Wednesday, May 16, 2012
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"If you tell the truth, you don't have to remember anything." - Mark Twain

Fraud

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Explanation of Fraud

Racine County has a dedicated hot line for reporting Welfare Fraud.  If you would like to report suspected fraud, please call (262) 638-6755.  You can call this number 24 hours a day, 7 days a week.   All information left on the hotline is investigated and will remain confidential.  Due to confidentiality laws, we can not give out information to callers regarding our customers.

The Public Assistance Fraud Program is based on Chapter 49 of the Wisconsin Statutes. The Chapter 49 Fraud Program has been administered in all geographic areas of the state since January 1, 1998. The program consists of fraud prevention, fraud investigation, and fraud overpayment collection activities of the FoodShare (formerly known as Food Stamps), Wisconsin Medicaid, and BadgerCare Plus programs.
 
With the large amounts of money involved in public assistance programs, it is very important to have a process to prevent and detect welfare fraud.  This process is done by the Fraud Unit in cooperation with the Racine County Sheriffs Department and the District Attorneys Office.  Members of these departments, as well as members of the Human Service Department serve on an anti-fraud task force that meet regularly regarding issues involving welfare fraud. Racine County has Fraud Investigators that address fraud prevention, investigations and recovery.  Racine County is also part of a Fraud Consortium which is a group of counties from the State of Wisconsin dedicated to preventing Welfare Fraud. 

How is Fraud Identified

Potential fraud may be identified by many sources, including: 

  • Financial and Employment Planner (FEP) , IM staff, and other agency personnel.
  • Complaints from general public.  If you would like to report suspected fraud, please call (262) 638-6755.
  • Periodic audits of suspected providers.
  • Use of computer databases including but not limited to:
    • CARES
    • DWD files, including wage and employer information for anyone with an employer in the state (e.g. New Hire).
    • Federal agencies.
    • Social Security benefits.
    • Wage information.
    • IRS interest income from savings.
    • Unemployment benefits from other states.
    • Interstate Data Exchanges.
    • Interstate Matches.
    • EBT transaction data
  • USDA Food & Nutrition Services (FNS) personnel.

Recipient Fraud

Examples of recipient fraud include but are not limited to:

  • Collusion with a provider of benefit or services to receive undue benefits/ payments
  • Concealing income or assets by failure to report ownership or acquisition such as:
    • Unreported income from jobs or from Unemployment Compensation, Social Security Benefits or Workers Compensation.
    • Unreported assets or resources such as vehicles, savings accounts, etc.
  • Disposing of substantial assets without informing the Human Services Department.
  • Concealing circumstances or a change in circumstances which would have resulted in a decrease or discontinuance of the payment or other benefits.
  • Misrepresenting the number and relationship of members of the family unit.
  • Misuse of the lost, stolen or destroyed benefits process.
  • Trafficking or fraudulent use of FoodShare benefits.
  • Misrepresenting identity or residence for the purposes of receiving FS or W-2 benefits from one or more agencies simultaneously.

Examples of Provider Fraud

Examples of provider fraud include but are not limited to:

  • Claiming compensation for program services that were not provided. (Child Care, Health Care, trial jobs, training etc.)
  • Receiving kickbacks, bribes or rebates. Examples of kickbacks, rebates or bribes include but are not limited to:
    • A child care provider paying a client a portion of the child care fees as an inducement to the client to place his/her children in the provider's care.
    • A child care provider returning a portion of his/her fees to a W-2 worker for referring clients to the provider.
    • A child care provider paying a portion of chid care fees claimed to a W-2 caseworker as a reward the worker for overlooking excessive hours claimed or unreported absences of children.
    • A W-2 worker receiving a fee from a client to approve false job activities reports.
    • A W-2 worker receiving payment from an employer for directing clients to the employer or for approving excessive hourly wage reports.
    • A transportation provider paying a W-2 worker a portion of transportation expense payments to approve excessive transportation expense claims.  
  • Assisting applicants to make false claims to obtain benefits for themselves.

Investigation of Fraud

Staff from the Human Services Department review suspected cases of fraud to verify the facts as reported on an application or during a review of eligibility.  The outcome of the case review will determine whether the matter is referred to the Sheriff's Department for criminal investigation.  The Sheriff's Department may become involved in the matter sooner if the circumstances require investigation to arrive at the true facts of a case or for other reasons.  The Human Services Department, Sheriff's Department and District Attorney work cooperatively to prevent, identify and prosecute fraud.

 

Fraud Prosecution

A recent case that resulted in successful prosecution for financial assistance fraud.


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