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BSI FY23 Year in Review

A summary of the activities of BSI in Fiscal Year 2023.
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Overview

Pie Chart with Information on BSI's FY23 Fraud Dollars Identified by Public Benefit Program

BSI By the Numbers

  • 2,8976: BSI cases at the start of FY23
  • 8,643: New investigations
  • 5,100: Total completed investigations
  • 782: Completed investigations with identified fraud

6,438: BSI cases at the start of fiscal year 2024

Pie Chart showing FY23 Fraud Dollars BSI identified by Referral Source
Chart with FY23 caseload information by referral source

Closed Cases with Identified Fraud by Disposition

When BSI investigations are completed, BSI fraud examiners make determinations regarding the final resolutions of 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 Office of the Attorney General (AGO), or the US Attorney’s Office.

All investigations completed and closed by BSI are considered closed cases, with or without identified fraud. Closed cases are cases that have been adjudicated completely, for which BSI will not pursue any further action. In some cases, a closed case without identified fraud does not necessarily indicate that fraud was not committed, but more likely 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.

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

  • Intentional program violations (IPVs) are cases that are returned to DTA, MassHealth, or EEC 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 (the subject is deceased, the subject moved and BSI was unable to locate them, 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), but they will not be subject to conviction following a probationary period.
  • General continuances 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 dismissed the case; the matter may be returned to the benefit program for further action.
  • Dismissed with financials are completed cases with identified fraud that were referred for prosecution where the court dismissed the case and the matter is returned to the benefit program for further action, including overpayment collection.
  • 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 for a potential audit or another state agency for further action.
  • Orders of restitution are completed cases with identified fraud that were referred for prosecution where the court’s final disposition includes an order of restitution.
  • Nolle Prosequi (Nolle Pros) are completed cases with identified fraud that were referred for prosecution where prosecution was declined by a district attorney after filing charges before a verdict was rendered.

During FY23, BSI closed 1,157 cases with identified fraud and categorized them under the following disposition codes:

  • 1,083 IPVs
  • 49 civil recoveries
  • 8 guilty court dispositions
  • 5 continuances without a finding
  • 4 dismissals
  • 3 referrals for further action with financials
  • 2 administrative closing with financials
  • 1 dismissal with financials
  • 1 Nolle Pros
  • 1 Order of Restitution
This is a bar graph that summarizes closed cases with identified fraud for FY23

6.     In the FY22 Annual Report, the number of cases reported at the start of FY23 was 2,898. During FY23, a case that did not progress through the workflow was discovered and subsequently fixed, which led to its exclusion under FY23 reporting criteria. BSI’s current case management system structures and stores BSI data differently than BSI’s former legacy database, Workstation.

 

7.    This number reflects the total number of cases with a disposition selected that signifies identified fraud. BSI uses different disposition codes to categorize completed and closed investigations with identified fraud.

8.     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).

9.     This number indicates cases without a disposition or financial type (calculated overpayment of specified public benefit) because they are pending court/non-court/calculation.

Date published: December 27, 2023

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