BSI FY21 Year In Review

A summary of the activities of BSI in Fiscal Year 2021.

Overview

Figure 6. FY21 Fraud Dollars Identified by Public Benefit Program

 

BSI By the Numbers

• 1,505⁴: BSI cases at the start of fiscal year 2021 (FY21)
• 3,224: New investigations
• 3,402: Total completed investigations
• 479: Completed investigations with identified fraud
• 1,327: BSI cases at the start of fiscal year 2022

Figure 7. FY21 Fraud Dollars Identified by Referral Source

 

*     Percentages do not total 100 because of rounding.

 

 

Table 2. FY21 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	11	135	204	935	174	26	20	1,505
New Investigations	32	180	504	1,893	581	29	5	3,224
Total Completed Investigations	9	222	512	2,043	593	16	7	3,402
Completed with No Fraud	2	20	475	814	516	4	5	1,836
Completed with Identified Fraud	3	192	29	143	8	1	0	3765
Completed as Potential Intentional Program Violation	0	0	2	1,021	45	0	0	1,068
Completed Pending Court/Non-Court/ Calculation6	4	10	6	65	24	11	2	1227

Closed Cases with Identified Fraud by Disposition

When BSI investigations are completed, BSI fraud examiners 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 a 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 cases, a closed case without identified fraud does not necessarily indicate that there was no fraud present, but rather that BSI was not able to obtain the necessary documentation to substantiate the fraud or that the individual was not receiving public assistance benefits during the period of allegation. Closed cases are cases that have been adjudicated completely, for which BSI will not pursue any further action.

BSI uses different disposition codes to categorize closed investigations with identified fraud. The seven disposition codes are as follows:

• Intentional program violations, or 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. 

During FY21, BSI closed 390 cases with identified fraud and categorized them under the following disposition codes: 379 IPVs, 5 guilty court dispositions, 2 civil recoveries, 2 administrative closings with financials, 1 dismissal with financials, and 1 continuance without a finding.

Figure 8. Summary of Closed Cases with Identified Fraud for FY21

4.    In the FY20 Annual Report, the number of cases reported at the start of FY21 was 1,531. The reporting criteria used during the FY20 Annual Report differs from FY21.

5.    This number reflects the disposition selected that signifies identified fraud.

6.    Completed Pending Court/Non-Court/Calculation includes calculated cases pending court/non-court outcomes and cases that are pending fraud calculation(s) from referral source(s).

7.   This number indicates cases without a disposition selected or financial types because they are pending court/non-court/calculation.