2006 Referral for Disqualification Hearing or Referral for Prosecution
2006.1 The Disqualification Hearing Referral Process
Consider all responsible adult individuals in the assistance unit potentially involved in the intent to commit a program violation for Food Stamps, POWER and Child Care for disqualification. Refer the individual(s) to the Fraud Investigator for possible disqualification if there is clear and convincing evidence which supports the intent to commit a program violation (fraud). An individual may be referred for disqualification even if no benefits were issued or an overpayment did not occur if there is evidence of intent to commit a program violation.
A. Submit documentation to support the overpayment(s)/claim(s) to the PRICE Unit if an overissuance occurred during the time period of the alleged program violation, (See Combined Manual Section 2005).
B. Review of the documentary evidence will be conducted by the Fraud Investigator and, if warranted, will submit a formal referral for disqualification from the appropriate program.
C. Communication between the Fraud Investigator and the Benefit Specialist and/or Benefit Specialist Supervisor will occur in order to discuss the issues surrounding the possible intent to commit a program violation regardless of the error cause/code.
D. Submission of a subsequent referral may take place if there was a “break in aid” and it appears another Intentional Program Violation occurred.
E. Separate referrals for disqualification hearings will be prepared for each individual that is formally referred.
F. A pending disqualification hearing or court action does not affect current eligibility for Food Stamps, POWER or Child Care.
2006.2 The Disqualification Hearing Process
A. Scheduling and sending notification of the disqualification hearing once the formal referral for disqualification is received from the Fraud Investigator is the responsibility of the PRICE Unit. A separate disqualification hearing will be scheduled for each individual that is formally referred for a disqualification hearing, unless the individuals request a joint hearing.
B. Indicated in The Advance Notice of Disqualification Hearing (DFS AM 9072), is the date, time and location of the hearing, as well as the reason the individual is being referred for a disqualification hearing. Included in this same envelope, will be a Waiver of Right to a Disqualification Hearing (DFS 723).
1. DO NOT contact the individual (Defendant) or begin discussions with the individual (Defendant) to sign the Waiver of Right to a Disqualification Hearing unless the individual (Defendant) initiates that discussion.
2. If the individual (Defendant) chooses to sign a Disqualification Waiver, the hearing will be cancelled and the Disqualification Hearing Officer will issue a Decision. A copy of the Decision will be sent to the individual (Defendant), the county field office and the Benefit Specialist/Benefit Specialist Supervisor will impose the penalties as stated in the Decision.
C. Preparation of the Disclosure Statement is the responsibility of the Benefit Specialist or Benefit Specialist Supervisor. However, if the Fraud Investigator is the primary referral source, the Fraud Investigator will prepare the Disclosure Statement.
D. Begin preparation of the Disclosure Statement upon receipt of the Advance Notice of Disqualification Hearing, The Disclosure Statement includes the following sections:
1. Statement of Facts – this statement should be clear and concise, including only the information necessary to show why the Agency (Plaintiff) believes an IPV (Intentional Program Violation) occurred;
2. Witnesses – identify each and include their title, if applicable;
3. Exhibits – include documentation to support every fact and proposed statement from witnesses. Mark exhibits in upper right hand corner with letters and keep in order so they are readily available during testimony. If using stickers, do not cover any writing or print on the page(s);
4. Consult with the Fraud Investigator assigned to your area for assistance and review the Disclosure State and exhibits prior to sending to the Hearing Officer and defendant;
5. Benefit Specialist or Benefit Specialist Supervisor should keep original documents, only copies should be sent to all other parties, including the Disqualification Hearing Officer; and,
6. Send the Disclosure Statement together with exhibits to the following as indicated on the Certificate of Service (last page of Disclosure Statement) to be received no later than five (5) working days prior to the hearing:
a. Individual (Defendant) – via U.S. Mail, certified, return receipt requested;
b. Fraud Investigator, via U.S. Mail; and,
c. Disqualification Hearing Officer as indicated in the Advance Notice of Disqualification Hearing via U.S. Mail, certified, return receipt requested.
Note: The address for the PRICE Unit, P. O. Box 967, Cheyenne, WY 82003 should appear on the return address side of the “green” receipt card.
E. Representation of The Agency (Plaintiff) will be normally by the Benefit Specialist and/or Benefit Specialist Supervisor and Fraud Investigator. The Benefit Specialist and/or Benefit Specialist Supervisor who believes an Intentional Program Violation occurred will be responsible for the case testimony during the disqualification hearing process. Participation may be by conference call or through video conferencing.
F. The DFS-FO is entitled to an attorney when the individual (Defendant) has an attorney. Contact a Program Consultant and the PRICE Unit immediately when this occurs.
