PURPOSE

The Program Integrity Unit ensures the integrity of agency programs and to maintain accountability in expenditure
of public funds through the prevention, detection, and investigation of fraud and abuse by clients and service
providers.  This includes the establishments of claims and recovery of erroneously issued benefits.

Program Integrity Claims Management Plan 7-1-22

 

SERVICES

•  Conduct front-end investigations (prior to application approval) to prevent program abuse.
• Conduct investigations of alleged program abuse or erroneous benefits by review of all agency records; collecting, researching and analyzing data; and calculating subsequent overpayments.
• Conduct internal Project Recall investigations, which is an internal review of randomly selected cases.
• Establish penalty and recovery of program funds when fraud or abuse has been validated.
• Improve quality and effectiveness of program services by educating staff on effective communication and error prevention.

ELIGIBILITY

Each specific program determines eligibility criteria.

The Program Integrity Unit services the following programs: Food & Nutrition Program, Family & Children's Medicaid Programs, Adult Programs, Special Assistance (SA), Child Care Services, and Work First Family Assistance (WFFA).

The unit provides assistance to agency staff in the above programs and to other agency staff who make referrals or provide information concerning alleged program abuse.  In addition, the unit works in coordination with the state and regional Program Integrity offices; Office of Attorney General, USDA and the State Division of Medical Assistance.  All reports or referrals are reviewed to determine validity and appropriate follow-up.

Referrals are received from agency staff, community persons, state offices, other agencies and community businesses.  Referrals can be made by telephone, mail in or office visit during our usual business hours Monday-Friday; 8:30 AM-5:00 PM. The length of time required for investigation varies depending on the individual case circumstances.

Reports of Food Assistance retailer fraud are referred to the USDA Food and Nutrition Services (FNS) office.

Reports of Medicaid provider fraud are referred to the State Division of Medical Assistance.

Referrals are not made to other agencies. However, information and data are collected from various private and public sources such as employers, landlords, financial institutions, health care institutions, law enforcement, court records, businesses, as well as city, county, state, and federal agencies.

Sheila Dorsett
Supervisor
Office: 919-560-8718
Fax: (919) 560-8856
Email: sdorsett@dconc.gov