CWES Overpayment & Underpayment - Suspected Fraud Overpayment

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

When fraud is suspected, a referral must be sent to the SIU via CalWIN. An overpayment claim may not be established based on suspected fraud.

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

• Conflicting information provided by the client or in the client’s record
• Community complaints
• Needs in excess of the amount received
• Referrals from EWs, SWs, or other persons who would have knowledge of the circumstances in the case.

Fraud Overpayment

In most instances, the EC will initiate a fraud referral without a determination of the dollar amount of the overpayment.

After an investigation and if the SIU establishes that fraud was committed in the receipt of supportive services, an overpayment calculation must be completed. A referral to Collections will be sent ONLY after the amount of the fraud overpayment has been calculated.

Refer to CWES Fraud Referrals - General.