63-705     Allegations Received Through the Fraud Hotline and CDSS Alerts

 

Table of Contents

 

 

Section

Fraud Hotline

63-705.1

Worker Actions

63-705.2

PAFD Resolved

63-705.3

CDSS Alerts

63-705.4

 

63-705.1
Fraud Hotline

The Public Assistance Fraud Division (PAFD) of the District Attorney’s (DAs) Office has a  Hotline to receive fraud allegations from the public. Referrals from the Hotline will be either generated in FRTS by the Hotline interface or will be entered directly into FRTS by Hotline workers.  Hotline referrals for active, pending or discontinued cases will be displayed in the case workers “Individual Work Basket” in FRTS.  Hotline referrals on  closed cases will be processed by PAFD. 

 

 

63-705.2
Worker Actions

The following are actions to be taken by the worker upon receipt of  a Hotline referral in their “Individual Work Basket” in FRTS:

 

·   The worker will review the referral and determine whether to forward  for investigation when the referral meets Full Field criteria. 

 

-  If the allegation is known information (i.e., documented in the case), eligibility and benefit levels should reflect this information.

-  If the information is not known, contact the client and question him/her about the information received.

 

·   If the worker determines that the allegation should be investigated by PAFD, the worker will  set the Refer to PAF Status to “Refer to PAF-Hotline in FRTS.  In the Additional Narrative section in FRTS the worker must explain what actions have been taken to resolve the complaint/allegation and promptly forward copies of necessary attachments to PAFD.

 

·   If  the worker is able to resolve the Hotline referral then it is not forwarded for investigation.  The worker will set the Refer to PAF Status to “Resolved by Worker” and notate how the referral was resolved in the Additional Narrative section.

 

REMINDER (Active, Pending, Discontinued Cases Only): Any referral initiated by the Hotline has a pending status on FRTS. It is the worker’s responsibility to indicate its disposition in FRTS to avoid an indefinite pending status and/or duplicate referrals.

 

 

63-705.3
PAFD Resolved Referral Correspondence
Procedures

The FRTS design does not allow online resolution of Hotline referrals once an “R” has been entered on the WRF3 FRTS screen indicating it was resolved. Staff must follow manual correspondence procedures. To complete the process, PAFD developed the Resolved Referral Correspondences form PAFD/RRC-1.

 

When the worker resolves the FRTS Hotline referral, the FRTS additional comments narrative entry must clearly state the reason for resolution. The PAFD Hotline Investigator will review this information.

 

The PAFD Hotline Investigator will:

 

·   Accept, return or request more information on the referral response from the worker;

·    Complete the top section of the Resolved Referral Correspondences form to communicate questions or issues regarding the worker referral response; and

·   Forward the original and one copy of the form to the Worker for action, retaining the bottom copy for their records.

 

The Worker will:

 

·   Review the information provided on the form by the PAFD Hotline Investigator upon receipt and take any necessary action as appropriate;

·   Complete the response area in Section 2 of the Resolved Referral Correspondences form and include attachments as appropriate;

·   Return the original completed response form with any attachments within ten (10) calendar days from receipt to PAFD, mail stop W413, attention PAFD Hotline; and

·   Send to the Document Processing Center (DPC) to be imaged.

 

PAFD will:

 

·   Track receipt of the Resolved Correspondences form from the worker;

·   Allow time for the worker to receive the form, as the completed response from the worker is due back to PAFD within 10 calendar days from receipt;

·   Have the PAFD Hotline Investigator contact the worker to question the delay if no response has been received by the 10th calendar day from receipt, and request a response within five (5) calendar days;

·   Have the PAFD Hotline Supervisor call the worker’s Supervisor regarding the delay if no response has been received by the 15th calendar day from receipt and request a response within five (5) calendar days;

·   Have the PAFD Hotline Supervisor call the FRC Manager regarding the delay if no response has been received by the 20th calendar day from receipt and request a response within five (5) calendar days;

·   Have the PAFD Lieutenant contact the FRC Regional General Manager to resolve the delinquent response, if a response is not received; and

·   Document the disposition of the hotline referral upon receipt by completing Section 3 on the Resolved Referral Correspondences form.

 

 

63-705.4
CDSS Alerts

After the Food and Nutrition Services (FNS) has permanently disqualified a retailer for trafficking SNAP benefits, The California Department of Social Services (CDSS) receives ALERT case data containing information on recipients whose transactions were the basis for the retailer being disqualified.

 

The CDSS will send a Warning Letter to all recipients included in the ALERT case file. The letter will inform the recipient that their EBT card was identified as having unusual transactions that were made at a retailer that has since been disqualified by FNS due to illegal trafficking. The letter will include information regarding the proper use of the EBT card and the penalties for trafficking.

 

A copy of each letter will be sent to the County and shall be imaged in the recipient’s case file. If a Warning Letter is returned as undeliverable, the CDSS will contact the County to request an updated address or status, in order to issue the Warning Letter to a new address, if still applicable. PAFD tracks the Alerts and reporting for CDSS.

 

 

 

ACL 13-45