Revision 15-4; Effective October 1, 2015

 

 

B—910 General Policy

Revision 15-4; Effective October 1, 2015

 

All Programs

An IPV occurs when a person intentionally makes a false or misleading statement, or misrepresents, conceals, or withholds facts for the purpose of receiving assistance under Texas Health and Human Services Commission (HHSC) benefit programs.

Note: A person may be charged with an IPV, even if benefits the person was not entitled to receive have not actually been received.

SNAP

An IPV occurs when a person commits an act that constitutes a violation of the Food and Nutrition Act, the Supplemental Nutrition Assistance Program (SNAP) regulations, or any state statute for the purpose of using, presenting, transferring, acquiring, receiving, possessing, or trafficking of benefits, authorization cards, or reusable documents used as part of an electronic benefit delivery system (Electronic Benefit Transfer [EBT]).

 

B—911 Elements of an IPV

Revision 11-4; Effective October 1, 2011

 

All Programs

An IPV must contain at least one or more of the following elements:

  • a falsified document,
  • a falsified statement,
  • a falsified interview,
  • a continuing scheme, or
  • trafficking of benefits.

See Glossary for definitions of the above terms.

 

B—912 IPV Disqualification Penalties

Revision 15-4; Effective October 1, 2015

General Policy

There is no IPV disqualification or disqualification penalty imposed for Medicaid or the Children's Health Insurance Program (CHIP). However, the Office of Inspector General (OIG) may establish an overpayment claim for an individual found guilty of committing fraud in these programs.

SNAP and TANF

A person found guilty by a court for an IPV will be disqualified as specified by the court. If the court fails to specify a disqualification, OIG will impose the appropriate IPV disqualification penalty as listed below.

TANF

A person found guilty of having committed an IPV through an administrative disqualification hearing (ADH) or having signed a waiver of an ADH for conduct that constitutes an IPV and that conduct occurred on or after September 1, 2003, will be disqualified:

  • 12 months for the first offense, and
  • permanently for the second offense.

A person convicted for conduct that constitutes an IPV of a state or federal offense, or granted deferred adjudication or placed on community supervision for that conduct, will be permanently disqualified from receiving financial assistance.

A person found guilty of an IPV in federal or state court, or in an ADH for making a fraudulent statement or representation with respect to the identity or residence of the individual in order to receive multiple benefits simultaneously, will be disqualified for 10 years.

SNAP

A person found to have committed an IPV either through an ADH or by a federal, state, or local court, or to have signed either a waiver of right to an ADH or a disqualification consent agreement in cases referred for prosecution, will be disqualified:

  • 12 months for the first offense,
  • 24 months for the second offense, and
  • permanently for the third offense.

SNAP Specified Offenses

  • A person found guilty of an IPV in federal or state court, or in an ADH for making a fraudulent statement or representation with respect to the identity or residence of the individual in order to receive multiple benefits simultaneously, will be disqualified for 10 years.
  • A person found guilty of an IPV in federal, state, or local court of having used or received benefits in a transaction involving the sale of a controlled substance will be disqualified:
    • 24 months for the first occasion, and
    • permanently for the second occasion.
  • A person convicted by a federal, state, or local court of an IPV due to trafficking in SNAP benefits or program access devices, such as EBT cards, and the conviction is for an aggregate amount of $500 or more, will be permanently disqualified.
  • A person found guilty of an IPV in federal, state, or local court of having used or received benefits in a transaction involving the sale of firearms, ammunition, or explosives will be permanently disqualified.

 

B—920 When to File an IPV Referral

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff are responsible for reporting to OIG any acts of fraud, waste, abuse, or misconduct in the following HHSC benefit programs:

  • Temporary Assistance for Needy Families (TANF),
  • SNAP,
  • Medicaid, and
  • CHIP.

 

B—930 How to File an IPV Referral

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff submit a fraud or IPV referral using either the:

  • Automated System for Office of Inspector General (ASOIG), or
  • Texas Integrated Eligibility Redesign System (TIERS) referral interface.

Note: If the fraud allegation contains confidential information and/or the person making the allegation requests to remain anonymous, the referral is submitted using ASOIG. Any supporting information and/or evidence should be attached to the referral using ASOIG. The TIERS referral interface does not allow attachments.

Staff must follow instructions in B-770, Filing an Overpayment Referral, for submitting a referral using either ASOIG or the TIERS referral interface.

