BSI FY18 Year In Review

A summary of the activities of BSI in Fiscal Year 2018.

Table of Contents

Overview

A pie chart shows the fraud dollars identified by BSI programs, with the total fraud dollars identified as $14,424,830.22.  $8,754,539.01 was identified at MassHealth; $3,025,105.41 was identified at Supplemental Nutrition Assistance Program; $825,564.72 was identified at Transitional Aid to Families with Dependent Children; $1,548,292.05 was identified at Department of Early Education and Care; and  $271,329.03 was identified at Emergency Aid to the Elderly, Disabled, and Children.
Figure 1. FY18 Fraud Dollars Identified, by Public Benefit Program*

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
 Unit

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

A bar graph showing Total cases with identified fraud for fiscal year 2018. 1 case had a warrants issued, 7 cases were referred for further action, 46 cases were civil recoveries, 66 cases were referred for prosecution, 922 total cases with identified fraud, and 2,322 cases were intentional program violations.
Figure 3. Summary of Cases with Identified Fraud for FY18

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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