County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide IntegrityFraud Detection and Prevention 20000A 1of 2 Revision Date January 1 2021 Background Counties are responsible for preventing and discovering fraudulent actions and completing an investigation when fraud is suspected Purpose The purpose of this section is to provide the definition of fraud and explain the criteria for fraud allegations This material revision is to consolidate the Integrity sections change to the current format and to remove processes from the Program Guide and move them to CalWORKs Processing Guide 20000A1 Policy Definition of Fraud Fraud exists when a person on behalf of themself or others has knowingly and with intent to deceive or defraud Made a false statement or representation to obtain benefits obtain a continuance or increase of benefits or avoid a reduction of benefits Failed to disclose a fact which if disclosed could have resulted in a denial reduction or discontinuance of benefits Accepted benefits to which they were not entitled or accepted an amount of benefits knowing it is greater than the amount to which they are entitled Made statements for the purpose of obtaining benefits continuing to obtain benefits or avoiding a reduction or denial of benefits that they did not know to be true with reckless disregard for the truth Fraud Related Allegations The following are examples of allegations that are considered fraudrelated and may require a fraud referral to the Bureau of Public Assistance Investigations BPAI Residency is questionable for example suspicion that the Assistance Unit AU is living out of the state or country Child out of home Unreported income Unreported property Expenses exceed income how does the customer meet their needs Documentation submitted appears to have been altered or counterfeit Duplicate aid The deprivation for the case is Absent Parent and it is suspected that the absent parent is in the home NonFraud Related Allegations The following examples of allegations are not considered fraudrelated therefore a fraud referral to BPAI will not be made neither will such a referral be accepted by BPAI In some instances a referral to another responsible agency such as Child Welfare Services may be appropriate and necessary Child abuseneglect County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide IntegrityFraud Detection and Prevention 20000A 2of 2 DrugAlcohol abuse Nonpayment of rent obligation Unrelated Adult UA in the homemisuse of funds o Note Misuse means improper use and is different from fraud refer to CPG 43100D Paternity is at issue o Note Establishment of paternity is the function of Local Child Support Agency LCSA not BPAI Unreported income from illegal sources such as drug trade and sex work Procedure Processing Guide 2000A1 Program Impacts None References EAS 20003 20004 20101 202012 Sunset Date This policy will be reviewed for continuance by December 31 2023 Rick Wanne Director Eligibility Operations