G. Postponement of the hearing may be requested by the DFS-FO when:
1. The individual (Defendant) appears with an attorney and did not inform the DFS-FO;
2. The Agency’s (Plaintiff’s) witness(es) has a physical or personal emergency and the Benefit Specialist Supervisor is unable to fill in; or,
3. Inclement weather conditions exist.
H. Await the Disqualification Hearing Officer’s Final Decision
1. The Decision will inform the individual (Defendant) of the decision, the reason for the decision and the date when the disqualification will take effect, if appropriate.
2. The original decision will be sent to the individual (Defendant) via U.S. Mail, certified, return receipt requested;
3. Copies will be sent to the Benefit Specialist or Benefit Specialist Supervisor and Fraud Investigator;
4. DO NOT TAKE ADVERSE ACTION ON THE CASE PRIOR TO RECEIVING THE HEARING OFFICER’S DECISION.
I. Appealing the decision of the Disqualification Hearing Officer to the appropriate Wyoming District Court for their area, must be done within thirty (30) days from the date the Decision made. This is the individual’s (Defendant’s) right.
J. Commission of an IPV by the individual (Defendant), disqualifies him or her, but does not disqualify the entire household.
K. Generate the appropriate notice (see Table V) within ten (10) days of receipt of the disqualification Hearing Officer’s Decision for Food Stamps and POWER when a decision is rendered and the assistance unit is currently receiving benefits. Include the following information in the notice:
1. The name of the disqualified adult household member(s); and,
2. The benefit level of the remaining assistance unit member(s).
2006.3 Penalties Imposed Following an IPV (Intentional Program Violation)
A. Apply any Food Stamp disqualification penalties imposed by the Disqualification Hearing Officer as follows:
1. The Benefit Specialist/Benefit Specialist Supervisor will assure the following:
a. Begin the disqualification penalty effective the first of the following month after receipt of the Decision when the Disqualification Hearing Officer rules in favor of the Agency (Plaintiff), unless the Decision is received after deadline, then begin the disqualification penalty effective the first of the second month after receipt of the Decision;
b. Change the SEPA screen participation code for the disqualified person to “DF” for the appropriate month(s);
c. Pass through FSAD screen for the issuance month as designated by the Disqualification Hearing Officer prior to deadline so that EPICS will recognize the disqualification and the recoupment;
d. Check FSAD and FSBH screens to assure benefits are issued accurately;
e. Issue an adequate notice;
f. Set an alert to remove the “DF” code on the SEPA screen for when the disqualification time period has been served by the disqualified individual; and,
g. Disqualification from the Food Stamp Program follows the individual (Defendant) across state lines;
(1) Impose the penalty for the time remaining when an individual applies in Wyoming, a disqualification is verified with another state and it is confirmed s/he is currently serving a penalty period; and,
(2) Impose the Wyoming penalty after the other state’s penalty expires; if applicable.
Note: Require the disqualification period(s) to run uninterrupted once the penalty begins for the specified number of months regardless of the assistance unit’s eligibility.
Delay additional disqualification penalties until a previous disqualification period ends.
If a disqualification penalty is not imposed against an individual due to agency error, establish an overpayment for the month(s) in which a disqualification should have been imposed; and disqualify the individual for the remaining month(s) of the disqualification time period.
2. Changes to the OVCA screen will be made by PRICE fiscal staff if an individual (Defendant) is found guilty of a Food Stamp IPV.
3. The following penalties are imposed by the Disqualification Hearing Officer when Intentional Food Stamp Program Violations have been committed:
a. Twelve months for the first disqualification;
b. Twenty-four months for the second disqualification;
c. Permanently for the third or subsequent disqualification;
d. Individuals found by a Federal, State or local court to have used or received benefits in a transaction involving the sale of a controlled substance shall be ineligible to participate in the Program;
(1) For a period of twenty four months upon the first occasion of such violation; and,
(2) Permanently upon the second occasion of such violation.
e. Disqualify permanently persons who have been convicted in a court of law to have used or received benefits in a transaction involving the sale of firearms, ammunition or explosives;
f. Disqualify permanently persons who are convicted of trafficking food stamps of $500.00 or more; and,
g. Disqualify, for a period of ten years, persons who have been found guilty of attempting to receive benefits in more than one state at one time if the event occurred after 8/23/96 (the state of residence is responsible for the disqualification).
