CWES Fraud Referrals - Fraud Indicators

The criteria listed in this section is intended to assist the EC in determining if a fraud referral is appropriate. If a fraud referral is questionable, the EC should consult with their supervisor. Although the criteria listed are not always an indication of fraud, the criteria should alert the EC to consider whether a referral may be necessary.

Indicators of fraud can be found at any point in time whether handling a case on a routine basis, determining eligibility for supportive services, reviewing attendance or payment records, or receiving a report from a member of the public.

Fraud referrals may be associated with payments made involving child care expenses, certain transportation costs, or work or training-related expenses. These may include, but are not limited to the following:

Child care payments made to the provider
Mileage and/or transportation payments made to the client
Ancillary expenses.

Child Care Fraud Indicators

Child care fraud may include, but is not limited to, a CalWORKs client or former CalWORKs client receiving or continuing to receive child care services they know they are not eligible for or no longer entitled to receive. Child care fraud may also involve a child care provider that is knowingly obtaining or receiving child care payments for services which they did not provide or are not entitled.

Below is a list of potential child care fraud indicators associated with clients and/or providers.

Client-Related

Client-related fraud indicators MAY be:

A client intentionally fails to report increased earnings knowing that those earnings will result in higher family fees or ineligibility.
A client intentionally fails to report changes in the hours he/she is engaged in CWES activities knowing that reporting changes will result in less hours of subsidized child care.
Client obtains child care when, in fact, the biological or adoptive parent is in the home and able to care for the child(ren), when the client knows such a person is obligated to provide care for the child(ren).
The tax deductions on pay stubs indicate married status for the client but client states they are single and the other parent is not available to care for children.
A client knowingly receives child care subsidies from two different sources for the same service.
A client receives cash aid fraudulently. (However, in such cases, child care eligibility needs to be reviewed separately.)
Client reports hours that are different than what provider reports.
Attendance in child care is irregular (agencies can limit the number of excused absences).
Client is consistently at home when they should be at work.
Hours claimed on attendance sheet are not authorized by CWES Worker or are not consistent with work schedule.
Client presents verification of residency, such as a rent receipt, lease or utility bill that appears to have been altered and/or written by the client.
Client presents ID document that appears to have been altered and/or does not appear authentic.
Client reports mailing address as post office box with no reasonable explanation.
Frequent address change for parent.
Previously employed client terminates employment but continues to receive child care benefits.
Parent incarcerated during a time when they were supposed to be working and claimed child care assistance.
Client is self-employed but has little or no business records to verify income.
Client previously on aid and parents separate when the cash aid case is discontinued due to employment of the primary wage earner.
Pay stubs are inconsistent with household composition, marital status, or income that client has previously reported.
Parent fails to provide proper documents to verify school enrollments and/or progress reports/grades.
Parent comes in to county welfare department office on a regular basis during the hours they are supposed to be working.

Provider-Related

Provider-related fraud indicators may be:

A provider submits time sheets for hours when child care services were not provided for the recipient’s child(ren).
Indication that provider has hours that are in conflict with times child care is being provided.
The EC telephones provider and provider is absent during times child care is being provided, and provider cannot furnish reasonable accounting of her time.
Provider has reported child care “operational” hours different than the times child care is actually being provided.
Indication that the provider has work/personal hours that are in conflict with the contractual hour, and there are no arrangements for providing care in their absence.
Provider reports excessive hours in one week or on an ongoing basis. Care provided for longer periods of time than recipient’s work or school schedule.
Check is being mailed to a third-party address.
Provider is attending a California community college during hours he/she is allegedly providing care.
Provider has work/school hours that are in conflict with time child care is being provided.
Provider charging CalWORKs clients more than other clients are charged. This refers to other unsubsidized clients or families.
Billing for days that are not contracted.
Provider incarcerated during a time when they were supposed to be providing care.
A community complaint is received that child care fraud is taking place.
A license-exempt provider is being paid for child care services that are actually being rendered by another individual on a regular basis.
Provider signs over child care checks to parent.
Provider submits supplemental billing statements on a regular basis.

Client/Provider-Related

Client/Provider-related fraud indicators MAY be:

The client and the child care provider are submitting time sheets for payment when child care services were not provided.
Neighbor or relative listed as providing child care when client has older child(ren) actually providing care.
Older child or relative denied as provider, and now the neighbor states they provide care. The neighbor is a “paper provider” (neighbor now shows as provider on paperwork), but care is actually done by older child or relative previously denied.
Billing statement(s) or parental sign in/out show evidence of having “white out” alterations, or photo copies are submitted, rather than the original documents.
Discrepancy between hours approved and hours claimed.
Child care billing statements are inconsistent with recipient’s work or school schedule.
Client and provider live 25 or more miles apart.
Two different clients claim they are providing child care for each other’s child(ren) but are actually only caring for their own.
Child has perfect attendance for a significant number of consecutive weeks, months, or days.
Parental sign-in/out sheet appears to have been completed in “one sitting”.
Provider and parent report living at same residence, but are not related.
Consistently late billing statements.
Someone other than the provider is calling regarding child care payments.
A complaint is received through a hot-line, or other reliable agency or source, that child care fraud is taking place.

What Is Not Child Care Fraud

The following are examples of what is not considered child care fraud:

A client continues to attend unapproved CWES activities and using child care services when the county has not sent a Notice of Action (NOA) informing the recipient that the activity is not or is no longer approved.
A client and a family member who is providing child care are sharing household expenses.
A license-exempt provider seeking the assistance of a relative or friend to care for the child(ren) during occasional appointments or to perform occasional tasks.
A provider submitting time sheets for care that was provided during time the client was not attending CWES activities when the provider was not notified that the care should cease.
A relative, such as a grandmother, being paid to provide child care for their relative’s child(ren). The only relative that is not authorized to be paid to provide care for a child is the child’s biological or adoptive parent or a stepparent who is part of the assistance unit.
When a licensed provider no longer has a valid license or a license-exempt provider is providing care for more than one family.
If a license-exempt provider has been providing child care while their TrustLine Registry application is being processed and TrustLine is denied.

Transportation-Related Fraud Indicators

Transportation-related fraud may include, but is not limited to, a CalWORKs client or former CalWORKs client receiving or continuing to receive transportation-related services that they know they are not eligible for or entitled to receive. Transportation-related fraud may also involve a repair shop that is knowingly obtaining or receiving payments for services which they did not provide or are not entitled.

Potential transportation-related fraud indicators may include:

Client receives a reimbursement for vehicle repairs that were not completed or done.
Client knowingly signs documents stating that the vehicle for which the repair request is being made is the only operational vehicle when in fact it is not.
Client submits altered or fraudulent documentation, receipts, or verification.
Client knowingly submits a vehicle repair request for alleged work that was never completed or done.
Client knowingly submits a vehicle repair request estimate for an amount that is higher than the actual costs of a repair.
Client knowingly uses vehicle repair monies for something other than the intended purpose.
Repair shop provides client with fraudulent receipts or estimates for work that was never completed.
Client is claiming mileage reimbursement but has not been driving the vehicle to an approved CWES activity or is not in an approved CWES activity.

Ancillary Expenses Fraud Indicators

Work or training-related expenses fraud may include, but is not limited to, a CalWORKs client or former CalWORKs client receiving or continuing to receive payments for work and training-related expenses that they know they are not eligible for or entitled to receive.

Potential work and training-related expense fraud indicators may include, but are not limited to the following:

Submitting a request for payment when not in an approved CWES activity or not attending an approved CWES activity.
Client uses monies paid for work or training-related expenses for something other than the intended purpose.