BSI FY20 Year In Review

A summary of the activities of BSI in Fiscal Year 2020.

Overview

Figure 6. Fiscal Year 2020 Fraud Dollars Identified by Public Benefit Program

 

BSI By the Numbers

• 1,952: BSI cases at the start of fiscal year 2020 (FY20)
• 3,770: New investigations
• 4,191: Total completed investigations
• 482: Completed investigations with identified fraud
• 1,531: BSI cases at the start of fiscal year 2021

Caseload by Referral Source

Figure 7. FY20 Fraud Dollars Identified by Referral Source

 

Table 2. FY20 Caseload by Referral Source

Caseload	Department of Early Education and Care	Data Analytics  Unit	MassHealth	Department of Transitional Assistance	Hotline	Task Force	Other	Total
Beginning Balance	12	50	266	1,318	257	40	9	1,952
New Investigations	7	160	968	2,151	451	14	19	3,770
Total Completed Investigations	9	75	1,004	2,539	527	29	8	4,191
Completed with No Fraud	2	29	951	1,377	434	7	7	2,807
Completed with Identified Fraud	7	46	51	316	39	22	1	482
Completed as Potential Intentional Program Violation	0	0	2	846	54	0	0	902

Closed Cases with Identified Fraud by Disposition

When BSI investigations are completed, BSI fraud examiners have to make determinations regarding the final resolutions of the cases, which may include referring the matter for prosecution, completing a civil recovery or referring the matter for further action. Cases referred for prosecution are cases in which BSI files a criminal complaint against the subject(s) or refers the case to the District Attorney’s Office, the Attorney General’s Office, or the US Attorney’s Office.

All investigations that are completed and closed by BSI are considered closed cases, with or without identified fraud. In some instances, cases are closed not because there was no fraud present, but because BSI cannot obtain the necessary documentation to substantiate the fraud, or because the individual was not receiving public assistance benefits during the period of allegation. Closed cases have been adjudicated completely, and BSI will not pursue any further action.

BSI uses different disposition codes to categorize closed investigations with identified fraud: intentional program violation (IPV), administrative closing with financials, civil recovery, continued without a finding, guilty, dismissed with financials, and warrant issued. During FY20, BSI closed 490 cases with identified fraud: 366 IPVs, 90 civil recoveries, 16 administrative closings with financials, 15 guilty court dispositions, 2 dismissals with financials, and 1 continuance without a finding.

• IPVs are cases that are returned to the DTA, MassHealth, or the Department of Early Education and Care to be handled administratively by those agencies.
• Administrative closing with financials are cases that are completed with an overpayment calculation, but recovery was not completed due to various factors (subject deceased, subject moved and BSI unable to locate, BSI error).
• Civil recovery cases are resolved through an agreement in which subjects agree to pay back part or all of the fraudulently obtained benefits to the Commonwealth. Repayment terms must follow the originating agency’s rules and regulations.
• Continuance without a finding are completed cases with identified fraud that were referred for prosecution where the subject admits that there is sufficient evidence against him/her for a reasonable jury to find them guilty of the charged offense(s). 
• Guilty are completed cases with identified fraud that were referred for prosecution where the subject has either pleaded guilty or received a guilty verdict after a bench or jury trial.
• Dismissed with financials are completed cases with identified fraud that were referred for prosecution where the court dismisses the case; the matter may be returned to the benefit program for further action. 

 

Figure 8. Summary of Closed Cases with Identified Fraud for FY20

Date published:	February 18, 2021