216 R.I. Code R. 216-RICR-20-05-3.6

Current through December 26, 2024

Section 216-RICR-20-05-3.6 - Program Abuse and Participant Sanctions

A. Abuse

1. Dual/Multiple Participation

a. Whether discovered through participation reports or other sources, once dual participation is verified, the State Agency shall not issue checks.

b. The local agency with which the participant has the next scheduled appointment or check pickup shall:

(1) Discuss dual participation with client; and

(2) Inform client that dual participation is not allowed; and

(3) Have client determine which agency he/she prefers; and

(4) Retrieve the WIC ID folder of other agency and send it to the Rhode Island Department of Health WIC Office; and

(5) Determine with the state agency whether checks should be issued. The dual benefits received should, in most cases, be applied towards the current or next month; and

(6) Notify in writing the state agency as to local agency preference, and steps that have been taken; and

(7) Terminate the client from one agency.

c. The circumstances of the dual participation will be reviewed by a state supervisor and local agency liaison and the local agency. This review must include a determination as to whether the child participants have been receiving the supplemental foods.

d. The state and local agency shall then determine the severity of the violation, procedures to be followed, and sanctions, if any, to be imposed.

e. If the client refuses reduction of service to one local agency only or persistently denies dual participation, in the face of conclusive evidence or there is evidence of deliberate dual participation, a supervisor at the state agency and the WIC coordinator at the local agencies involved must review the case for disqualification from the WIC Program.

2. Other Violations of Program Abuse

a. Violations of Program rules, shall include but not be limited to:

(1) The violations described where evidence indicates absence of intent or deliberateness or where other extenuating circumstances would not support a conclusion of WIC Program abuse.

(2) Failure of a payee to make all supplemental food available to a participant.

(3) Failure to inform the local agency of a change in address, residence, or other circumstances which might have an effect on eligibility.

(4) Failing to report any unused WIC foods to the local agency WIC staff.

(5) Any other violation of Program regulations, rules, or procedures.

(6) Attempting any violation of Program rules.

b. Investigation: When there is reasonable evidence of violations, the local agency must notify the client (via telephone or mail) and offer an interview to consult with and counsel the client covering relevant topics, including but not limited to:

(1) What occurred and where, in a manner indicating that the participant is given the benefit of the doubt (if applicable);

(2) Advising the client that the practice is in violation of program regulations or procedures and warn that person that any information given may be used against him/her in determining sanctions or penalties or in any subsequent appeal procedure, and inform them of the penalties that may be instituted for such practices (if applicable);

(3) Counsel and educate the client on the proper procedures to be used, in picking up and cashing WIC checks, indicating the correct procedures and why they are necessary. Offer the client the opportunity to ask any questions and answer them (if applicable);

(4) A determination will then be made of the client's intention, the severity of any violation, and of the client's cooperation in attempting to change the practices (if applicable). The local agency will then take appropriate additional measures as warranted.

c. Prosecution of Fraud and Abuse

(1) All instances of fraud, abuse or misrepresentation must be reported to the State WIC Office.

(2) The state agency may, at its discretion, refer cases which appear to violate the provisions of R.I. Gen. Laws § 23-13-17 to federal, state or local authorities for prosecution pursuant to the provisions of 7 C.F.R. § 246.23, incorporated in § 3.2(A) of this Part.

B. Sanctions Against Clients

1. The local agency will follow procedures to handle abuse or violations of the program. The local agency will confer with the state agency, before imposing any sanction. The state agency reserves the authority to direct that sanctions be imposed by the local agency or that sanctions be modified or not imposed.

a. When sanctions are to be imposed, the local agency shall notify the participant by registered mail, return receipt requested, that there is evidence that he/she has engaged in violation(s) or abuse of the WIC Program. Notice of imposition of the sanction may be included or deferred until further steps are completed.

b. The participant shall be advised of the sanction to be imposed for the abuse or violation, and/or the effective date of the sanction (giving at least fifteen days' notice). He/she shall be offered an opportunity prior to the imposition or effective date of the sanction to meet in conference to present any information or evidence that the information is in error, that the violation did not take place, that extenuating circumstances exist, or that severe hardship or serious health risk may result from WIC Program disqualification.

c. The Competent Professional Authority shall determine whether a serious health risk may result from WIC Program disqualification.

d. The local agency must consider a serious health risk to the participant and other relevant factors in determining whether or not the sanction should be waived in a particular case.

e. If restitution by the participant is required under 7 C.F.R. § 246.23(c), incorporated above at § 3.2(A) of this Part such restitution will be in cash and will equal the value of Program benefits improperly issued unless it is determined that the recovery would not be cost effective.

f. If not waived or modified, the following sanctions shall apply:

(1) Category I: Disqualification for three months and, if appropriate, restitution of the value of benefits improperly issued.

(2) Category II: Disqualification for one month and, if appropriate, restitution of the value of any benefits improperly received.

g. In the event of physical abuse or threat of physical abuse of staff the sanction will be imposed without offering a conference, or despite a determination of health risk, this is appropriate to protect the safety of staff. The local agency staff must notify the client that, such abuse during a certification appointment may prevent the completion of the certification/recertification and lead to denial of eligibility or failure to recertify.

h. Before disqualifying a child participant, the local agency must determine whether the abusive person can be excluded from the agency and an acceptable alternative payee utilized.

i. If not already accomplished, the participant shall be given fifteen day notification by certified mail, return receipt requested, of the implementation of the disqualification from the WIC Program. Any notice of violation or disqualification shall include the Fair Hearing statement, request, and information forms. The notification must specify the date that the person may reapply for the WIC Program. This date should allow for enough time in advance of the end of the disqualification period for the person to be reinstated in the following month.

j. After this period, the local agency shall review the eligibility of the participant as a new applicant.

C. In addition to the sanctions above, additional measures may include:

1 A warning letter, indicating further violations would be grounds for more severe penalties or for establishing a case of abuse.

2. Cancellation of checks or reduction or deletion of items in the food package as determined by the competent professional authority as being unusable, unneeded, excess benefits, or not being made available to the participant.

3. Disqualification for one month if the investigation or review reveals that the participant is ineligible or violates WIC Program rules, regulations, or requirements twice within a 24 month period, or disqualification for three months for three violations within a 24 month period.

4. If restitution by the participant is required, such restitution will be in cash and will equal the value of WIC Program Benefits improperly issued unless it is determined that the recovery would not be cost effective.

5. Document in the record the efforts for counseling, content, and the response of the participant.

216 R.I. Code R. 216-RICR-20-05-3.6