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FY18 1st Quarter Summary by Unit

A unit-by-unit breakdown of identified fraud by the Bureau of Special Investigations in the first quarter of fiscal year 2018.

Table of Contents

Central Processing Unit

The Central Processing Unit (CPU) received 1,574 new referrals for investigation in the 1st quarter of fiscal year 2018 (FY18) from the following sources:

 

Source

Number of Referrals

Percentage of Total

Department of Transitional Assistance (DTA)

1,440

91.5%

MassHealth

82

5.2%

BSI Hotline

42

2.7%

Department of Early Education and Care (EEC)

6

0.4%

Data Analytics Unit (DAU)

2

0.1%

US Attorney’s Office Public Assistance Task Force

2

0.1%

 

The primary sources of fraud in these 1,574 new referrals based on the number of cases are as follows:

Type

Number of Cases

Percentage of Total

Supplemental Nutrition Assistance Program (SNAP)

1,056

67.1%

Transitional Aid to Families with Dependent Children (TAFDC)

281

17.9%

Emergency Aid for Elderly, Disabled, and Children (EAEDC)

116

7.3%

MassHealth

110

7.0%

Classification to be Determined

6

0.4%

Other

5

0.3%

CPU team members processed, analyzed, and reviewed 2,013 cases.  CPU identified 786 referrals as potential Intentional Program Violation (IPV) cases, where BSI determined that a fraud claim had merit but returned the case to DTA for further action based on our evidence.  Additionally, CPU closed 794 cases administratively with no fraud determined after completing a preliminary investigation. CPU designated the remaining 433 cases for assignment to either the MassHealth or DTA units.

MassHealth Unit

During the 1st quarter of FY18, there were 231 new cases assigned to BSI’s MassHealth Unit, which completed 164 investigations.  In total, the MassHealth Unit identified $405,543.30 in fraud in 90 cases. Seventy-four cases resulted in a finding of no fraud or were closed administratively.

$405,543.30 The amount of fraud identified by the MassHealth unit in the first quart of FY18

 

The MassHealth Unit also collaborated on cases with different units within BSI. The MassHealth Unit worked with the DTA Unit on 15 investigations, including 2 EEC cases.

The Unit’s teamwork with BSI’s Data Analytics Unit (DAU) continues to contribute to the success of investigations into MassHealth’s Personal Care Attendant program.  DAU’s success at uncovering long-term care overlap has increased the number of completed cases and identified fraud.

Department of Transitional Assistance Unit

For the 1st quarter of FY18, the DTA Unit completed 184 cases and identified fraud totaling $701,852.12 in 84 cases. Eighty-one of those cases were DTA (non-EEC) referrals, generating $446,232.49 in identified fraud. The DTA Unit completed three cases for EEC that identified $255,619.63 in fraud. 

$701,852.12 The amount of fraud identified by the Department of Transitional Assistance Unit in the first quarter of FY18

 

In addition, the DTA Unit lent its efforts and resources to the federal Public Assistance Task Force, which resulted in six cases (three stolen-identity cases and three unreported-income cases) that the US Attorney’s Office is handling. Finally, charges were filed in Boston Municipal Court on one DTA case received through our hotline.

Data Analytics Unit

During the 1st quarter of FY18, the DAU’s efforts continued to uncover suspicious MassHealth provider activity.  In some cases, these efforts supported open federal and state investigations.  Twenty-nine DAU sourced referrals from previous quarters resulted in investigations by the MassHealth and DTA units that identified $91,848.13 in fraud this quarter.

Date published: April 18, 2018
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