FRAUD INVESTIGATION SECTION

The Fraud Investigative Section - Has the responsibility, under federal regulation, to conduct client related and internal fraud investigations. This responsibility includes the determination of whether there is a basis in fact for believing that fraud may have been committed and subsequent referral to the county prosecutor. In Mercer County, the Fraud Investigative Section is organized as follows:

Administration - In the year 2004, the Assistant Chief Investigator under the direction of the Chief of Administrative Services was responsible for directing and administering all of the agency’s fraud related programs including involvement with various out of state welfare fraud departments involving duplicate benefits. Reorganization of guidelines with the Prosecutor's Office was completed in 2004. Implementation of new procedures of replacement of negotiable documents involving the Social Services Department was also completed in 2004.

Investigator II - Completes thorough investigations based on TANF, Food Stamps and Medicaid regulations, testifies, if required in both Grand Jury and Administrative Law hearings. Completes internal investigations assigned by the Assistant Chief Investigator, reports directly to the Assistant Chief Investigator, conducts joint investigations with the City of Trenton Police Department, Mercer County Prosecutors Office, the New Jersey State Police, Bureau of Program Integrity and the Division of Medical Assistance and Health Services.

Intake - Screening and tracking all referrals received. All agency bank letters and maintains the Fraud Department’s records.

Special Investigation Unit - Investigates complaints of alleged fraud in all programs (TANF, Food Stamps, General Assistance, Medicaid); and refer cases to appropriate prosecuting authority. Performs as legal counsel representatives for the Agency at the Office of Administrative Law hearing. Prepares and presents to the Grand Jury cases referred to the Prosecutor's Office. Investigates and replaces all agency checks/vouchers reported lost or stolen. Responsible for conducting pre-certification and post-certification investigations; also investigation of cases suspected of an ongoing or potential fraud that were referred by eligibility workers. Investigates and reports findings to the New Jersey Division of Family Development results of the Public Assistance Reporting Information System Matches (PARIS Match).

Claims Determination Unit - Responsible for computing and collecting of non-fraud overpayments, which includes instituting recoupment/allotment reductions, obtaining agreements to repay and processing civil complaints. The Unit also processes computer matches i.e., Wage Reporting Match, Internal Revenue Match, Social Security Match and Resources Match.

Fraud Claims Unit - Responsibilities include converting Food Stamp claims from non-fraud to fraud; monitoring and pursuing collection of those clients convicted in criminal courts; processing Food Stamp disqualifications and civil complaints. Also functions as the liaison for the SOIL (State Offset Individual Liability) and TOP (Treasury Offset Program) programs. This unit also has the responsibility of submitting cases for Federal and State Intercept Programs. The function of transferring of claims between counties and other states. Acts as the liaison for the e-DRS System which is a Federal database of all disqualified recipients. This Unit also processes the Medicaid Matches.

At the Mercer County Board of Social Services we utilize a comprehensive system to ensure integrity in all the programs administered by the Agency. The mission is specific:

Prevent overpayments, whenever possible.
Reduce amounts of overpayments that do occur.
Maximize recovery of overpayments.
Effectively prosecute those guilty of defrauding the system.

REVIEW OF GOALS AND ACCOMPLISHMENTS - 2004

Our efforts to maximize recoveries continue to be successful. Collection is still 100% to annual loss.

The joint investigation with the United States Department of Agriculture’s Food and Nutrition Service continued. The target of the investigation was Electronic Benefits Transfer (EBT) Food Stamp traffickers. Agents from the Food Nutrition Service and Investigators from the Assistant Chief Investigator's Office and Special Investigations Unit continue to uncover suspicious storeowners and Food Stamp recipients participating in trafficking in Mercer County and Pa. These probes result in the permanent disqualification of those particular vendors and recipients who were in violation of the Food Stamp regulations. These investigations will continue through 2005.

The new procedures required for Replacement of Negotiable Funds was implemented, this procedure will enable the Agency to place some degree of reporting changes responsibility on the landlords. This procedure will reduce the number of duplicate payments and overpayments made to landlords in the Social Services Department.

A Memorandum of Understanding between the Mercer County Board of Social Services and Mercer County Prosecutor's Office was drafted, presented and approved by the Board. This document gives the Mercer County Prosecutor's Office use of our ABACUS computer system with the understanding that the Prosecutor's Office will notify the Agency in a timely manner of all criminal convictions. This process will enable the Agency to impose disqualification penalties within the 45 day requirement time period under the Food Stamp Manual regulations. Prior disqualifications received after the 45 day time period were considered administrative errors on the part of the Agency.

The integrations of Special Investigations Unit and the Early Detection and Prevention Unit were successful. The Fraud Investigation Section continues to be responsible for the processing of all computer Matches. Those Matches include; Wage, IRS, SSA, Interstate, Unemployment, and Medicaid. The results continue to be successful with almost 6,000 hits which produced 600 overpayments established.

DEPARTMENT GOALS FOR 2005

Maintain the collection rate currently at 100% to annual loss. This can be attained by enhancements to the Dunning letter system, voluntary garnishment process and Internet activity.
Develop the Computer Match System to be more cost effective and create more timely hits. This would involve cooperation with State and Federal authorities. Increase the number of completed cases in all areas of the Matches.
Continue the process of case targeting claims.
Participate in Joint Application Design in order to ultimately increase Treasury Offset Program collections.
Work diligently with the Efficiency and Effectiveness Committee toward resolving departmental issues.
Complete the process started in 2004 to enhance and convert the Fraud PIX program to the Microsoft XP operating system.
Continue negotiations with the Prosecutor's Office to enhance the present Prosecutor's guideline for prosecution of fraud cases, which would enable the Agency to more effectively prosecute and pursue collections on all fraudulent overpayments.

SUMMARY OF ACTIVITIES – 2004

FRAUD PREVENTION	(See chart #4 & #5)
Referrals received	1,089
Investigations completed	960
Positive dispositions	378
Projected annual savings	$1,386,000

CLAIMS RECEIVED	(See chart #1, #2 & #3)
Referrals received	1,486
Number and amount of claims	1,411 - $1.2 Million
Number of civil action referrals	858
Number of judgments obtained	643
Number of cases referred for Federal and State Intercept Programs	12,940
Computer Match:
Hits	6,000
Overpayments	600
FRAUD DETECTION and PROSECUTION
Referrals received	427
Investigations completed	356
Referred to prosecuting authority	57
Positive adjudications
Criminal	23
Pre-trial intervention	0
Administrative disqualifications	97
Total	120

RESTITUTION
Total dollars collected	$1,870,548 (See chart #6)

CHART #1

CHART #2

CHART #3

CHART #4

CHART #5

CHART #6

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