Agencies must establish that an Intentional Program Violation (IPV) has been committed in order to :
● Disqualify a family or provider for fraud;
● Determine that an overpayment occurred due to fraud.
See Chapter 14.12.3 (Disqualfication for Fraud – Families) and Chapter 14.12.6 (Disqualification for Fraud – Providers).
Fraud exists when:
A family has willfully or intentionally withheld, concealed, or misrepresented information to receive or to attempt to receive more benefits than they are eligible to receive or to help another person to receive or to attempt to receive more benefits than the person is entitled to receive.
A provider has willfully or intentionally withheld, concealed, or misrepresented information to be authorized by CCAP; to receive or to attempt to receive payments to which the provider was not entitled; or to help another person to receive child care assistance to which that person is not entitled.
CLIENT ELIGIBILITY FRAUD REFERRALS
Refer clients you suspect of fraud for investigation.
For counties participating in the Fraud Prevention Investigation (FPI) program, use the Fraud Prevention Referral form (DHS-3335A) (PDF) to make a referral for an FPI.
For counties not participating in the FPI program, follow your county process to make a referral for possible client fraud investigation and use the Fraud Prevention Referral form (DHS-3335A) (PDF) to notify the DHS Office of Inspector General (OIG) of the investigation. County processes for making referrals may include contacting your county’s fraud investigator or investigative unit, your county attorney, and/or your local sheriff’s department.
Client eligibility fraud referrals should be made whenever case file information exhibits characteristics of possible misinterpretation or omission of relevant facts or resolve current eligibility issue, including possible fraud.
These situations may occur at the time of application, redetermination, a change report, when case file information is updated or reviewed for accuracy, or when your agency receives a report of potential fraud.
PROVIDER FRAUD REFERRALS
Refer or notify the DHS Office of Inspector General (OIG) Child Care Provider Fraud Investigations Unit of providers you suspect of fraud. Some counties may have the resources to investigate provider fraud locally. However, all counties should use the Child Care Provider Investigations Communications Form (DHS-6811) (PDF) to inform the OIG of all child care provider investigations.
Send referrals or notifications whenever it appears a provider is withholding, concealing, or misrepresenting information in order to:
Become a registered provider;
Receive payments for which the provider is not entitled; and/or
Resolve current registration or payment issues, including possible fraud.
These situations could occur at registration, renewal, billing, when information is updated or reviewed for accuracy, or when the county receives a report of potential fraud.
CONTINUATION OF BENEFITS
During a fraud investigation, continue benefits if current eligibility exists. Do not close a case or deny benefits to people under investigation for fraud if they are otherwise eligible.
Disqualify parentally responsible individuals (PRI) and child care providers who have committed an Intentional Program Violation (IPV). See Chapter 14.12.3 (Disqualification for Fraud - Families), Chapter 14.12.6 (Disqualification for Fraud - Providers) for information on disqualification procedures, Chapter 14.12.9 (Administrative Disqualification Hearing).
NOTIFICATION OF OVERPAYMENTS
If the fraud investigator or county attorney believes that claims activity may hinder an investigation, county workers must delay notifying the client or provider of an initial overpayment until fraud has been determined or the case has been closed. Counties are required to start recovery or recoupment by the last day of the calendar quarter that includes the discovery date of the claim. See DISCOVERY DATE in Chapter 2 (Glossary). Because subsequent criminal investigation may identify additional information about overpayments, the discovery date will not occur until fraud has been determined or the case is closed.
Minnesota Statutes 119B.13
Minnesota Statutes 119B.16
Minnesota Statutes 119B.125
Minnesota Statutes 256.98
Minnesota Rules 3400.0183