INVESTIGATION CASES George Tipton, Chief Agent, OKDHS Office of Inspector General Mark Zaleha, Fraud Control Specialist, Ohio Department of Job and Family Services
TEAMWORK We thought we would get together and make a presentation about PARIS related investigations…
MARK GEORGE Not all Fun and Games … but working with George is not all fun and games.
Is PARIS really that important? PARIS is one of many tools – New hire/wages – IEVS – assorted data matches – Death index – Offender matches – Anonymous referrals – Internal and inter-agency referrals
Importance of PARIS by the numbers Australia recently compared effectiveness of data matching initiatives for their Social Service Programs. Savings were reported on a bi-weekly basis.
Australian Numbers Tax Declaration Form1987Commencing employment$14,754,587 Job placement2001commenced employment$3,401,818 Death1997Deceased/stolen identity of deceased$3,105,255 Rent assistance1997Inflated shelter cost and occupants$2,606,968 Scholar Enrollment1997Students not properly enrolled$1,496,358 Corrective Services1992Prisoner or stolen a prisoner’s identity$1,248,705 Immigration1990Customers who have left Australia$1,234,478 Claimant Matching1989Duplicate assist. changes residence$676,528 Pay As You Go2001Undeclared or under-declaring inc.$446,119 Care provider income2007Undeclared income from care givers$173,569 International reviews2007Customers who reside overseas$140,667 Bank verification2009Undeclared assets or income$80,491 Trusts2000Undeclared assets$52,082 Pensions - retirement1997Undeclared Govt pensions/retirement$45,003 Investment property2002Undeclared investment properties$42,949 Companies2000Undeclared interests in companies$25,567 Govt Housing1997Recipients of Defense Housing$19,635
Australian Numbers Tax Declaration Form1987Commencing employment$14,754,587 Job placement2001commenced employment$3,401,818 Death1997Deceased/stolen identity of deceased$3,105,255 Rent assistance1997Inflated shelter cost and occupants$2,606,968 Scholar Enrolment1997Students not properly enrolled$1,496,358 Corrective Services1992Prisoner or stolen a prisoner’s identity$1,248,705 Immigration1990Customers who have left Australia$1,234,478 Claimant Matching1989Duplicate assist. changes residence$676,528 Pay As You Go2001Undeclared or under-declaring inc.$446,119 Care provider income2007Undeclared income from care givers$173,569 International reviews2007Customers who reside overseas$140,667 Bank verification2009Undeclared assets or income$80,491 Trusts2000Undeclared assets$52,082 Pensions - retirement1997Undeclared Govt pensions/retirement$45,003 Investment property2002Undeclared investment properties$42,949 Companies2000Undeclared interests in companies$25,567 Govt Housing1997Recipients of Defense Housing$19,635
Combining PARIS Related Activities Tax Declaration Form 1987Commencing employment$14,754,587 Job placement2001commenced employment$3,401,818 Death1997 Deceased/stolen identity of deceased $3,105,255 Rent assistance1997 Inflated shelter cost and occupants $2,606,968 PARIS Related Dup. Ben./Residence/Pension $2,066,67 6 Scholar Enrolment1997Students not properly enrolled$1,496,358 Corrective Services1992 Prisoner or stolen a prisoner’s identity $1,248,705 Pay As You Go2001Undeclared or under-declaring inc.$446,119 Care provider income 2007 Undeclared income from care givers $173,569 Bank verification2009Undeclared assets or income$80,491 Trusts2000Undeclared assets$52,082 Investment property 2002Undeclared investment properties$42,949 Companies2000Undeclared interests in companies$25,567 Govt Housing1997Recipients of Defense Housing$19,635
PARIS MATCHES What kind of cases are uncovered with PARIS matches?
