State Survey Analysis Report
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APPENDIX 18. DEFINITION OF FRAUD
18. How does the CCDF Lead Agency define fraud?
21 State agencies responded to Question 18 (Appendix 18: pp. 113–117) |
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| State | Definition of Fraud |
|---|---|
Arizona |
Currently, the definition of “fraud” used by the Attorney General’s Office for criminal prosecution purposes is the only definition in use in Arizona (since the legal process establishes “fraud” via conviction).Per Arizona Revised Statutes 13-2311 “..Any person, who, pursuant to a scheme or artifice to defraud or deceive, knowingly falsifies, conceals or covers up a material fact by any trick, scheme or device or makes or uses any false writing or document knowing such writing or document contains any false, fictitious or fraudulent statement or entry is guilty of a class 5 felony”. |
California (DE) |
In California, the CCDF lead agency is the Department of Education. There is no definition of fraud in Education Code. By policy, the Department defines fraud as the intentional provision of inaccurate or incomplete information to obtain a benefit or payment to which the parent or provider would otherwise not be entitled. |
California (DSS) |
In California, the lead agency for Stage One Child Care is CDSS. “Fraud” is defined in both California’s Code of Regulations (CCR Division 20, Chapter 20.003), and in the Welfare and Institutions Code (WIC §10980), where CDSS derives its statutory authority. Please go to http://www.leginfo.ca.gov and click on “California Law” to access the State code section. For the California Code of Regulations, please go to: http://www.cdss.ca.gov/ord/CDSSManual_240.htm |
Connecticut |
Overpayments are considered intentional if the parent or provider knowingly withheld or provided false information on matters affecting eligibility, benefits or a claim for services as determined by a court or administrative disqualification hearing official. An overpayment is considered unintentional under the following circumstances: (A) if there was clearly no intent to commit fraud or to obtain benefits or payments under false pretenses; (B) if the parent or provider did not purposefully withhold or provide erroneous information; (C) if illness, a family emergency or other good cause reasons exist for not reporting information timely or accurately; or (D) if the error was due to a delay in taking action as the result of an administrative hearing request. |
Georgia |
An intentional program violation is an intentional action by an individual to establish or maintain a family unit’s eligibility, or to increase or prevent a decrease in the family unit’s benefits, by providing false or misleading information or withholding information. This list is not all inclusive. |
Kansas |
See http://www.srskansas.org/KEESM/keesm11200.htm#11210 |
Kentucky |
“Fraud” means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to him/her or some other person. It may include any act that constitutes fraud under applicable Federal or State law. |
Maryland |
Someone who obtains or attempts to obtain monies, property, Food Stamps, Medical Care or other assistance to which he is not entitled. |
Massachusetts |
Fraud is not defined in EEC’s regulations. EEC’s “working definition” of fraud is a deliberate act to deceive or misrepresent in order to secure an unfair or unlawful gain. |
Minnesota |
Improper Payments Fraud -Attachment 2256.98 Wrongfully obtaining assistance; theft. Subdivision 1. Wrongfully obtaining assistance. A person who commits any of the following acts or omissions with intent to defeat the purposes of sections 145.891 to 145.897, the MFIP program formerly codified in sections 256.031 to 256.0361, the AFDC program formerly codified in sections 256.72 to 256.871, chapters 256B, 256D, 256J, 256K, or 256L, and child care assistance programs, is guilty of theft and shall be sentenced under section 609.52, subdivision 3, clauses (1) to (5): (1) obtains or attempts to obtain, or aids or abets any person to obtain by means of a willfully false statement or representation, by intentional concealment of any material fact, or by impersonation or other fraudulent device, assistance or the continued receipt of assistance, to include child care assistance or vouchers produced according to sections 145.891 to 145.897 and MinnesotaCare services according to sections 256.9365, 256.94, and 256L.01 to 256L.16, to which the person is not entitled or assistance greater than that to which the person is entitled; (2) knowingly aids or abets in buying or in any way disposing of the property of a recipient or applicant of assistance without the consent of the county agency; or (3) obtains or attempts to obtain, alone or in collusion with others, the receipt of payments to which the individual is not entitled as a provider of subsidized child care, or by furnishing or concurring in a willfully false claim for child care assistance. The continued receipt of assistance to which the person is not entitled or greater than that to which the person is entitled as a result of any of the acts, failure to act, or concealment described in this subdivision shall be deemed to be continuing offenses from the date that the first act or failure to act occurred. Subd. 2. Joint trials. When two or more defendants are jointly charged with the same offense under subdivision 1, or are jointly charged with different offenses under subdivision 1 arising from the same course of conduct, they shall be tried jointly; however, if it appears to the court that a defendant or the State is substantially prejudiced by the joiner for trial, the court may order an election or separate trial of counts, grant a severance of defendants, or provide other relief. The process: • County agency staff determines eligibility and maintains ongoing case management services for families applying and receiving benefits from the child care assistance program. When a worker receives questionable or inconsistent information that creates overpayments or possible fraud, according to program policy, the child care worker makes a referral to their county Fraud Prevention Investigation (FPI) unit. The investigator determines