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Executive Summary of the BSI FY18 Annual Report

An overview of the activities of the Bureau of Special Investigations in Fiscal Year 2018.

Table of Contents

Overview

The fiscal year 2018 (FY18) Annual Report of the Bureau of Special Investigations (BSI) summarizes BSI’s work and initiatives to execute the Office of the State Auditor’s mission to make government work better. This is done through BSI’s statutory charge to investigate fraud, abuse, and illegal acts involving public assistance benefits throughout the Commonwealth. During FY18, BSI continued to investigate and identify fraud in order to maintain program integrity and uphold the Commonwealth’s residents’ faith in public assistance programs. BSI’s efforts ensure that public assistance programs operate with integrity so that benefits are available to residents who truly need them.

In FY18, BSI identified $14,424,830.22 in fraud.

 

$14,424,830.22 The amount of fraud identified by BSI in FY18

BSI’s fraud investigation strategy is twofold: investigations involving individual recipient fraud, and those involving provider fraud. In FY18, BSI opened 7,630 new investigations and completed 8,114 investigations. This report includes a comprehensive breakdown of the fraud identified within each of the specific programs BSI investigates. Of the 922 completed cases with identified fraud, the average amount of fraud was $15,645.15, keeping pace with FY17, during which BSI completed 1,150 identified-fraud cases with an average of $14,678 in identified fraud per case.

Public assistance programs administered by the Department of Transitional Assistance (DTA), the Department of Early Education and Care (EEC), and MassHealth provide vital social services for the Commonwealth’s most vulnerable and disadvantaged residents—children, people with disabilities, low-income individuals and families, and seniors. Statistical data on BSI cases from FY17 and FY18 demonstrate that BSI identified less fraud in investigations involving children (10–19 years old) and seniors (70–99 years old) in comparison with other age demographics. BSI identified the highest levels of fraud in cases involving subjects 30–49 years old; subjects 30–39 years old produced the highest dollar amount of identified fraud. Cases that involved four-member households generated the highest levels of fraud, whereas households with more than four members generated the least amount of fraud. In FY18, allegations regarding a non-custodial parent (the parent who does not have primary custody) produced cases with the largest amount of fraud, totaling $1,236,430.91. By contrast, cases with allegations of undisclosed employment produced cases with the most fraud in FY17, totaling $1,740,972.37. Overall, allegations about employment, a non-custodial parent, a personal care attendant, or another earner in the home generated cases with the largest amounts of fraud in FY18.

Of particular note, this year BSI completed 300 cases involving Personal Care Attendant (PCA) fraud, totaling $1,379,493.93. The number of BSI cases involving PCA fraud has more than doubled since FY16 when the Bureau identified 147 such cases.

 

$1,379,493.93 The amount of PCA fraud identified by BSI in FY18

BSI receives referrals from myriad sources, including DTA, MassHealth, EEC, BSI’s fraud hotline, various federal agencies, and internal referrals generated by BSI’s Data Analytics Unit. BSI also collaborates with many federal agencies and is the only Commonwealth agency to participate on the US Attorney’s Public Assistance Task Force. In the course of its work, BSI examiners interact with numerous state and federal agencies, including the US Department of Agriculture, the US Department of Health and Human Services, the Massachusetts Office of the Inspector General, the US Attorney’s Office, the Massachusetts Attorney General’s Office, District Attorneys throughout the Commonwealth, and local law enforcement. BSI’s partnerships with these agencies are crucial to its efforts to combat fraud, maintain the public’s trust in public assistance programs, and protect benefits for residents of the Commonwealth who truly need them.

Date published: March 14, 2019
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