 

B—940 Texas Works (TW) Responsibilities

Revision 15-4; Effective October 1, 2015

 

All Programs

TW staff:

  • identify potential fraud or IPV;
  • submit fraud or IPV referrals, using ASOIG or the TIERS referral interface, within 30 days of the date the IPV is identified;
  • process fair hearing requests related to claims or collections following instructions in B-1035, Appeals Related to Accounts Receivable Tracking System (ARTS), in TIERS;
  • forward any payments received in the local office to:
     

    Texas Health and Human Services Commission
    Fiscal Management Services
    ARTS Billing
    P.O. Box 149055
    Austin, TX 78714-9055

  • refer questions regarding collections on established claims to Fiscal Management Services (FMS);

    Note: The FMS hotline number is 1-800-666-8531. ARTS is administered by FMS staff who monitor and process payments from HHSC claims.
  • report fraud and/or violations of SNAP rules by drug addict/alcohol treatment centers and group living arrangement facilities by emailing Form H1095, Treatment Facility Fraud Referral, along with Form H1096, Notification Letter, and if applicable, Form H1853, Documentation of Findings for Form H1852, to OIG General Investigations at OIG_GI@hhsc.state.tx.us; and
  • report retail stores allowing unauthorized purchases and accepting benefits for previous purchase to Lone Star Business Services at LoneStar@hhsc.state.tx.us.

 

B—941 Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification

Revision 15-4; Effective October 1, 2015

 

SNAP

When out-of-state SNAP IPV disqualification data from the SNAP federal Electronic Disqualified Recipient System (eDRS) is identified on Data Broker, the advisor must discuss the IPV with the member to determine whether the member agrees with or disputes the information. The advisor must complete as much of the application process as possible and dispose the application for other programs if applicable; however, the advisor must follow procedures below for SNAP. Exception: This policy does not impact SNAP Combined Application Project (SNAP-CAP) or SNAP Supplemental Security Income (SNAP-SSI) Eligibility Determination Groups (EDGs) administered by Centralized Benefit Services (CBS), with one exception in SNAP-CAP as described in B-475.2.1, Identifying Intentional Program Violations (IPVs) and Felony Drug Convictions.

Procedures When Data Broker Identifies an eDRS Match

 

If the situation is ... then ...
  1. an expedited SNAP application, and the household does not dispute the IPV data,

the advisor must:

  • complete Form H1856, SNAP Out-of-State Intentional Program Violations, indicating it is for an expedited application;
  • send a copy for imaging;
  • email the form using secure Voltage to Customer Care Center (CCC)-eDRS eligibility staff at HHSC OES CCC IC, indicating Expedited in the email subject line; and
  • document this action in case comments.

CCC-eDRS staff will review the form for accuracy and forward it immediately to OIG-Central Disqualification Unit (CDU) at CDU@hhsc.state.tx.us.

If the email is received by 4:30 p.m. Central Standard Time, OIG-CDU staff will take action the same day to enter the IPV disqualification data from Form H1856 into TIERS, create a reported change task to notify the advisor to complete and dispose the SNAP EDG, and also email notice of this to the advisor. Exception: Out-of-state IPVs with non-standard penalty periods are noted on Data Broker and require secondary verification as described in Box D.

  1. an expedited SNAP application, and the household disputes the IPV disqualification,

the advisor must:

  • postpone verification of the IPV penalty and certify the application without the penalty;
  • complete Form H1856, indicating it is for an expedited application;
  • send a copy for imaging;
  • email Form H1856 using secure Voltage to CCC-eDRS eligibility staff at HHSC OES CCC IC to obtain secondary verification of the out-of-state IPV data; and
  • document this action in case comments.

If the out-of-state IPV verification is:

  • received by the final due date, the CCC-eDRS advisor forwards Form H1856 to OIG, who will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify the local office advisor to complete and dispose the SNAP EDG.
  • not received by the final due date, the local office advisor must dispose the application without imposing the IPV disqualification.

When the secondary verification is subsequently received, the CCC-eDRS advisor forwards Form H1856 to OIG-CDU staff at CDU@hhsc.state.tx.us, who will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify CCC to dispose the penalty as a change and create an overpayment claim referral back to OIG.

  1. a SNAP non-expedited application, household addition or redetermination,

the advisor must discuss the out-of-state IPV disqualification with the household to confirm the IPV data if possible. If the household does not dispute the IPV data, the advisor must:

  • complete Form H1856,
  • send a copy for imaging,
  • email Form H1856 using secure Voltage to CCC-eDRS eligibility staff at HHSC OES CCC IC, and
  • document this action in case comments.

CCC-eDRS staff will review the form for accuracy and forward it immediately to OIG-CDU at CDU@hhsc.state.tx.us.

