County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide Intentional Program Violation Number Page 44350J 1 of 5 Revision Date 100118 BackgroundCounties are responsible for investigating any case of an alleged Intentional Program Violation IPV and ensuring that appropriate cases are acted upon either through Administrative Disqualification Hearing ADH or referral to a court of appropriate jurisdiction PurposeThis section has been revised to remove obsolete procedures and to update the section to the current format PolicyGeneral IPVs are acts which disqualify a recipient from CalWORKs for either a timelimited period or permanently They may include A false or misleading statement or misrepresentation concealment or withholding of facts Any act intended to mislead misrepresent conceal withhold facts or propound a falsity IPVs may be established by any of the following Court of appropriate jurisdiction Conviction of welfare fraud charges by a State or Federal court including any determination made on the basis of a plea of guilty or nolo contendere ADH process An ADH decision that finds an IPV occurred Disqualification Consent Agreement A recipients waiver of an ADH with or without an admission that the facts alleging an IPV are true IPVs from another state or out of county IPVs are to be used to disqualify recipients from cases in San Diego County Out of state or out of county IPVs are to be counted when determining whether to apply a first second or permanent disqualification Bureau of Public Assistance Investigation BPAI Responsibility BPAI is responsible for investigating any case of alleged IPV BPAI may confer with the District Attorney in establishing criteria for investigations and meeting the prosecution threshold In those cases in which it appears that clear and convincing evidence exists to substantiate the IPV BPAI may file a request for a complaint with the District Attorney office Cases not meeting the threshold for prosecution are reviewed by Quality and Eligibility Support Department QESD for ADH IPV Determination and State Fair Hearings Once an IPV has been determined a recipient may request a state fair hearing on how an IPV disqualification is imposed But the finding of an IPV and the length of a disqualification period are not subject to state fair hearing appeals County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide Intentional Program Violation Number Page 44350J 2 of 5 Informing Requirements Written notice of the disqualification penalties for IPVs is required at the time of application and at renewal To meet this requirement the Eligibility Workers are to ensure that all CalWORKs applications and renewals include use of the SAWS 2A SAR Referral for ADH to Quality and Eligibility Support Department QESD Send referrals via email to QESD at HHSA EOQESDSupport stating in the subject line Request ADH Review and include the case name case number and brief summary in the email Do not refer for ADH if Cases with a onemonth overpayment and no prior history of overpayment SSI Caretakers Excluded Person Undocumented Alien Fleeing Felon Earnings of a child unless prior overpayment involving same issue QESD staff will follow the ADH Policies and Procedures posted in the EPPG site under QESD section 44350J6 216 IPV Notification Required Action The 216 IPV Notification form is a priority directive that requires followup action by the next work day after receipt The 216 IPV is initiated by QESD and sent to the assigned Family Resource Center FRC liaison The FRC liaison must coordinate IPV actions with QESD and monitor for FRC compliance with the 216 IPV instructions The 216 IPV informs the FRC of the effective date of disqualification QESD will factor in the need for timely NOA who the violator is and the time period of the disqualification Ten days advance notice is required to discontinue a person for an IPV The reverse side of the 216 IPV contains specific instructions to take on both active and inactive casespersons Workers can consult with the FRC liaison if they have questions on IPV procedures The 216 IPV requires certifying signatures by both the assigned worker and a FRC supervisor that all IPV actions have been completed When all IPV actions have been taken the 216 IPV will be imaged in the case The FRC will send an email to QESD at HHSA EOQESDSupport within five business days Recipient Fraud Penalties All of the following penalties result from a conviction in a state or federal court or ADH Any resources and income of the disqualified individual are considered available to the Assistance Unit AU County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide Intentional Program Violation Number Page 44350J 3 of 5 Fraud Occurred On or After January 1 1998 Six Month Penalty Individuals who have been convicted for the first time for any of the following acts for the purpose of establishing or maintaining the familys eligibility for aid or increasing or preventing a reduction in the amount of that aid Making false or misleading statements or misrepresenting concealing or withholding facts Committing any act intended to mislead misrepresent conceal or withhold facts or propound a falsity Twelve Month Penalty Individuals who have been convicted for the second time for any of the following acts for the purpose of establishing or maintaining the familys eligibility for aid or increasing or preventing a reduction in the amount of that aid Making false or misleading statements or misrepresenting concealing or withholding facts Committing any act intended to mislead misrepresent conceal or withhold facts or propound a falsity Two Year Penalty Individuals convicted of felony fraud in a state or federal court for theft of 2000 or less Individuals who have been convicted for the first time the submission of more than one application for the same type of aid for the