Dws.utah.gov/deporgcharts  (Deputy Director’s – Operations – PEP Unit)

x    Steps involved in identifying a potential improper payment

x    Steps involved in verifying an improper payment

x    Establishing claims for improper payments

x    Collecting improper payments, including, for example, the authority to reduce payments to recover overpayments

x    Distribution of recovered improper payments

x    Sources of funding for addressing improper payments

q   Other (please specify : )                                                                                              

 

Identification and Assessment of Improper Payments

4.       Has your State performed an assessment or analysis to determine whether the program is at risk of improper payments?

For which of the following uses of program funds did your state perform an assessment or analysis to determine whether the program is at risk of improper payments? (Please check all that apply.)

x b.  “Nonassistance” benefits or services, for example, one-time cash payments designed to divert a family from welfare or payments for car repairs or rental assistance

x c.   Other types of benefits and services for families not receiving cash assistance

q d.  Payments to service providers

q e.  Other (Please specify:) ________________________________________________________

q No.

 

5.       Please describe your process for identifying and handling improper payments.

The allegation date is the date the Employment Center Staff submits the potential overpayment for establishment processing. 

Payment Specialists are responsible to calculate improper payments.  Agency Errors for TANF Funds are not established or collected.   Potential overpayments with the threshold of over $125.00 will be referred for establishment.

Potential overpayment referrals that cannot be calculated because the Investigator and/or Payment Specialist have exhausted all potential avenues to gather the supporting information and the household refuses to cooperate in providing the necessary information are considered incomplete claims.   A GIIC notice will be sent to the customer(s) and if the still refuses within 10 days to cooperate in providing the necessary information the TANF benefits will be closed IC (Incomplete Claims).  The TANF benefits will remain closed until the customer cooperates.

After the Payment Specialists calculates the overpayment they are responsible to submit the calculated potential overpayment to the Pre-Adjudication staff within the PEP Unit except for the Payment Specialists that are currently on the Payment Specialist Pilot Project.  The Payment Specialist Pilot Project is a pilot to consolidate two job functions, calculation and notification.

An overpayment waiting for an administrative hearing decision is not considered delinquent.  If the administrative hearing decision states that the overpayment exists, the household is re-notified of the overpayment.  If the administrative hearing decision states that the overpayment does not exist, the overpayment against the household is closed.

 

6.       Which methods, if any, did your state use to identify a total amount of improper payments for the program? (Please check all that apply.)

Calculation based on:

x Findings from the state’s Single Audit

q Other audit findings from state auditors

q Findings from other state or local auditors, including legislative review entities (Please specify :) ______________________________________________________________________________

x Findings from state or local fraud units (Please specify : PEP Unit) ______________________________________________________________________________

q Reviews of service providers and/or contractors

q Reviews of sampled cases, although not statistically representative of all program payments

q Statistically representative sample of payments

q Other (Please specify :) ____________________________________________________________________

 

7.       Does your State calculate an improper payments (including fraudulent payments) rate, that is, a measure of the percentage of total payments that are determined to be improper? (Please check one response and provide the appropriate data.)

x No 

q Information not available.

 

Describing Improper Payments:  Sources, Types, Causes

8.       Please rank the following sources of improper payments (1 to 7) for the program in your State over the past two fiscal years, beginning with one (1) indicating the primary source of improper payments.  Error is defined as an inadvertent mistake whereas fraud is defined as a willful misrepresentation. (Please rank each source below.)

___ Provider error

_3_ Agency error

_2_ Client fraud

___ Provider fraud

___ Agency fraud

___ Other (Please specify)_________________________

 

9.       Of all improper payments in your State, what proportion of those payments would you estimate are overpayments, and what proportion would you estimate are underpayments?  An overpayment is defined as a payment larger than what should have been made/received or any payment that is received when none should have been received.  An underpayment is defined as a payment smaller than what should have been made/received or no payment was received when there should have been one.

Underpayments       37.61%

 

10.   To what extent, if any, have the following factors contributed to improper payments in your State over the past two fiscal years?  (Please check one answer in each row.)

Table 10

Factors contributing to improper payments	Great extent	Moderate extent	Little extent	No extent	Don’t know
Related to clients
a. Nonreporting/underreporting of income	X
b. Client receiving payment in more than one jurisdiction			X
d. Incorrect reporting of household size	X
e. Incorrect citizenship or immigration status		X
f. Incorrect information on client’s compliance with program requirements, such as participating in required activity		X
g. Other (Please specify):  Assets		X
Related to providers
h. Overstating performance		X
i. Claiming for services not rendered		X
j. Other (Please specify): Child Care Provider (FX) receiving benefits e.g., food stamps, etc. and not reporting income from Child Care Payments	X

Prevention of Improper Payments

11.   Please describe your top 3 priorities for preventing and reducing improper payments (e.g., training/meetings for providers on rules and responsibilities; training for agency staff on correct implementation of rules and responsibilities; clear communication with parents on rules and responsibilities; use of information technology.)

