Investigations and Fraud Management (IFM)
The Investigations and Fraud Management division has the responsibility for conducting investigations of internal matters at the direction of the Inspector General and for conducting investigations of suspected fraud and abuse within the programs the Department administers.
What is Investigations and Fraud Management?
The Investigations and Fraud Management (IFM) division of the OIG has the responsibility for conducting general investigations of suspected recipient misrepresentation primarily in the Department's Income Maintenance and Social Services Programs.
IFM also has the responsibility for pursuing Supplemental Nutrition Assistance Program (formerly known as Food Stamps) and cash assistance repayments.
The IFM has three Units to carry out its duties and responsibilities:
- Criminal Investigations
- Front-End Fraud
- Claims and Collections
In addition to the three units, IFM also conducts intra-agency internal affairs investigations involving allegations of inappropriate employee activity, which might result in administrative (disciplinary) action or referral for criminal prosecution.
These internal affairs investigations are conducted at the request and approval of the Inspector General. All such investigations are of a highly sensitive nature. Every effort is made to maintain confidentiality and to protect the individual privacy rights of all potential investigative witnesses and suspects.
Criminal Investigations Unit
The Criminal Investigations Unit investigates allegations of suspected welfare fraud or other criminal activity involving recipients of DHHR benefits or services.
Other special investigations may include complaints involving non-Medicaid providers, vendors or grantees who receive program-related benefits or financial payments for services from DHHR.
Finding are compiled in detailed written investigative reports which are delivered to county prosecuting attorneys to evaluate for further action.
Criminal Investigations Unit had the following outcomes during FY 2014:
- Received 995 referrals
- Presented 62 cases worth $478,104 to prosecuting attorneys
- Presented 47 cases worth $366,080 to the grand jury
- Established 51 intentional program violations through investigative actions
Contacts for the Criminal Investigations Unit:
Robert Cooper, Supervisor
Phone: (304) 465-9613
Fax: (304) 372-7888
Robert Lane, Supervisor
Phone: (304) 375-2560
Fax: (304) 558-0851
Front-End Fraud Unit
The Front-End Fraud Unit performs a more thorough, pre-certification review of applicant or recipient eligibility on cases meeting certain criteria. This unit is currently operational in five West Virginia counties.
This effort is supported by federal agencies providing related, matching funds as a highly effective means of preventing recipient abuse or fraud before it occurs.
Front-End Fraud Unit had the following outcomes during FY 2014:
- Received 1,771 referrals
- Identified actual savings to DHHR in the amount of $158,616 with projected savings of $951,696
Contacts for the Front-End Fraud Unit:
Andrew Petitt, Supervisor
Phone: (304) 425-8738
Fax: (304) 487-3589
Claims and Collections Unit
The Claims and Collections Unit is responsible for determining certain recipient benefit overpayment claims; negotiating appropriate repayment agreements; imposing any applicable program sanctions for violators; collecting the overpaid benefit amounts; and the ongoing monitoring as to the status of DHHR debtor claims.
Claims and Collections Unit had the following outcomes during FY 2014:
- Establised claims worth $3,118,278
- Received collections in the amount of $2,991,057
- Established 362 intentional program violations
Contacts for the Claims and Collections Unit:
Lenny Madia, Supervisor (Northern WV)
Phone: (304) 627-2929
Fax: (304) 627-2171
Tammy Hollandsworth, Supervisor (Southern WV)
Phone: (304) 847-2861
Fax: (304) 847-7244
REPORT RECIPIENT WELFARE FRAUD
- COMPLETE THE ONLINE REPORTING FORM
- Call the TIPLINE at (304) 558-1970
- Write us:
Department of Health and Human Resources
Investigations and Fraud Management
Office of Inspector General
1900 Kanawha Boulevard, East
Capitol Complex, Building 6, Room 817-B
Charleston, WV 25305