Suspected Fraud in TANF and Medicaid 449-07-01

(ML 2821 Rev. 11-02)

(Manual Renumbered effective 04/01/2004 ML2914)

 

Eligibility staff must refer to the state's attorney any household suspected of fraudulently obtaining assistance. In North Dakota, suspected violations of this nature are usually prosecuted under "theft" or "false statements" statutes. It is the act and not the amount of improper benefit received that must be considered.

 

Suspected fraud violations occurring on Indian reservations should be referred to the state's attorney. If the state’s attorneys office does not have jurisdiction over the matter, the case will be referred to the U.S. Attorney's office that has jurisdiction on that reservation. If the state's attorney does not refer the matter to the U.S. Attorney's office, the county social service office should do so.

 

Copies of all referrals of suspected fraud to the state's attorney's office shall be sent to the regional representative and to the director of Economic Assistance Policy Division. The latter copy will enable the Department of Human Services to file semiannual fraud reports with the federal government.

 

Follow-up information on the status of each referral must be provided to the regional representative and to the director of Economic Assistance Policy Division at least every three months while a referral is pending, and at any time final action is taken on a referral.

 

The county social service office’s investigation should attempt to establish whether a recipient intentionally failed to disclose full and accurate information. The investigation must be conducted in a courteous and direct manner by giving notice of unresolved questions, providing the opportunity to reply, advising of the right of appeal, and noting the possible need to refer the matter to the state's attorney. If county social service office staff conclude that the recipient's failure to disclose full and accurate information may have been intentional, a referral of all relevant information, whether or not confidential, is proper and consistent with the necessary administration of the program.

 

Assistance improperly or fraudulently received through TANF must be recouped according to policy outlined in Service Chapter 400-17. Any overpayment case on which recoupment has not been made should be identified so that recoupment can be initiated if the case is reopened at a later date.

 

Individuals found to have committed intentional program violations either through a disqualification hearing or by a court of appropriate jurisdiction, or who have signed either a waiver of right to an administrative disqualification hearing or a disqualification consent agreement in cases referred for prosecution shall be ineligible to participate in the TANF Program as follows.

 

  1. First violation -- 12 months;

  2. Second violation -- 24 months; and

  3. Third violation -- permanently.

 

If a court of appropriate jurisdiction fails to impose a disqualification period for the intentional program violation, the county shall impose one of the disqualification periods as stated above, unless it is contrary to the court order.

 

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