12.   For each activity listed below, indicate whether or not your State performs it to verify the accuracy of information needed to determine eligibility for and/or proper amount of a program payment.  If yes, indicate when in the process the step or activity is performed and how often it is performed.

Table 12

Steps or activities  performed	Is the step/activity performed?	If yes, at what stage in the process (e.g., pre-approval/approval; redetermination at  3 mos., 6 mos. or 12 mos. ;etc.)?	If yes, how often?	Please insert a checkmark by the 3 items you consider the most effective.
a. Require documentation from client	x Yes   q No	Application, Review and/or re-determination	3-6 Months	x
b. Fingerprint clients	x Yes   q No	ONLY for worksite learning at Application	1
c. Access online databases	x Yes   q No	eFind – application and review	3-6 Months
d. Match automated computer files	x Yes   q No	EFind – application, review and daily alerts	Daily
e. Conduct telephone, fax, or email contacts	x Yes   q No	Mostly telephone – as often as necessary	As Needed
f. Conduct home visits	x Yes   q No	Normally only the PEP Unit makes home visits – application or anytime customer is receiving benefits	As Needed	x
g. Initiate a fraud investigation if warranted	x Yes   q No	Can be done at anytime	As Needed
h. Conduct program integrity/quality control review	x Yes   q No	Targeted edits, Quality Control pulls – anytime customer is receiving benefits	Monthly	x
i. Other (Please specify :)	q Yes   q No

 

13.   Data sharing is a method used to obtain and disclose information about individuals from within your agency, from other agencies and/or from independent, third party sources, including federal and State agencies or private companies.  These activities can be conducted before an initial payment is made to an individual or provider (pre-payment) and also after payment is made (post-payment) to verify eligibility and payment accuracy.   For each source listed below:

Indicate whether or not your agency or State utilizes this data source to better ensure accurate payments under the program.  If your State utilizes the source, indicate when in the process the source is used (before the payment is issued or at some point after the payment is issued), and/or indicate how often that source is used. (Please check all appropriate responses for each row.)

Table 13

Data source	Is the source used?	If yes, when in the process (e.g., pre-approval/approval; redetermination at  3 mos., 6 mos. or 12 mos. ;etc.)?	If yes, how often?	Please insert a checkmark by the 3 items you consider the most effective.
a. Income Eligibility Verification System (IEVS)	x Yes   q No	12 Months	As Needed
b. Other human services programs in your agency/State	x Yes   q No	As Needed	As Needed
c. State department of labor or employment security	x Yes   q No	As Needed	As Needed	x
d. State directory of new hires	x Yes   q No	As Needed	As Needed	x
e. State department of motor vehicles	x Yes   q No	As Needed	As Needed	x
f. Public Assistance Reporting Information System (PARIS)	x Yes   q No	3 Months	As Needed
g. State data (from other States) on length of TANF receipt	x Yes   q No	3 Months	As Needed
h. State data (from other States) on potential concurrent TANF receipt	x Yes   q No	3 Months	As Needed
i.  State data (from other States) on client or provider debarment from benefits, for fraud or other infraction	x Yes   q No	3 Months	As Needed
j. Lottery agencies	x Yes   q No	Only PEP Unit	As Needed
k. Prisons and criminal justice agencies at State level	x Yes   q No	Only PEP Unit	As Needed
l. National Criminal Information Center (NCIC)	x Yes   q No	Only PEP Unit	As Needed
m. Local jails	x Yes   q No	Only PEP Unit	As Needed
n. Credit bureaus	x Yes   q No	Only PEP Unit	As Needed
o. Financial institutions	x Yes   q No	Only PEP Unit	As Needed
p. State tax intercepts	x Yes   q No	Only PEP Unit/ PAO Units	As Needed
q. Immigration authorities	x Yes   q No	As Needed	As Needed
r. K-12 school systems	x Yes   q No	As Needed	As Needed
s. Community colleges	x Yes   q No	As Needed	As Needed
t. Other providers of services, education, training	x Yes   q No	As Needed	As Needed
u. Child support	x Yes   q No	As Needed	As Needed
v. Social Security Administration (SSA) form W-2 (wage statements)	x Yes   q No	eFind	As Needed
w. SSA Social Security number verification	x Yes   q No	eFind	As Needed
x. SSA Supplemental Security Income (SSI) data	x Yes   q No	eFind	As Needed
y. SSI death information	x Yes   q No	Vital Statistics	As Needed
z. Other (Please specify :)	q Yes   q No

