Special Assistance SA-3410 RECIPIENT FRAUD

XII. AGENCY RESPONSIBILITY

A. Continue to Work with A/R

Regardless of what the board or its designee decides or what action is taken by the court, the agency must continue to work with the a/r. Promptly notify the a/r of any action taken in the case. If the a/r remains eligible, the case cannot be terminated just because fraud is suspected.

B. Agency Records

1. The agency must maintain records on the number of cases referred for investigation, the number of suspected fraud cases referred to the board, action taken to recover overpayments and the amounts recovered. (SA-3410 Figures 5 and 6 are suggested formats for maintaining agency records.)

2. The agency must keep in the record or separate fraud file, copies of all documentation, evidence and summaries for future reference.

3. Reporting Requirements and Forms

a. Complete a DSS-1656, Refund Receipt, when a Special Assistance (SA) recipient refunds an overpayment either by cash or personal check. Submit the DSS-1656 according to instructions in Section 3250 of the EIS Manual.

(1) Remit to:

Program Benefits Payment Section

2109 Mail Service Center

Raleigh, NC 27699-2109

b. Notify DMA Program Integrity of any possible Medicaid fraud. Refer to MA-2900, Recipient Fraud and Abuse Guidelines.