PARIS Case #1 PARIS case of denial... In Ohio, PARIS matched recipients are sent “Request for Contact” letters A recipient is instructed to contact the agency to resolve the PARIS detected discrepancy or face possible “adverse action”
Client Statement Accepted Actual case notes: 10-18-10: “CONSUMER CALLING ABOUT LETTER SHE RECEIVED THAT SHE IS RECEIVING BENEFITS IN ANOTHER STATE. STATES THAT SHE HAS NEVER BEEN ANYWHERE ELSE.”
Overworked Staff May Look The Other Way Assistance Group’s statement was accepted. During a PARIS audit, an investigation revealed concurrent benefits from May 2010 to Feb. 2011 with another state.
PARIS Case #2 Timely PARIS match… In this case, the Assistance Group requested their public assistance case be closed the same month that PARIS alert was issued (October). The worker was going to dismiss the match, but observed the PARIS Federal income was over $7000, indicating previous months of income.
Additional Investigation PARIS match income levels indicated “Active Duty” employment five months prior to match SNAP “Out of State Activity Report” indicated Oak Grove, KY use from August continuing Children did not return to school in September Monthly income exceeded 130% threshold Overpayments totaling $5000
ATTENTION TO DETAIL Completing the match as “no effect, not known, no benefit change” would have been easy, but attention to details revealed a very substantial overpayment
PARIS match Social Security recipient… A single male reported his only source of income was social security income of $1060. PARIS Federal Income match indicated retirement income of $1435 in addition to the SS income. The recipient was contacted to obtain information about the match. PARIS Case #3
Recipient Contact The recipient was contact to address the PARIS discrepancy Provided verifications indicated unreported retirement income from date of application SNAP repayment agreement signed for $2717 Waiver of Administrative Disqualification Hearing was signed for Intentional Program Violation (IPV) Collection incentive retained (35%)
PARIS matches contribute to prosecutions Oct. 31, 2011 – Binghamton, NY: Broome Security Case Integrity Unit is one of the most aggressive in NY State. WBGH TV interviewed the county executive. Two programs (one includes PARIS) are primarily used in their investigations. PARIS Case #4
INVESTIGATION PROGRAMS SAVE MONEY Investigation programs saved the county/state over $6 million last year. Multiple cases prosecuted.
PARIS match – But Wait, THERE’S MORE… Ohio PARIS match revealed a mother and child had received concurrent benefits in California and Nevada. Ohio’s investigation revealed the child’s SSI was paid to the CA address. Working with NV, Ohio prepared a prosecution case of fraud due to application falsification and concurrent benefits. PARIS Case #5
Grand Jury Indictment Resulted in a Warrant for Arrest Efforts to serve the warrant were not successful. The suspect had fled the county!!
A Second Look… Efforts to locate the suspect resulted in a second look at the “Out of State” SNAP transaction history. Two additional states were targeted as part of the investigation.
Ohio Working With Four States Building Case of Residence Falsification and Theft May result in a ten year disqualification of SNAP participation
Lesson Learned? A PARIS match is a lead, not an end. A solid PARIS match may be just the beginning. A PARIS match is a snapshot in time. SNAP “out of state transaction history” reports may reveal additional states for investigation.
Story: Welfare Fraud Check, Aug. 11, 2011 – Craig Bayless, Michigan Front-end Eligibility Program. Goes door-to-door checking cases. This day, he is working on two cases involving people receiving benefits from multiple states (PARIS). PARIS Case #6
The “New” Program is Working “The projected savings for this year are $20 million (dollars)…Craig was able to reach an agreement with one of his clients, which will shut down her benefits in other states…”
Institutionalized … Group Home MN contact OK regarding a PARIS Medicaid match. Harvey Rabbit entered a MN group home in 4/11, not reported to OK. Mr. Rabbit was open in OK with SNAP and Medicaid, an annual reporting case, but required to report his move to MN within ten days. PARIS Case #7
VIDEO SURVEILLANCE OBTAINED Store videos showed that an individual had been using Harvey’s OK SNAP card while he had been living in the MN group home. OK has provided documentation and information to assist MN in their Medicaid investigation.