if the family’s case will be handled through the County Fraud Prevention Investigation (FPI) unit or referred to their County attorney office for prosecution. • If the family is determined guilty, the entire family will be disqualified from receiving child care assistance, for a specific time period according to the number of prior offenses; 1st offense: 3 months, 2nd offense 6 months and 3rd offense 2 years and permanently disqualified from child care assistance for any additional offenses. A family with an outstanding debt is not eligible for child care assistance until 1) the debt is paid in full; or 2) satisfactory arrangement is made to retire the debt and the family is in compliance with the arrangement. For non-fraudulent cases, the county will recoup a percentage of the overpayment depending on the type of overpayment and the sequences of events that cause this overpayment, such as failure to report changes timely that result in an overpayment. • For child care providers, if they are determined guilty, they are disqualified from caring for any children receiving CCAP payments. The disqualification periods are: 1st offense = 1 year, 2nd offense 2 years and permanently barred from caring for children receiving child care assistance payments. A child care provider with an outstanding debt is not eligible to care for a child receiving child care assistance until; 1) the debt is paid in full; or 2) satisfactory arrangement is made to retire the debt and the child care provider is in compliance with the agreement. |
Mississippi |
To willfully and intentionally misrepresent eligibility status for related benefits. |
Missouri |
Fraud is defined as any payment made or receive as a willful and intentional violation of the program’s rules and regulations. |
Nebraska |
For clients/parents, we use the following definition: Any action by an individual to intentionally: 1. Make a false statement, either verbally or in writing, to obtain benefits to which the individual is not entitled; 2. Conceal information to obtain benefits to which the individual is not entitled; or 3. Alter one or more documents to obtain benefits to which the individual is not entitled. We do not have a written definition for provider fraud, but it would be very similar, involving the intentional action to receive payment for which the provider was not eligible, either by caring for more children than regulation would allow, billing for children for whom care was not provided, overstating hours of care, etc. |
New Hampshire |
“Fraud'' means an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person. It includes any act that constitutes fraud under New Hampshire criminal code, RSA title LXII. |
North Carolina |
Fraud is defined as a misrepresentation or false statement regarding a material fact, or failure to disclose a material fact that results in obtaining, attempting to obtain, or continuing to receive child care subsidy funds or services for himself or herself or another person. |
Ohio |
Ohio Administrative Code Section 5101:2-16-71 “(D) Child care recipient fraud is the willful withholding or falsification of information or the willful misuse of child care services resulting in the recipient receiving child care benefits for which the recipient is not eligible. Recipient fraud includes the following: (1) Knowingly, and with the intent to deceive or defraud, providing false information or withholding information regarding eligibility factors such as family income, number of family members, ages of family members, or the recipient's hours of employment or training. (2) Knowingly, and with the intent to deceive or defraud, failing to report any changes which would affect the family's eligibility for child care benefits, within ten working days of the date the change occurred, in accordance with paragraph (R) of rule 5101:2-16-35 of the Administrative Code. (3) Knowingly, and with the intent to deceive or defraud, using child care services when the recipient is not employed or in training. (4) Knowingly, and with the intent to deceive or defraud, using child care services during hours and/or for purposes not authorized by the eligibility determiner. (5) Knowingly, and with the intent to deceive or defraud, using child care services for an ineligible child.” Ohio Administrative Code Section 5101:2-16-72 “(C) Child care provider fraud is the willful withholding or falsification of information or misuse of child care services by the provider, with an intent to deceive or defraud, resulting in the provider receiving payments from the CDJFS for which the provider is not entitled. |
Oklahoma |
The term fraud is legally defined as an intentional false representation of a truth or matter of fact whether by words or by conduct, by false or misleading allegations, or by concealment of that which should have been disclosed , for the purpose of inducing another in reliance upon it to part with some valuable thing or surrender a legal right. |
Utah |
Making false statements or misinterpretations with the knowing or willful intent to obtain services, payments, or other gains. |
Washington |
Fraud is defined as: “Purposeful deception to cause a person to give up a property or other right. The term person includes the State.” This is the definition used by the Division of Fraud Investigations, within DSHS. |
West Virginia |
Fraud is defined as intentional misrepresentation by either a client to receive services or a provider in billing for services leading to overpayments of at least $1,000.00. |
Wisconsin |
Anyone who, with knowledge and purpose makes false statements, suppresses facts, gives information which misrepresents true circumstances, in order to become eligible or remain eligible for public assistance benefits commits fraud. These actions are referred to as intentional program violation (IPV). 2. A fraud conviction in a criminal court or a determination after an administrative hearing. |
| Those that did not provide an answer: | |
Alabama |
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District of Columbia |
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Montana |
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Puerto Rico |
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Appendix 19 >>