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New focus on fraud prevention in state programs

| September 20, 2013 | 0 Comments
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The Walker administration is looking to rein in public assistance fraud. The governor vowing to step up oversight of taxpayer-supported programs. Kevin Moore is deputy secretary of the Department of Health Services. ‘The ability for people who want to defraud the system is always a challenge for any state government,” said Moore.

The effort will include more stringent verification of program eligibility at the “front end” – that is, when people apply for benefits. “What you’re successfully doing is preventing people who shouldn’t be on the program from ever accessing the program,” Moore said.

Walker’s six strategies for increasing fraud prevention and detection include:

  • · Strategy One: Pilot a front-end verification project at Milwaukee Enrollment Services (MilES) to review all applications in which an applicant indicates a household member is self-employed to determine if any additional proof is needed before the case is fully processed.
  • · Strategy Two: Develop an Error Prone Profile module for the Department’s public assistance eligibility determination, CARES, that will identify at the time of application cases that need further verification or additional investigation before the case can be fully processed. Wisconsin’s SeniorCare Program has an Error Prone Profile established that has been successful in flagging cases that need additional review.
  • · Strategy Three: Require all BadgerCare Plus and FoodShare members and applicants, who indicate they have self-employment income, to submit their tax returns for income verification or sign IRS form 4506-T that will give the Department permission to request a transcript of the individual or family’s tax return to verify the income the individual or family reported to the IRS. Current program guidelines do not require self-employed applicants or members to submit a tax return for a business, if it has been established for less than six months. Implementing this option would require self-employed applicants or members to submit tax returns at application, renewal, or when there has been a significant change in circumstances, regardless of how long the business has been established.
  • · Strategy Four: Evaluate and implement additional data exchanges to maximize the information that individuals provide to all State agencies. The Department would evaluate connecting the Department’s public assistance eligibility determination system, CARES, to databases maintained by the Register of Deeds, Department of Revenue, Department of Workforce Development, Department of Veterans Affairs, Department of Transportation, Department of Financial Institutions, Department of Administration, and the Department of Natural Resources.
  • · Strategy Five: Create a Recipient Fraud and Abuse Prevention Task Force to include the Department of Health Services, Department of Children and Families, Wisconsin Department of Justice and other state, federal, and local representatives. The structure of this task force would be similar to the Health Care Fraud Task Force that is convened by the United States Attorneys and the Nursing Home Fraud and Abuse Task Force.
  • · Strategy Six: Require an asset test – property, liquid assets, and vehicles – for FoodShare applicants and members. The Department will not be able to require the asset test for BadgerCare Plus members because under federal rules related to the Affordable Care Act, states cannot test the assets of non-elderly, non-disabled Medicaid members. 

“We continue to develop and work on policies, procedures, and utilize technology, to try to make sure that our programs are being used by those most in need, and to catch those people who are trying to defraud taxpayers out of their money,” said Moore.

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