Fraud or Willful Deception
(1)Any employee who becomes aware of what appears to be a payment based on incorrect or fraudulent information shall notify his/her supervisor immediately. The worker and supervisor having responsibility for payment will determine whether the payment was based on incorrect information.
(2)If it appears that fraud may be involved, a referral for investigation will be immediately forwarded to the SOSCF Assistant Administrator of Management Operations who will notify the Administrator.
(3)In instances involving potential fraud, it is not appropriate to follow the chain of command since that can interfere with the investigation.
(4)If the investigation of the referral can best be accomplished by an audit, the Assistant Administrator of Management Operations will refer all or part of the investigation to the SOSCF Management Operations Audit Unit.
(5)The client, claimant, or payee shall not be contacted unless directed by Management Operations or a law enforcement agency to do so.
(6)The Audit Unit will begin the investigation immediately. If sufficient documentation establishes fraud, referral will be made to the appropriate agencies.
(7)The Audit Unit investigation is intended to either clear any suspicion of wrongful action or, if needed, result in subsequent referral for recovery of improperly expended funds and possible prosecution.
(8)At all times the civil rights and personal liberties of a person who is suspected of fraudulent activities or willful deception to obtain services or payments will be protected.
(9)When incorrect information has been provided which affects the payment or when a client or provider is unwilling to resolve the incorrect payment problem, the division may terminate services, or terminate the contract. The decision whether to terminate service or the contract will be made by the regional administrator or assistant administrator responsible for the program.
Rule 413-310-0230 — Fraud or Willful Deception,