Suspected Overpayment

Receipt of Information

When information in the case record, or other information received, indicates that there is the possibility that an overpayment may have occurred or is occurring, it is the responsibility of the EW to review the case and determine if eligibility was or is affected.

There are many indicators which the EW may observe or receive that cause the EW to suspect that there is an overpayment. These include, but are not limited to:

Conflicting information provided by the client or in the case record.
Community complaints.
Needs in excess of the amount of assistance received.
Referrals from CWES Workers, Social Workers, Child Support Officers, or other persons who would have knowledge of the circumstances in the case.

EW/Client Responsibility

It is the responsibility of the client to provide any required information to assist the EW in correctly determining eligibility for the AU. The EW must assist the client in obtaining any required information which is not in the possession of the client. This includes sending for items which verify the client's statements. The client must complete and sign the “Release of Information” (CSF 13) specifically noting the information required.

Use of the GEN 853

If clients are unable to provide documentation or verification of their statements, a “Sworn Statement” (GEN 853) may be taken.

When having the GEN 853 completed by the client, the EW must:

Insure that the client understands that the form is being completed under penalty of perjury.
Have the client provide the requested information in their own writing and using their own words to describe the facts.
Witness the client's completion of the form and the signature.
Sign the bottom of the form as the witness to the client's statement and signature.

If the GEN 853 is not completed in the presence of the EW, but is being filled out by another individual who is making a statement in support of the client's facts, the EW must request that the form be notarized. If this is not completed, it is not a valid affidavit.

Action Based on GEN 853

Based upon the recipient's statement on GEN 853, the EW must take appropriate action based on the following chart:

IF...	THEN...
The statement seems reasonable and there is no conflicting information,	No further action is needed.
The statement still does not clarify all the questions or does not seem reasonable,	Send a referral for fraud to the DA’s office via the Client Referral subsystem of Cal- WIN. The EW must weigh all available information and take appropriate action. The Journal Detail page must be thoroughly documented as to what action was taken and why.

Example 1

A community complaint is received stating that the recipient's child is not living with the family. The EW must contact the client to determine the validity of the claim. Any required supporting documentation must be obtained, including a “School Enrollment Verification and Release of Information” (CSF 37). Request that the school complete the student's address and return the completed form directly to the EW. If the child is not of school age, ask the client for the names of other persons, providers, or agencies who could verify the presence of the child in the home. A “Release of Information” (CSF 13) must be obtained prior to making an outside contact.

If the child is temporarily absent from the home, the pertinent information must be obtained and documented on the Journal Detail page as well as on the community complaint response form. In the absence of any other supporting documentation, the EW may use a GEN 853 which must be completed, signed and dated by the client and the EW.

Example 2

A community complaint is received stating that the fully employed father of children is in the home. The EW reviews the case record and determines that the basis of deprivation is absent parent. The EW must contact the client to determine the validity of the claim.

The EW may require that the client come in and complete another SAWS 2A and or new absent parent referral forms stating that she understands her reporting responsibilities. If the client completes a GEN 853, it should indicate where the father of the children is living and list all those living in her home.

If the father is not in the home, the client should add any appropriate statements which may have led to the conclusion that he lives there, such as “father visits children on weekend,” “father picks up children after school and stays until recipient gets home from work,” etc.
If the father is in the home, the EW needs to secure all required information to determine ongoing eligibility for the AU and take appropriate action.

Example 3

The recipient reports no income. Her children are in school from 9 a.m. to 2:30 p.m. Whenever EW tries to make contact by phone there is no answer and when an SCD 50 is sent, the recipient responds but can never come into office before 3:30. The client comes into the office to provide an explanation and has no verification other than her statement. The EW must secure a GEN 853 which indicates the recipient's work status, the last date worked if applicable, an explanation as to why recipient isn't available before 3:30; i.e., takes care of mother, volunteers at school, doesn't like to be home alone so visits friends until children get home.

Example 4

A “Request for Information from Employer” (SCD 549) is returned stating that the recipient left her job to take another position. The recipient previously stated that she quit because of child care problems.

If there is no evidence to the contrary, the EW must secure a GEN 853 indicating the recipient's work status and including an explanation of why the previous employer gave that information; (i.e., recipient had been offered another position but later discovered the position was not a shift she could work, or this is what she told her employer even though it was not true, or her employer was angry with her so he is providing incorrect information). If the SCD 549 indicates another employer's name or if the recipient gives that information, the EW should send an SCD 549 to that employer. Remember, the client must sign the SCD 549 or a specific release of information before the EW may contact the other employer.

Referral to the Special Investigations Unit (SIU)

General

When fraud is suspected, a referral must be sent to SIU using the Client Referral subsystem of CalSAWS. If there is doubt about the appropriateness of the referral the EW may discuss the case with the SIU liaison. The purpose of the SIU liaison is to give guidance and consultation in case situations in which the SIU is involved or may become involved. If the SIU is already involved, the EW must contact the assigned investigator.

If there has been a community complaint, any other documentation in the case record which substantiates the EW's suspicions should also be attached, as well as any which support the client's contentions.

Reminder: The Client Referral subsystem is only to be used to refer cases to the SIU when the EW suspects fraud may be occurring.