OIG-CDU staff will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify the advisor to complete and dispose the EDG. Exception: Out-of-state IPVs with non-standard penalty periods are noted on Data Broker and require secondary verification as described in Box D.

If not possible to contact the household or the household disputes the IPV, then the advisor must:

  • manually pend the SNAP EDG action until the final due date for CCC-eDRS staff to complete secondary verification,
  • complete Form H1856,
  • send a copy for imaging,
  • email Form H1856 using secure Voltage to CCC-eDRS staff at HHSC OES CCC IC for a secondary verification as described above, and
  • document this action in case comments.

If the secondary verification is not received and OIG has not entered the IPV disqualification by the:

  • final due date on an application or redetermination, process it without imposing the IPV disqualification.
  • 20th day after sending Form H1856 on a requested household addition, process the change without imposing the IPV disqualification.

When the CCC-eDRS advisor subsequently receives the out-of-state IPV verification, the CCC-eDRS advisor forwards it to OIG. OIG-CDU staff will enter the IPV disqualification data from Form H1856 into TIERS and create a reported change task to notify the advisor to dispose the EDG and create an overpayment claim referral back to OIG.

  1. the IPV data on a Data Broker report is marked as “non-standard” (i.e., the penalty period listed is not a standard length),

the advisor must:

  • manually pend the SNAP EDG action until the final due date for CCC-eDRS staff to complete secondary verification,
  • complete Form H1856,
  • send a copy for imaging,
  • email Form H1856 using secure Voltage to CCC-eDRS eligibility staff at HHSC OES CCC IC to obtain secondary verification of the IPV before imposing the disqualification in Texas, and
  • document this action in case comments.

Note: Postpone verification if expedited. If not expedited, process the application as explained in Box C.

Note: If the individual is not active on a SNAP EDG or the application has already been denied, OIG will enter this out-of-state IPV data into TIERS since the individual is known to TIERS. No advisor action is required in this situation.

 

B—942 Disqualifying a Household Member with a Current TANF Out-of-State IPV Disqualification

Revision 15-4; Effective October 1, 2015

 

TANF

When the advisor discovers that an individual has an out-of-state TANF IPV disqualification, the advisor must discuss the IPV with the individual to determine whether the individual disputes the information.

If the household does not dispute the IPV data … the advisor must …

 

  • complete as much of the application process as possible and dispose the application for other programs if applicable,
  • pend the TANF EDG until OIG notifies the advisor to complete and dispose the EDG, and
  • send a secure email referral to OIG-CDU staff at CDU@hhsc.state.tx.us containing the following information:

    Subject: TANF Out-of-State IPV

    Out-of-state IPV information:

    • TANF EDG number
    • Originating state where IPV occurred
    • Disqualified individual's:
      • Name
      • Social Security number (SSN)
      • Date of birth (DOB)
    • Client number in originating state
    • Number of disqualified months
    • Disqualified begin date
    • Disqualified end date
    • Offense occurrence
    • Offense description
    • Federal or state court or administrative hearing decision date

Document the IPV information and the email sent to OIG in TIERS Case Comments.

OIG-CDU staff will enter the IPV disqualification data from the email into TIERS and create a reported change task to notify the advisor to complete and dispose the EDG.

If unable to contact the household or the household disputes the IPV data … the advisor must …

 

  • complete as much of the application process as possible and dispose the application for other programs if applicable,
  • pend the TANF EDG until OIG notifies the advisor to complete and dispose the EDG*, and
  • send a secure email referral to CCC-eDRS staff at HHSC OES CCC IC containing the following information:

    Subject: TANF Out-of-State IPV – Pending Secondary Verification

    Out-of-state IPV information:
    • TANF EDG number
    • Originating state where IPV occurred
    • Disqualified individual's:
      • Name
      • SSN
      • DOB
    • Client number in originating state
    • Number of disqualified months
    • Disqualified begin date
    • Disqualified end date
    • Offense occurrence
    • Offense description
    • Federal or state court or administrative hearing decision date
    • Whether the individual was/wasn’t contacted
    • If the individual disputes the IPV, details regarding why the claim is disputed

      Document the IPV information and the email sent to CCC-eDRS in TIERS Case Comments.

      CCC-eDRS staff will obtain secondary verification of the IPV and immediately forward the secondary verification to OIG. OIG will enter the IPV information into TIERS.

      * If OIG has not entered the IPV disqualification by the final due date, process the application or redetermination without imposing the IPV disqualification.

