Section 218-RICR-10-00-1.6 - Fraud Unit ReferralsA. When a complaint of possible fraud is received which concerns a recipient of the Rhode Island Works Program (RIW) cash assistance, General Public Assistance (GPA), Child Care Assistance Program (CCAP), Supplemental Nutrition Assistance Program (SNAP), Medicaid Assistance (MA), or an allegation of fraud by a provider, the agency representative obtains all information regarding the complaint.B. An agency representative who notes a recipient or household exhibits an indication of questionable eligibility shall refer the case to the fraud detection unit. 1.6.1Responsibilities of the Fraud Detection and Prevention Unit A. Under the direction of the Office of Internal Audits, the fraud unit shall analyze data to determine the risk of fraud.B. If a referral is regarding an allegation of medical provider fraud, the fraud unit shall refer such claim to the Program Integrity Division within the Office of Health and Human Services or the Office of the Attorney General.C. If a claim warrants further investigation, the case shall be reviewed in accordance with the investigative procedures established by the Office of Internal Audits.D. Upon completion of the investigation, the fraud unit shall determine whether an overpayment has occurred. If an overpayment is determined, such claim shall be classified as fraud, agency error or household error.E. If such claim is determined to be fraud, the fraud unit shall pursue administrative penalties set forth by the federal and state regulations. At its discretion the fraud unit may refer any case that is determined to be of a criminal nature to the Rhode Island State Police or the Office of the Attorney General.F. A recipient has the right to an administrative disqualification hearing. If such recipient waives the hearing and chooses to sign the waiver agreement, the waiver shall be returned to the fraud unit within ten (10) days.G. All overpayments shall be referred to the DHS's Collection, Claims and Recoveries Unit (CCRU) for collections.218 R.I. Code R. 218-RICR-10-00-1.6