B. Apply any POWER disqualification penalties imposed by the Disqualification Hearing Officer as follows:
1. Benefit Specialist/Benefit Specialist Supervisor will assure the following:
a. Apply the family penalty to the assistance unit member(s) for the appropriate time period;
b. Change the SEPA screen participation code for the disqualified person to “DI” for the appropriate months;
c. Enter the “XG” code and zero under the amount on UNIN screen when the family penalty is to be applied to an outstanding overpayment balance due to an IPV as the result of a disqualification or prosecution;
d. Use the “MA” plan code on OVCA screen and enter the amount which is equal to the family penalty to be imposed so the benefit will be reduced correctly;
e. Set an alert and change the amount on UNIN screen when the overpayment balance is less than the family penalty (i.e., family penalty is $100 and balance owed is $65, change the code on the UNIN screen to “XG” equals $35) and the individual has not completed the disqualification penalty period; and/or
f. Set an alert and enter the full amount of the family penalty on UNIN screen when the overpayment is paid in full but the individual continues to be disqualified; and,
g. Determine the amount of all other recoupments assuring the amount is not less than 10% of the gross income and available assets of the assistance unit. (DO NOT USE THE % symbol on OVCA screen for a POWER overpayment, see Section 2004).
2. Changes to the OVCA screen will be made by the PRICE fiscal staff if an individual (Defendant) is found guilty of a POWER IPV.
3. The following penalties are imposed by the Disqualification Hearing Officer when Intentional POWER Program Violations have been committed:
a. Twelve months for the first disqualification;
b. Twenty-four months for the second disqualification;
c. Permanently for the third or subsequent disqualification; or,
d. Disqualify for a period of ten years a person(s) found guilty of attempting to receive benefits in more than one state at one time (dual benefits).
4. Review the case when the disqualified individual reapplies for POWER benefits and take the following actions:
a. DO NOT disqualify the individual if the disqualification time period has expired. See B, 1, g. of this section to determine recoupment amount if the overpayment has not been paid in full;
b. Disqualify the individual for the duration of the disqualification time period; DO NOT extend the disqualification time period; or,
c. Delay imposing the penalty until a previously imposed penalty ends. Penalties cannot run concurrently.
C. Apply any Child Care disqualification penalties imposed by the Disqualification Hearing Officer as follows:
1. Benefit Specialist/Benefit Specialist Supervisor will disqualify the assistance unit that was not prosecuted but was found guilty of an IPV, until full restitution is made and for a time period as indicated in “C, 3. b - d” of this section.
2. Changes to the Access database will be made by the PRICE fiscal staff if an individual (Defendant) is found guilty of a Child Care IPV.
3. The following penalties are imposed by the Disqualification Hearing Officer when Intentional Child Care Program Violations have been committed:
a. Further child care assistance will not be authorized until full restitution is made; and,
b. Twelve months for the first disqualification; or,
c. Twenty-four months for the second disqualification; or,
d. Permanently, or as specified in the notice from the Disqualification Hearing Officer for the third or subsequent disqualification.
4. Review the case when the disqualified individual reapplies for Child Care and take the following actions:
a. Continue the disqualification of the individual until restitution has been paid in full, even though the disqualification time period has expired;
b. Disqualify the individual for the duration of the disqualification time period if the restitution has been paid in full; DO NOT extend the disqualification time period; or,
c. Delay imposing the penalty until a previously imposed penalty ends. Penalties cannot run concurrently.
D. Notify the PRICE Unit upon discovering an incorrect penalty was imposed for a disqualification for all programs.
2006.4 When the Individual Was Found Not Guilty (Acquitted) of an IPV
A. The Benefit Specialist/Benefit Specialist Supervisor will assure the following:
1. Placing a copy of the findings in the case record;
2. Keep the percentage of a Food Stamp recoupment at 10% of the benefit amount;
3. For POWER, the recoupment amount that is entered on the OVCA screen should not be less than 10% of the gross income for the family unit;
4. The individual is not removed from the Food Stamp and/or POWER assistance unit, if the individual is receiving benefits; and,
5. Authorization of child care may be done, but if an overpayment exists, a DFS 707 must be signed and payment made regularly for continued child care assistance.
B. Changes to the OVCA screen will be made by PRICE fiscal staff.
2006.5 The Referral for Possible Prosecution
For Food Stamps, POWER and Child Care, consider all responsible adult individuals in the assistance unit potentially involved in the intent to commit a program violation. If there is “beyond a reasonable doubt” evidence to support the intent to commit a program violation, refer the individual(s) to the Fraud Investigator for a possible prosecution referral.
