(a) CO-DFS shall accept referrals for investigation of possible overpayments for the following programs: - (i) Aid to Families with Dependent Children (AFDC);
- (ii) Aid to Families with Dependent Children of Unemployed Parents (AFDC-UP).
- (iii) Child Care (CC) (includes low income and non-IV-E Foster children), AFDC Working Child Care (includes IV-E Foster children), Transitional CC, Food Stamps E&T Participants and At-Risk and Child Care and Development Block Grant (Block Grant);
- (iv) Emergency Assistance (EA);
- (v) Food Stamps (FS) (includes employment and training program);
- (vi) General Assistance (GA) (excludes loans and interim assistance);
- (vii) Individual Family Grant (IFG);
- (viii) Interim Assistance (IA);
- (ix) Low Income Energy Assistance Program (LIEAP);
- (x) Medicaid (ME) (for all coverage groups--eligibility overpayments only);
- (xi) Minimum Medical Program (MMP);
- (xii) Old Age Assistance (OAA);
- (xiii) Refugee Assistance (RA);
- (xiv) Social Services (SS) (includes client and provider purchased services such as IV-E Foster Care, IV-E Subsidized Adoption, State Foster Care and State Subsidized Adoption, Chins, MMP-Foster Kids and Subsidized Adoption);
- (xv) State Hospital Placement (SHP);
- (xvi) State Licensed Sheltered Care (SLSC);
- (xvii) The Emergency Food Assistance Program (TEFAP);
- (xviii) Wyoming Opportunities for Work - Supportive Services (WOW-SS); and
- (xix) other programs as assigned.
(b) DFS shall consider the following as sources of information and/or referrals of possible overpayments: - (i) Notices of Retained Child Support or memorandums from the Self-Sufficiency Unit with evidence the absent parent is in the home;
- (ii) Complaints from any person or agency made in person, by telephone or in writing stating an individual or household's eligibility or benefit amount may be affected by failure to report a fact(s) or misrepresentation of a fact(s);
- (iii) External audits or reviews, such as but not limited to:
- (A) state or federal audits or reviews;
- (B) quality control reviews; and
- (C) management evaluation reviews;
- (iv) Internal reviews, such as but not limited to:
- (A) periodic reviews (AFDC);
- (B) entitlement and authorization reviews (CC);
- (C) recertification (FS);
- (E) management, quality assurance, supervisory or second party reviews; and
(c) FO-DFS shall refer ongoing cases for fraud investigation to DFS-ORP Investigators so the cases may be reviewed for indicators to determine whether possible fraud may exist.
(d) Cases shall be approved and referred for investigation only when: - (i) the issue affects eligibility; and
- (ii) the documentation in the case file indicates the client was advised of the responsibility to report the income, resources, or household composition; and
- (iii) the required verifications have been obtained; and
- (iv) policy has been applied correctly to determine eligibility and calculate benefits.
(e) DFS-ORP will prioritize the cases received based on the ability to investigate with the likelihood of successful prosecution as follows: - (i) unreported income cases which would result in an overpayment of total assistance in excess of $500;
- (ii) unreported resources which would cause ineligibility;
- (iii) child out of the home using school, child care, and/or preschool records along with statements from friends or relatives;
- (iv) household composition using landlords, contracts, utilities, telephone and city directory listings.
(f) DFS-ORP will take the following actions when the criteria in (e) has been met: - (i) analyze the referral to determine what issue(s) is/are involved;
- (ii) obtain the necessary verification;
- (iii) ascertain what evidence FO-DFS has provided;
- (iv) look for the conduct that indicates the violation;
- (v) identify the eligibility criteria the conduct violates;
- (vi) choose to notify the client of the investigation where notice will not prejudice the case or make evidence more difficult to obtain;
- (viii) notify FO-DFS of the facts;
- (ix) make recommendations and request the evidence necessary to continue the investigation; and
- (x) assure that FO-DFS takes the appropriate action on the case to redetermine eligibility, recalculate and establish the amount of the benefit(s), and determine and establish the amount of the resulting overpayment(s).