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BSI FY24 Year In Review

A summary of the activities of BSI in FY24.
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Overview

Figure 1. FY24 Fraud Dollars Identified by Public Benefit Program

This is a pie chart showing the fraud dollars identified by the public benefit program with the total fraud dollars identified as $10,265,265. The amounts of fraud dollars identified are as follows: DTA had $6,018,514; MassHealth had $3,819,733; EEC had $284,676; and Personal Care Attendants had $142,340.

BSI By the Numbers

584 Completed investigations with identified fraud

6,438 BSI cases at the start of FY24 

                               +

3,155 New investigations

                               -

5,704 Total completed investigations

                               =

3,889 BSI cases at the start of fiscal year 2025


 

Figure 2. FY24 Fraud Dollars Identified by Referral Source

This is a pie chart showing the fraud dollars identified by the referral source with the total fraud dollars identified as $10,265,265. The amounts identified by each source are as follows: BSI’s DAU identified $4,849,579; DTA identified $3,521,807; the Hotline identified $622,214; the US Attorney's Office Public Assistance Task Force identified $581,064; EEC identified $384,813; MassHealth, identified $206,242; and BSI identified $99,546.


 

Table 1. FY24 Caseload by Referral Source

CaseloadBSIEECDAUMassHealthDTAHotlineLaw EnforcementPCA6 Task ForceTask ForceOtherTotal
Beginning Balance295802534,93656321558206,438
New Investigations11017301,6681,3612612103,155
Total Completed Investigations85226604,0071,3481282015,704
Closed with No Fraud0229417581,129128711,996
Closed with Identified Fraud51167132663600204908
Closed as Potential Intentional Program Violation00012,93317100003,105

Completed Pending

Court/Non-Court/

Calculation9

3230550120011011310

Closed Cases with Identified Fraud by Disposition

BSI investigations may result in 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 (USAO).

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.

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

  • Cancellations are cases that are recommended for return to DTA because the preliminary investigation failed to develop sufficient evidence to warrant further BSI investigation.11
  • No fraud determinations are rendered in cases where the allegation of fraud could not be substantiated following investigation.
  • Intentional program violations (IPVs) are cases that are returned to DTA, MassHealth, or EEC to be handled administratively by those agencies.
  • Consolidations are cases that are merged with already-open BSI cases following a subsequent referral.
  • 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.
  • Administrative closings are cases that are completed without an overpayment calculation due to various factors (the subject is deceased, the subject moved and BSI was unable to locate them, BSI error, etc.).
  • 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.
  • Continuances 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.
  • 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.

During FY24, BSI closed 5,64312 cases and categorized them under the following disposition codes:

Figure 3. Summary of Closed Cases for FY 24

This is a bar graph breaking down the cased BSI closed in fiscal year 2024. BSI closed a total of 5,643 cases, broken down as follows: 1 was referred for further action; 3 were continuances without a finding; 4 were guilty; 12 were administrative closings; 17 were civil recovery; 42 were consolidations; 517 were intentional program violations; 1,942 were no fraud determinations; and 3,105 were cancellations.

6.     PCA refers to Personal Care Attendant and identifies MassHealth overpayments for PCA services; overpayments for member healthcare benefits are identified by Medicaid.

7.     BSI’s DAU completed a large referral project in the fourth quarter of FY24, which has not yet been processed through CPU. DAU generated 1,196 referrals for CPU analysis in FY24. As a result, those referrals are not reflected in this report but will be available in the FY25 annual report.

8.     Of the 584 cases completed with identified fraud during FY24, 490 cases were closed with a final disposition selected that signifies identified fraud.

9.     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).

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

11.     Pending DTA’s administrative process, these cases may be deemed intentional program violations or unintentional program violations.

12.     This reflects the total number of cases BSI closed with a final disposition during FY24; BSI completed 5,704 investigations during FY24, some of which are still pending a fraud calculation or final disposition as of drafting this report. 

Date published: January 30, 2025

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