A. The Benefit Specialist/Benefit Specialist Supervisor will take the following actions for all overpayment(s)/claim(s) coded as “DE” error cause/code when a potential referral for prosecution is warranted:
1. Set up the overpayment(s)/claim(s) on EPICS and complete the DFS 710; and/or complete the DFS 710 if the program is not on EPICS;
2. Contact the Fraud Investigator assigned to your area when it has been determined alleged fraud has been committed;
3. Discuss with the Fraud Investigator whether a notice of overpayment should be sent to the individual;
4. Send the overpayment notices (see Table V) to the individual if the Fraud Investigator approves; and,
5. DO NOT discuss the possibility of criminal investigation or prosecution with the individual(s).
2006.6 The Disqualification Process Following a Conviction
A. Automatic program disqualification proceedings will take place following the completion of a prosecution case and a conviction occurred. The Fraud Investigator will be responsible for the formal referral for disqualification.
B. The individual (Defendant) is not entitled to another hearing – their hearing was provided through the criminal court proceedings.
C. The Disqualification Hearing Officer will send a Notice of Disqualification to the individual (Defendant), notifying them of the subsequent disqualification penalties.
D. A copy of the Notice of Disqualification will be sent to the appropriate Benefit Specialist or Benefit Specialist Supervisor who will apply penalties to the case as indicated in the disqualification portion of Section 2006.3.
2006.7 Food Stamp Penalties Imposed Following a Conviction
A. The Benefit Specialist/Benefit Specialist Supervisor will take the necessary actions to assure the appropriate food stamp disqualification penalties are imposed as indicated in the disqualification portion of Section 2006.3.
B. Changes to the OVCA screen will be made by the PRICE fiscal staff if an individual (Defendant) is convicted through the criminal courts.
C. The following penalties are imposed by the Disqualification Hearing Officer when an individual has been convicted in a court of law because an Intentional Food Stamp Program Violation(s) has been committed:
1. Twelve months for the first disqualification;
2. Twenty-four months for the second disqualification;
3. Permanently for the third or subsequent disqualification;
4. Individuals found by a Federal, State or local court to have used or received benefits in a transaction involving the
sale of a controlled substance shall be ineligible to participate in the Program;
a. For a period of twenty four months upon the first occasion of such violation; and,
b. Permanently upon the second occasion of such violation.
5. Disqualify permanently persons who have been convicted in a court of law to have used or received benefits in a transaction involving the sale of firearms, ammunition or explosives;
6. Disqualify permanently persons who are convicted of trafficking food stamps of $500.00 or more;
7. Disqualify, for a period of ten years, persons who have been found guilty of attempting to receive benefits in more than one state at one time if the event occurred after 8/23/96 (the state of residence is responsible for the disqualification); or
8. Any other disqualification time period which was imposed by the judge who presided over the criminal matter and imposed a specific time period for disqualification from the Food Stamp Program.
2006.8 POWER Penalties Imposed Following a Conviction
A. The Benefit Specialist/Benefit Specialist Supervisor will apply the family penalty ($100) to the family unit member(s) who was convicted of fraud until full restitution of all POWER erroneous payments is made.
B. Changes to the OVCA screen will be made by PRICE fiscal staff if an individual (Defendant) is found guilty through the criminal courts.
C. The Disqualification Hearing Officer will impose a disqualification time period from the POWER Program when an individual has been convicted in a criminal court of law if the judge who presided over the criminal matter imposed a specific time period for disqualification from the POWER Program.
2006.9 Child Care Penalties Imposed Following a Conviction
A. The Benefit Specialist/Benefit Specialist Supervisor will take the necessary actions to assure the appropriate child care disqualification penalties are imposed on the assistance unit as indicated in this section.
B. Changes to the Access database will be done by PRICE fiscal staff if an individual (Defendant) is found guilty through the criminal courts.
C. The following penalties are imposed by the Disqualification Hearing Officer when an individual has been convicted in a court of law because an Intentional Child Care Program Violation(s) has been committed:
1. Disqualify from the date of the judgment, the Child Care assistance unit who is convicted of fraud in a court of law until full restitution of all erroneous payments is made and the legal sentence has been completed;
2. Any other disqualification time period which was imposed by the judge who presided over the criminal matter and imposed a specific time period for disqualification from the Child Care Program.
2006.10 When the Defendant Was Found Not Guilty After Prosecution Proceedings
A. The Benefit Specialist/Benefit Specialist Supervisor will assure the following:
1. Place a copy of the court findings in the case record;
2. The percentage for a Food Stamp recoupment remains at 10% of the benefit amount;
3. For POWER, the recoupment amount that is entered on the OVCA screen should not be less than 10% of the gross income for the family unit;
4. The individual is not removed from the Food Stamp and/or POWER assistance unit, if the individual is receiving benefits; and,
5. Authorization for Child Care may be appropriate, but if an overpayment exists, a DFS 707 must be signed and payment made regularly for continued child care assistance.
B. Changes to the OVCA screen will be made by the PRICE fiscal staff.