BSI FY22 Year In Review

A summary of the activities of BSI in Fiscal Year 2022.

Table of Contents

Overview

Figure 1. FY22 Fraud Dollars Identified by Public Benefit Program

A pie chart showing the fraud dollars identified by the public benefit program, with the total fraud dollars identified as $13,519,349.55. $4,865,970.10 was identified at MassHealth; $5,070,599.32 was identified at the Supplemental Nutrition Assistance Program; $1,637,350.13 was identified at the Department of Transitional Assistance; $1,572,578.33 was identified at the Department of Early Education and Care; $340,822.67 was identified by the Emergency Assistance for the Elderly and Dependent Children; $12,

BSI By the Numbers

  • 1,3304: BSI cases at the start of fiscal year 2022 (FY22)
  • 5,191: New investigations
  • 3,623: Total completed investigations
  • 668: Completed investigations with identified fraud
  • 2,898: BSI cases at the start of fiscal year 2023

Figure 2. FY22 Fraud Dollars Identified by Referral Source

A pie chart showing the fraud dollars identified by referral source, with the total fraud dollars identified as $13,519,349.55. $549,925.37 was identified at MassHealth; $6,684,959.64 was identified at the Department of Transitional Assistance; $3,211,751.66 was identified by BSI’s Data Analytics Unit; $1,197,201.37 was identified at the Department of Early Education and Care; $906,643.81 was identified by the U.S. Attorney’s Office Public Assistance Task Force; $938,555.70 was identified by the hotline; an

Table 1. FY22 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

35

93

197

786

162

39

18

1,330

New Investigations

24

393

872

3,050

833

12

7

5,191

Total Completed Investigations

26

93

563

2,306

607

23

5

3,623

Completed with No Fraud

4

7

477

776

503

4

2

1,773

Completed with Identified Fraud

5

42

30

233

24

4

1

3395

Completed as Potential Intentional Program Violation

0

0

31

1,089

61

0

1

1,182

Completed Pending

Court/Non-Court/

Calculation6

17

44

25

208

19

15

1

3297

 

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 the 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, etc.).
  • Civil recovery cases are resolved through an agreement in which subjects agree to repay 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 for a reasonable jury to find them guilty of the charged offense(s).
  • General continuance are completed cases with identified fraud that were referred for prosecution where a general continuance has been ordered following either the subject’s guilty plea or a guilty verdict after a bench or jury trial.
  • 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 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.
  • Refer for further action with financials are completed cases with identified fraud that were referred for further action; the matter may be referred to the Office of the State Auditor or another state agency for further action.
  • Rejected are completed cases with identified fraud that were referred for prosecution where prosecution was declined prior to filing charges.
  • Nolle Prosequi, or Nolle Pros, are completed cases with identified fraud that were referred for prosecution where prosecution was declined after filing charges before a verdict is rendered.

During FY22, BSI closed 409 cases with identified fraud and categorized them under the following disposition codes:

  • 370 IPVs,
  • 22 civil recoveries,
  • 5 Nolle Pros,
  • 4 guilty court dispositions,
  • 2 refers for further action with financials,
  • 2 dismissals with financials,
  • 1 administrative closing with financials,
  • 1 general continuance,
  • 1 continuance without a finding, and
  • 1 rejected.

4. In the FY21 Annual Report, the number of cases reported at the start of FY21 was 1,327. Three cases received an updated completion date due to BSI’s case migration workflow, which led to their exclusion under FY22 reporting criteria. The BSI CMS structures and stores BSI data differently than BSI’s former legacy database, Workstation.

 

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.

Help Us Improve Mass.gov  with your feedback

Please do not include personal or contact information.
Feedback