Overview
Fraud Investigations
- 2,852: Number of BSI cases at the start of FY18
- 7,630: Number of new investigations
- 8,114: Total completed investigations
- 922: Completed investigations with identified fraud
- 2,368: Number of BSI cases at the start of FY19
Investigations by Source
Figure 2. FY18 Caseload by Referral Source
Caseload |
EEC |
Data Analytics |
MassHealth |
Department of Transitional Assistance |
Hotline |
Task Force |
Other |
Total |
---|---|---|---|---|---|---|---|---|
Beginning Balance |
28 |
114 |
540 |
2,000 |
14 |
6 |
150 |
2,852 |
New Investigations |
40 |
248 |
788 |
6,041 |
470 |
44 |
0 |
7,631 |
Total Completed Investigations |
31 |
137 |
1,104 |
6,340 |
336 |
22 |
144 |
8,114 |
Completed with No Fraud |
10 |
24 |
961 |
3,550 |
314 |
0 |
11 |
4,870 |
Completed with Identified Fraud |
21 |
113 |
143 |
478 |
12 |
22 |
133 |
922 |
Completed as Potential Intentional Program Violation |
0 |
0 |
0 |
2,312 |
10 |
0 |
0 |
2,322 |
Identified Fraud Cases by Disposition
BSI uses different disposition codes to categorize its investigations, including Intentional Program Violation (IPV), Referred for Further Action, Referred for Prosecution, Civil Recovery, and Returned to DTA as Potential IPV. Below is a summary description of some of the more commonly used BSI codes:
- Intentional Program Violation, or IPV, is a case that is returned to the Department of Transitional Assistance (DTA), MassHealth, or the Department of Early Education and Care (EEC) to be handled administratively by those agencies.
- Cases referred for further action are completed cases with identified fraud that require management discussions to determine appropriate resolutions. These cases are referred for prosecution, or BSI will facilitate a civil recovery, or are returned to the appropriate agency for its administrative process.
- Cases referred for prosecution are cases in which BSI files criminal complaints against the subjects or refers the cases to the Attorney General’s Office, a District Attorney’s Office, or the US Attorney’s Office.
- Civil recovery cases are resolved through an agreement in which the subject agrees to pay back part or all of the fraudulently obtained benefits to the Commonwealth.
- Cases returned to DTA as potential IPVs are cases that are completed by the Central Processing Unit and determined to have potential overpayments but do not merit the deployment of BSI resources.
Date published: | March 14, 2019 |
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