CWES Fraud Referrals - Overpayments As a Result of Fraud

A fraud referral to the SIU may be initiated by an EC or by another source (e.g., CalWORKs EW, APP, community complaint, etc...). Upon review of the fraud referral, the SIU Investigator may determine that an overpayment computation is necessary.

In most instances, the calculation of the overpayment will be made after the fraud has been substantiated. The SIU will access the overpayment computation information after it is made to Collections via the Client Referral subsystem in CalWIN.

The following table explains who will calculate the overpayment computation in these types of situations.

The following table describes the process for an overpayment computation as a result of a SIU determination to investigate fraud:

A. The EC or Other Source:

• Makes a fraud referral to the SIU. Refer to Initiating a Fraud Referral for details.

B. The SIU:

• Determines that a fraud investigation is appropriate.
• Forwards written instructions to the appropriate CWES Fraud Designee that an overpayment computation is necessary, based on findings.

C. The CWES Fraud Designee:

• Routes the SIU instructions to the appropriate EC as stated in prior table.

D. The EC:

• Computes the overpayment amount in CalWIN per the SIU’s written instructions for either a client or child provider overpayment. Refer to CWES Business Model 7.8.1.1 for more details.
• Generates the “Support Services Overpayment/Underpayment Notice” (WTW 11) or “Support Services Repayment Agreement” (WTW12), and completes the “Overpayment/Underpayment Computation” (SCD 1842C) for client overpayment or the “Child Care Provider Payment Notice” (SCD 1788) for provider overpayments. The overpayment notices provide the following information:
  • Reason for overpayment
  • Time-period of overpayment
  • Amount of overpayment
  • Computation.
• Initiates a referral to Collections in CalWIN. Refer to CWES Overpayment & Underpayment - Referral to Collections  for details.
• Forwards a copy of the overpayment notice (WTW 11 or SCD 1788) to IDM for scanning.

E. Collections:

• Receives the overpayment referral through the VACS/CalWIN interface.

Note: After the SIU has secured a conviction resulting from a fraud referral, Collections is contacted by the Probation Department for the overpayment balance(s) so that a specific restitution order can be made. Therefore, it is important that the CWES overpayment information be available to Collections.