 

B—943 Expiration of an IPV Disqualification Penalty

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

Once the IPV disqualification penalty begins, it continues even when benefits expire or the EDG is denied. If the person reapplies for benefits, advisors must ensure that the person has served the IPV disqualification penalty before certifying the person for benefits.

Example: A person reapplies for TANF and SNAP on April 4, 2011, for herself and her three children.

The advisor checks the person's IPV disqualification status by viewing the person's Individual-Summary using the hover menu IPV Sanctions page. The person was found guilty of committing an IPV offense on February 4, 2011, resulting in a 12-month SNAP IPV disqualification beginning March 1, 2011, through February 28, 2012. Since the disqualification period has not expired, the advisor must continue the person's disqualification.

Notes:

  • Form OIG5042, Notice of Disqualification Enforcement, may be viewed under Case Data Search.
  • To determine eligibility for the remaining household members, advisors use the budgeting procedures in:
    • A-1362.2, TANF — Budgeting for a Household Member Disqualified for Noncompliance with SSN, TPR, Failure to Timely Report a Certified Child's Temporary Absence, Intentional Program Violation, Being a Fugitive or a Felony Drug Conviction; and
    • A-1362.4, SNAP — Budgeting for Persons Disqualified for Intentional Program Violations, SNAP Employment Services Noncompliances, Felony Drug Convictions or Being a Fugitive.

 

B—944 Reinstatement of an IPV Disqualified Person

Revision 14-1; Effective January 1, 2014

 

TANF and SNAP

When the IPV disqualification penalty period expires on an active EDG, TIERS automatically adds the formerly IPV disqualified person to the household and adjusts benefits accordingly.

 

B—945 Request for New Administrative Disqualification Hearing (ADH)

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

When a person disqualified for an IPV contacts the local office and claims that the individual did not receive an ADH notice and requests a new hearing, staff must notify the Office of Social Services (OSS) – Eligibility Services Support (ESS) Centralized Representation Unit (CRU). CRU coordinates with OIG in processing new ADH requests.

Staff provide CRU the following information:

  • person's name,
  • EDG number,
  • date of disqualification, and
  • status of the person's EDG (active, denied, pending).

Note: If the ADH officer grants a person's request for a new hearing, the CDU:

  • removes the IPV disqualification, and
  • contacts Texas Works to re-run the budget to allow for the person’s continued benefits pending the new ADH.

 

B—950 OIG Responsibilities

Revision 15-4; Effective October 1, 2015

 

All Programs

OIG General Investigations is organized as follows:

  • State Office Operations Unit,
  • Central Disqualification Unit,
  • Claims Investigations (CI) units, and
  • Field Investigations (FI) units.

OIG staff:

  • review allegations of HHSC benefit program recipient fraud, including employee fraud as well as recipient and/or retailer EBT trafficking fraud;
  • investigate allegations of recipient and/or employee fraud to determine whether fraud exists and, if applicable, the amount of an overpayment;
  • establish fraud claims through the Fiscal Management Services Accounts Receivable Tracking System;
  • coordinate with the HHSC Fair and Fraud Hearings Division for investigations submitted for ADH;
  • coordinate with the local district attorney office for investigations submitted for prosecution;
  • coordinate with U.S. Department of Agriculture (USDA) EBT trafficking investigations;
  • dispose investigations based on the results of either prosecution or ADH;
  • impose an IPV disqualification penalty, if applicable; and
  • coordinate with the HHSC-OSS – Eligibility Operations CCC to adjust active HHSC program benefit amounts, if appropriate.

 

B—951 Facts Do Not Support an IPV

Revision 15-4; Effective October 1, 2015

 

All Programs

The facts do not support an IPV when:

  • OIG staff review and determine that the facts do not support the allegation,
  • a court determines the person is not guilty, or
  • an ADH hearing officer determines that no IPV was committed.

OIG staff may process these claims as inadvertent household errors/misunderstandings.

 

B—952 Facts Support an IPV

Revision 15-4; Effective October 1, 2015

 

All Programs

When OIG determines that the facts support an IPV allegation, OIG submits the case to either the:

  • local district attorney for prosecution, or
  • Fair and Fraud Hearings Division for an ADH.

Note: A person may waive the right to an ADH by signing Form OIG5040, which allows OIG to establish a fraud claim and impose an IPV disqualification.

 

B—953 Enforcement of IPV Disqualification

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

OIG-CDU staff enforce the IPV Disqualification and associated disqualification penalty.

