Under what circumstances is a consumer fraud referral made?
When processing an intentional overpayment, always review if the consumer deliberately concealed or misrepresented facts. You can make a fraud referral if all the following apply, the:
Consumer appears to have falsified documents or information; Total established overpayment in WCAP is at least $5,000; Overpayment did not occur partially due to department error (such as not acting on information received).
How is a consumer fraud referral made?
For consumer fraud, use the proper referral form, DSHS 02-182 (X) DFI Referral. Designate the cause as intentional and enter the overpayment information in the child care section. Attach copies of all evidence, including forms containing questionable information reported via the telephone by the consumer, and copies of false documents provided by the consumer. Attach copies of all overpayment forms submitted to the Office of Financial Recovery (OFR).
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EXAMPLE 1
A consumer reports the absent parent is not in the home; they were not listed or mentioned as a member of the household. The AW later learns they were in the home when the application was submitted.
Is this an overpayment? Possibly. Determine if the family would have been eligible for WCCC if the information had been known at the time of application. Consider the copayment and units authorized. If the family's copayment would have been more with the new information or if we would have authorized less child care units/hours then process the overpayment for the difference.
Is this a fraud referral? Possibly. Consider if the consumer was aware they should report this information and it was deliberately withheld and if the amount of the overpayment would be at least $5,000.
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EXAMPLE 2
A consumer reports they have three children who live in the home. Only one needs child care. Eligibility is determined based on a 4 person household. Later the AW discovers only 1 child is in the home, the other two have not lived with her for years.
Is this an overpayment? Possibly. Re-determine eligibility as a two person household. The overpayment could be for the entire child care payments made or for the difference in the copayment amounts.
Is this a fraud referral? Possibly, consider if the client deliberately reported false information with the intent to get benefits and if the overpayment amount is at least $5,000.
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EXAMPLE 3
A consumer provides income information that later proves to be much lower than the actual income. The consumer can provide the information by self-report, an employer letter, etc.
Is this an overpayment? Possibly. Re-determine eligibility with the correct income. The overpayment could be for the entire child care payments made or for the difference in the copayment amounts.
Is this a fraud referral? Possibly, consider if the client deliberately reported false information with the intent to get benefits and if the overpayment amount is at least $5,000.
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