneously,

If found to have committed an IPV  either through an A DH, by a Court of Law or appropriate jurisdiction:

·         10 year disqualification for the first conviction.

Trafficking in CalFresh benefits with a value of $500 or more,

If convicted by a Court of Law:

·         Permanent disqualification for the first conviction.

For any other IPV

If found to have committed an IPV  either through an ADH, by a Court of Law or appropriate jurisdiction:

·         One year for the first IPV.

·         Two years for the second IPV.

·         Permanent disqualification for the third IPV.

The disqualification penalties will apply only to individuals disqualified for IPVs which occurred during a certification period after the household has been notified by the County of the disqualification penalties.  Once a disqualification penalty has been imposed against the individual, the period of disqualification will continue uninterrupted until completed, regardless of the individual(s) CalFresh eligibility status.

 

63-453.7

IPV Disqualification Procedures

When an individual(s) is determined to have committed an IPV act, OSU and Family Resource Center (FRC) staff will apply the following procedures:

OVERPAYMENT SPECIALIST UNIT (OSU)

If ...

Then ...

The individual(s) is in an active case, OSU will,

·      Notify via email the Corrective Action Liaison (CAL) with a copy to the FRC manager of the IPV disqualification; and

·      Change the IHE claim type to IPV; and

·      Image the IPV notification form 216IPV HHSA and supporting paperwork with the following information:

o Name of the individual(s) that is disqualified, and

o Length and effective date of the disqualification.

A case is closed or the individual(s) is no longer a part of the CalFresh household, OSU will,

Image the IPV notification form 216IPV HHSA and add sanction narrative in Case Comments.

FAMILY RESOURCE CENTER (FRC)

When the worker becomes aware of an IPV disqualification through an IPV Notification form in the case or email from OSU,  the worker will:

Stage

Description

Initial Application

·         Review the (imaged) IPV notification form 216IPV HHSA  to determine if the individual(s) is disqualified and if the entire or a partial disqualification period has been completed.  Enter the IPV information into CalWIN for the individual(s) if applicable;

·         Exclude the disqualified individual(s) from the CalFresh household for the remainder of the disqualification period, if the individual(s) disqualification period has not been completed.

·         Contact OSU if the case record indicates a household member has been convicted of an IPV but the notification is not in CERMS.

Ongoing Cases

When an email is received from OSU via the CAS to disqualify an individual from CalFresh, the worker will:

·         Review the IPV notification 216IPV HHSA form and OSU’s Case Comments to implement the disqualification period as instructed, and

·         Send the proper notices to the household as explained in  63-454.3.  Timely notice is not required to reduce the household’s allotment due to the IPV disqualification.  Refer to  63-303.13.

Refer to 63-244.1 and 63-244.4 for the treatment of income and 63-238.4 for treatment of expenses of IPV disqualified individuals.

 

63-453.8

Timeframes for Imposition of Disqualification Penalties

The worker will take immediate action to disqualify the individual as instructed on the 216IPV HHSA and to send the required notices as instructed in  63-454.3.

An IPV sanction is a County Initiated Action.  Therefore, the worker will implement the sanction and discontinue the individual mid-period.  Timely notice is not required to reduce the household’s allotment due to the IPV disqualification.  Refer to 63-285.1 and 63-303.13.

 

63-453.9

Reinstating an IPV Disqualified Individual to CalFresh (Lopez v. Wagner Settlement Agreement)

The Lopez v. Wagner settlement agreement requires counties to provide information to disqualified individuals of how to resume benefits upon expiration of the IPV disqualification penalty by: 

·      Sending the DFA 377.7A1 along with the CalFresh Notice of Administrative Disqualification DFA 377.7A for the disqualified member to request reinstatement of CalFresh benefits following an IPV disqualification when the disqualification is not permanent (Refer to  63-454.3); and

·      Taking the following actions to reinstate disqualified household members to CalFresh based on the monthly report of disqualified individuals ending the disqualification period:

If ...

Then ...

The disqualified household member is still a member of the CalFresh

household in which he or she was previously receiving benefits,

The worker will automatically add the disqualified household member to the household the month following the expiration of the disqualification period, subject to the continuing eligibility of the household.

In the case of a missing verification, the worker will notify the household and allow at least 10 days for the verification to be returned.  The individual will not be added back to the household if the requested verification is not received.

The disqualified household member is a member of a different CalFresh

household, and

 

If the change...

Then ...

Has been reported to the County,

The worker will automatically add the individual to the CalFresh household the month following the expiration of the disqualification period, subject to the continuing eligibility of the household.

Has not been reported to the County,

The disqualified household member will be added to the household the month following the end of the disqualification period, when the county receives a request to add the person.  The disqualified household member could request reinstatement either:

·   Verbally over the phone or

·   In person at a FRC; or

·   In writing either by letter, a note,  or the Eligibility/Status Report (SAR 7); or

·   By submitting the DFA 377.7A1.

 

 

The disqualified household member does not reside in a CalFresh household,

The disqualified household member must reapply for CalFresh.

If the application is submitted prior to the end of their disqualification period, benefits will be issued, if otherwise eligible, the first day following the end of their disqualification period.

A CalFresh application may be submitted up to 30 days prior to the end of the disqualification period.  Staff will ensure eligibility is determined before the end of the disqualification period.

The disqualified household member is eligible for Expedited Services (ES) if he or she meets the criteria and their disqualification period has ended before CalFresh ES benefits are issued..

When the disqualified household member is added back to the household, the worker will send CalFresh Notice of Change CF 377.4.