Institutionalized … Prison KS contacted OK on a PARIS-SNAP match where Mr. Worthy One received benefits from 12/10 to 5/11. In OK, Worthy One, adult, received benefits on his mother’s case from 2008 through 7/11. There is more… PARIS Case #8
Worthy One Worthy One had been in Community Corrections from 7/10 to 5/11, and in prison from 5/11 to the present. Confinements provided 3 hots and a cot. Both states have substantial overpayments. OK is also working an IPV on Worthy One’s mother.
Hey Man, Triple Play The case of Hey Man began in OK as a fleeing felon investigation, 4 outstanding warrants. Hey Man also appeared on the “triple dipper” list. Other states included AZ, NV and NY. Working with transaction activity reports and NY investigators, OK investigators have located Hey Man. PARIS Case #9
Hey Man is currently residing in a NY prison OK will be third in line behind KS when Hey Man is released from his NY confinement.
Four Corners Geography Lesson “Four Corners” can view four states. Hugo Slavia and his 3 children began SNAP in CO 8/11. Concurrent benefits with NM beginning 12/1/11 and OK on 12/31/11. Hugo’s OK transaction activity report shows he spent one day in OK. All remaining OK SNAP benefits were spent in NM and CO. PARIS Case #10
NM has worked a fraud case on Hugo for dual participation with CO. OK has a $3,000 overpayment on Hugo. OK also has an outstanding felony warrant for him if anyone knows where he is.
PARIS Case #11 Captain Crunch …was matched with OK, NY and TN. The Captain had been on Medicaid in NY since 2010 and receiving SNAP in TN when he applied for assistance with OK in 6/11. Working with TN investigators, OK completed a 3 month overpayment and intentional program violation. But wait, there’s more…
GEORGIA QUIKI- MART OK Case Review OK review of the case revealed OK SNAP benefits spent in GA. A five minute phone call and five faxed pages to GA should result in a second overpayment and disqualification.
Farmer Boy PARIS match of concurrent benefits received in IL: 5/10, OK: 4/11, OH: 5/11, NV: 6/11, WA: 6/11, OR: 7/11, AZ: 8/11. Washington discovered pending applications in TX and NV. PARIS Case #12
WHAT NOW? Each state after IL has an overpayment and an IPV (intentional program violation). OH birth certificate, but not on in OH when applying in OK. Each state has the ability to track out of state spending. IL, OK, OH NV, WA, OR TX, NM
Alpha Omega Convenience Store OK investigated store for trafficking in SNAP. It was the store location’s third violation. Rough neighborhood. Traded SNAP benefits for cash and drug paraphernalia. Parking lot was a “hangout” for local prostitutes. SNAP benefits could purchase a good time and crack too. PARIS Case #13
How is PARIS Involved ? 3 year investigation resulted in federal indictments on store owner and clerk for trafficking $850K in SNAP. 450 recipients involved with waivers and ADH’s.
Transaction History Reports Data revealed out of state transactions. PARIS confirmed dual state participation with LA. Phone call to LA for cooperation and info exchange of transaction histories. OK pursued overpayments and two ADH’s on two recipients. Two charges: concurrent benefits and trafficking.
Ireland: Dec. 29, 2011 “A crackdown on non-resident welfare claims has delivered substantial savings to the Government in the past year…One of the biggest areas of success was a project dealing with non-residency welfare claims.”
The initiative targets particular areas where there is a risk of welfare fraud or abuse “…direct intervention, where people were visited in their homes and workplaces, and checks carried out.”
“Some 4,745 cases were reviewed and around 12% of those had their payments terminated… “…saving the taxpayer some 6.2 million Euros” ($8 million U.S. Dollars). IRELAND POPULATION 2011, 4.67 MILLION U.S. POPULATION 2011, 317 MILLION