 

B—953.1 Notice of an IPV Disqualification

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

CDU staff receive the following notices that a household member has been disqualified due to an IPV:

  • Form H1856, SNAP Out-of-State Intentional Program Violations. TW staff submit this form to CDU upon discovery of a person's current IPV disqualification that was administered by another state. See B-941, Disqualifying a Household Member with a Current SNAP Out-of-State IPV Disqualification, for directions.
  • Form OIG5038, Notice of Disqualification Decision. OIG staff submit this form to CDU indicating when a court finds a person guilty of an IPV, or a court defers adjudication and the person voluntarily signs Form OIG5036, Disqualification Consent Agreement.
  • Form OIG5040/5040S, Waiver of Disqualification Hearing. OIG staff submit this form to CDU indicating when a person waives the right to an ADH.
  • Form H4857, Notice of Decision, Administrative Disqualification Hearing. ADH hearing officers submit this form to CDU indicating the ADH decision that a person committed an IPV.

 

B—953.2 Imposing an IPV Disqualification

Revision 15-4; Effective October 1, 2015

 

TANF and SNAP

CDU staff has primary responsibility for enforcing IPV disqualifications upon receipt of:

  • Form H1856, SNAP Out-of State Intentional Program Violations;
  • Form OIG5040, Waiver of Disqualification Hearing, signed by the person;
  • Form H4857, Notice of Decision, Administrative Disqualification Hearing; or
  • Form OIG5038, Notice of Disqualification Decision.

CDU imposes the IPV disqualification penalty:

  • by the court-specified date (as indicated on Form OIG5038);
  • within 45 days of the court disqualification decision date (as indicated on Form OIG5038) if the court did not specify a disqualification date;
  • within 45 days of the date the person signs Form OIG5036, Disqualification Consent Agreement;
  • the first month after the date the local OIG office receives a signed Form OIG5040; or
  • the month after the date the person receives Form H4857.

CDU enters the IPV disqualification details in the disqualified individual's IPV Sanction screen and:

  • sends an email request to the OSS - Eligibility Operations CCC to rebudget the household's future SNAP EDG benefit amount when the interface record exceptions out of a mass update or the IPV was manually entered by OIG staff; and
  • sends Form OIG5042, Notice of Disqualification Enforcement, notifying:
    • the household of:
      1. the begin and end dates of the IPV disqualification penalty period; and
      2. its new benefit amount (if applicable); and
    • TW staff of the enforcement of the IPV disqualification penalty.

When an IPV disqualification is not imposed in a timely manner, CDU staff initiate an overpayment referral to establish an agency error overpayment claim for any months the household received benefits to which it was not entitled.

 

B—953.3 Amendment of IPV Disqualification Penalties

Revision 15-4; Effective October 1, 2015

 

All Programs

CDU staff are authorized to modify IPV disqualification information if applicable. TW staff should contact CDU if TW staff believe IPV information is incorrect. CDU will research and respond to the problem.

 

B—960 Fiscal Management Services (FMS) Responsibilities

Revision 11-4; Effective October 1, 2011

 

 

B—961 IPV Claim Collection

Revision 15-4; Effective October 1, 2015

 

All Programs

FMS establishes repayment agreements and collects on IPV claims including court-deferred adjudications.

TANF

When the person fails to comply with its repayment agreement, FMS initiates recoupment at 10 percent of the household's recognizable needs.

SNAP

When the person fails to comply with its repayment agreement, FMS initiates recoupment at 20 percent of the household's allotment or $10, whichever is greater. When a current household member is disqualified for an IPV, recoupment is computed using the allotment the household would receive if the disqualified member were included in the household size.

 

B—970 HHSC Employee Fraud

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff are responsible for reporting allegations of fraud involving HHSC benefit program certification procedures by HHSC employees to the unit supervisor. The supervisor forwards the report to the program manager.

Program managers report serious violations of HHSC employee fraud to the OIG director of general investigations at 512-491-2823.

Note: Allegations of employee fraud reported by email must be reported using an electronically secure mode.

 

B—980 Documentation Requirements

Revision 15-4; Effective October 1, 2015

 

All Programs

Staff must document the reason(s) for creating a fraud or IPV referral in the case comments.

Note: If the reason contains confidential information and/or the person making the allegation requests to remain anonymous, the referral must be submitted using ASOIG. Any supporting information and/or evidence should be attached to the referral using ASOIG. The TIERS referral interface does not allow for attachments. Staff must follow instructions in B-771, Filing an Overpayment Referral Using Automated System for the Office of Inspector General (ASOIG).

Related Policy
Documentation, C-940
The Texas Works Documentation Guide