same period of time for the purpose of receiving more than one grant in order to establish or maintain the familys eligibility for aid or increasing or preventing a reduction in the amount of aid Four Year Penalty Individuals who have been convicted for the second time for the submission of more than one application for the same type of aid for the same period of time for the purpose of receiving more than one grant in order to establish or maintain the familys eligibility for aid or increasing or preventing a reduction in the amount of aid Five Year Penalty Individuals convicted of a felony fraud in a state or federal court for theft of more than 2000 but less than 5000 Permanent Penalty Individuals found to have committed a fraudulent act by a state of federal court including plea of guilty or nolo contendere or ADH for any of the following acts o Made fraudulent statements or representation regarding their place of residence in order to receive assistance simultaneously from two or more states or counties o Submitted false documentation for nonexistent or ineligible children o Received cash benefits in excess of 10000 through fraudulent means Individuals convicted of felony fraud in a state or federal court including any determination made on the basis of a plea of guilty or nolo contendere for receipt or attempted receipt of cash aid benefits of 5000 or more Individuals found for the third time to have committed any of the following County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide Intentional Program Violation Number Page 44350J 4 of 5 o Making false or misleading statements concealing or withholding facts o Committing any act intended to mislead misrepresent conceal or withhold facts or propound a falsity o Submitting more than one application for the same type of aid for the same period of time for the purpose of receiving more than one grant in order to establish or maintain the familys eligibility for aid or increasing or preventing a reduction in the amount of aid Note Only the individuals found to have committed fraud is disqualified If the person has been discontinued for another reason the entire disqualification is to be served when the person is again active Recipient Fraud Penalties Fraud Occurred Before January 1 1998 Individuals found to have committed an IPV either through an ADH or by a court of appropriate jurisdiction are ineligible for cash aid benefits as follows Six months for the first violation Twelve months for the second violation Permanently for the third violation Individuals found to have committed an IPV either through an ADH or by a court of appropriate jurisdiction based on any of the following Submitting more than one application for the same period of time and for the purpose of receiving more than one grant of aid Submitting documents for nonexistent children Submitting false documents for the purpose of showing ineligible children to be eligible for aid Are ineligible for aid for the following time Two years for the first violation Four years for the second violation Permanently for the third violation Treatment of Persons Subject to Fraud Penalties Person is Convicted Before July 1 1998 Sanction A person who is convicted before July 1 1998 is sanctioned The sanctioned persons AU is subject to mandatory vendor payment The sanctioned person is not entitled to cashlinked MediCal and is not required to participate in WelfaretoWork WTW activities Person is Convicted July 1 1998 or later Penalty A person who is convicted on July 1 1998 or later is penalized A penalized person remains in the AU The penalized persons needs are not considered in the Family Maximum Aid Payment MAP or AU MAP when determining the AUs financial eligibility and grant levels As an AU member the individual will continue to receive cashlinked MediCal is required to participate in WTW activities unless exempt and will have time on aid counted against the Time On Aid TOA limit All income of the penalized individual will be used in the AUs eligibility and grant determination and all appropriate income disregards are allowed The needs of the penalized person are to be restored the first day of the month following the end of the penalty period County of San Diego Health and Human Services Agency HHSACalWORKs Program Guide Intentional Program Violation Number Page 44350J 5 of 5 SanctionedPenalized Person Not on Aid If the AU or individual responsible for the IPV goes off of aid prior to imposing or during the penaltysanction period the penalty is suspended until the individual is found eligible for cash aid by joining another AU or reapplying at a later time Out of CountyOut of State IPV Notifications Required Actions When notified by another county of an IPV for an active recipient workers are to request documentation of the IPV finding and the overpayment Apply the disqualification as indicated by the other county Begin recoupment of the overpayment When the overpayment can no longer be recouped refer the remaining balance to the Office of Revenue and Recovery ORR Identify the county of origin on the overpayment referral and attach the documentation from the other county When notified by another state of an IPV for an active recipient workers are to request documentation of the IPV finding and the overpayment Apply the disqualification as indicated by the other state Do not recoup a CalWORKs TANF overpayment from another state No regulatory or fiscal authority currently exists Procedure EPPG 11 Quality Eligibility Support Department QESD Administrative Disqualification Hearing ADH for QESD Staff Policy and Procedures References Confidentiality Fraud Civil Rights CFC and State Hearings Manual 20350 All County Letters ACL No 1741 17118 1822 Sunset Date This policy will be reviewed for continuance by 103121 Approval for Release Rick Wanne Director Eligibility Operations