Recovery of Improper Payments

14.   For the most recently completed fiscal years, how much in program improper payments has your agency, or another agency within your State, recovered? (Please indicate your responses in the space provided below.)

q      Includes fraudulent improper payments

Next most recently completed fiscal year   TANF $345,479.00  (Specify ending month/ year)  June 2004

q      Includes fraudulent improper payments

q      Not tracked

 

15.   What penalties does your program mandate for clients, agencies, or providers, who commit an error leading to improper payments?  Civil Penalties/Disqualifications

A.  Agency:  (Nothing for TANF)

C.     Providers:  Nothing

D.     County/Local Agency:  Nothing

 

Fraud:  Intentional Overpayments

16.     How does the TANF Lead Agency define “fraud”?

2.    The severity of the suspected intentional program violation is classified as fraud in accordance with the value of payments, assistance, or other benefits received, misappropriated, claimed, or applied for as follows:

a.    second degree felony if the value is or exceeds $5,000;

b.    third degree felony if the value is or exceeds $1,000 but is less than $5,000

3.    Incidents of trafficking in food stamps that occur within a six-month period, committed by an individual or coconspirators, are deemed to be a related series of facts and circumstances regardless of whether the transactions are conducted with a variety of unrelated parties.

4.    The department reserves the right to pursue prosecution of fraud based upon cost effectiveness and contracts agreed upon with the AG’s office.

5.    A suspected intentional program violation that meets the fraud criteria but is not pursued due to subsection 3 will be pursued as an intentional program violation.

Fraud is established when clear and convincing evidence proves "that the overpayment was obtained intentionally, knowingly, recklessly, by false statement, misrepresentation, impersonation, or other fraudulent means, such as committing any of the acts or omissions.

Intentionally, or with intent or willfully with respect to the nature of his conduct or to a result of his conduct, when it is his conscious objective or desire to engage in the conduct or cause the result.

Knowingly, or with knowledge, with respect to his conduct or to circumstances surrounding his conduct when he is aware of the nature of his conduct or the existing circumstances.  A person acts knowingly, or with knowledge, with respect to a result of his conduct when he is aware that his conduct is reasonably certain to cause the result.

Recklessly, or maliciously, with respect to circumstances surrounding his conduct or the result of his conduct when he is aware of but consciously disregards a substantial and unjustifiable risk that the circumstances exist or the result will cover.  The risk must be of such a nature and degree that its disregard constitutes a gross deviation from the standard of care that an ordinary person would exercise under all circumstances as viewed from the actor's standpoint.

Acts or omissions occur when each person who applies for public assistance shall disclose to the state agency administering the public assistance each fact that may materially affect the determination of his eligibility to receive public assistance, including his current:

1.    Marital status;

2.    Household composition;

3.    Employment;

4.    Income;

5.    Receipt of monetary and in-kind gifts; and

6.    Other resources

Acts or omissions also occur when each of the following persons, who intentionally, knowing, or recklessly commits any of the following acts, is guilty of public assistance fraud:

Any client who, while receiving public assistance, acquires income or resources in excess of the amount he previously reported to the state agency administering the public assistance, and fails to notify the state agency to which the client previously reported within ten days after acquiring the excess income or resources.

 

17.  Does your agency maintain data on fraudulent payments in the program as a subset of your improper payments data? (Please check one response.)

If yes, please list the methods you use for finding occurrences of fraud and indicate whether you would rate each method as very effective, somewhat effective, somewhat ineffective, or very ineffective.

Investigation – very effective

q      No 

Does any other entity in your State maintain this information, such as a State fraud unit or Inspector General? If yes, please provide us with a contact name and phone number:

 

18. What steps, if any, beyond improper payments prevention, does your State take to specifically prevent     fraud?  Customer Educational Training regarding reporting requirements, etc.

 

19.  Is your agency required to report, or to have information available, on improper payments to the State legislature, the Governor, or any other higher-level agencies? (Please check one response.)

X - No

 

Other

20.  Describe any other information that may be relevant to improper payments in the program that you       wish to share with us.

It would be helpful to have more clear direction in the TANF regulations on processing and collecting Improper Payments.

 

21.  Please submit copies of pertinent sections of manuals and other State-issued guidance that you would like to make available, or provide the web site address where they can be found.

On this page they need to click on "Contents" and then from the navigation on the left side they can get to section 800.

 

Thank you very much for your time and assistance!

 

Improper Payments Information Survey for the Utah TANF Program form in (Word), (PDF) file format