63-703 Fraud Allegations

 

Table of Contents

 

Section

Fraud Related Allegations

63-703.1

Non-Fraud Related Allegations

63-703.2

 

63-703.1

Fraud Related Allegations

Staff should only verify mandatory factors for CalFresh eligibility. However, staff should continue to contact the household to clarify any questionable information affecting eligibility submitted by the household. To be considered questionable, the information should, in general, meet the criteria listed in 63-117.23. Questionable information is not, in and of itself, grounds for a denial/discontinuance or a referral for investigation. It is merely grounds for further exploration by the worker.

Where verification is required to resolve questionable information, the worker must document why the information was considered questionable, or at a minimum indicate where the inconsistency exists, and what documentation was used to resolve the questionable information. The worker must also document the reason why an alternate source of verification, such as a collateral contact or fraud referral, was needed.

 

The following are examples of allegations that are considered fraud-related and may require a fraud referral: 

         Questionable residency (i.e., living out of country);

         Suspected duplicate aid.

         Questionable household composition;

         Unreported income;

         Unreported property (non-MCE households);

         Expenses exceeding income (How is client meeting his/her needs?);

         Submitted documentation appearing to have been altered or counterfeit; or

 

A request for investigation shall be made when there are reasonable grounds to suspect that a crime has occurred. Reasonable grounds exist when one or more of the following criteria are met:

         An overissuance may have or has resulted from a recipient's failure to report information affecting eligibility or benefits;

         A questionable situation exists and the applicant/recipient or third party will not cooperate in providing necessary verification that affects eligibility or benefit amount;

         The program staff person finds conflicting information that could affect eligibility or benefit amount, and any further action on his/her part could jeopardize the investigator's ability to investigate;

         Situations involving embezzlement, collusion, conspiracy, trafficking, black marketing or other general program violations;

         Forgery situations, providing that the instrument (e.g., warrant, Authorization to Participate) has been transacted;

         The program staff person receives an allegation of fraud from any government agency; or

         A public complaint containing facts which allege a crime (i.e., fraud, perjury, trafficking, embezzlement, etc.) against a public social services program.

 

 

 

63-703.2

Non-Fraud Related Allegations

The worker must not submit and the Public Assistance Fraud Division (PAFD) will not accept fraud referrals for the following types of allegations because they are not fraud-related: 

         Child abuse/neglect;

         Drug & Alcohol abuse;

         Non-payment of rent obligation; and/or

         Unreported income from illegal sources, such as drug trade, prostitution, etc.

In some instances, a referral to another responsible agency, such as Child Protective Services, is appropriate and required.