Intake Investigation Referrals (FRED)

Overview

The intake investigation referral process is known as Fraud Early Detection (FRED). Intake workers primarily use it; a continuing worker may also initiate a FRED referral in many circumstances. For example, the continuing worker should initiate a FRED referral if there are reasonable grounds for suspicion of fraud when adding a program to an existing case or restoring benefits when the client reapplies within one month of discontinuance.

The primary intent of the FRED program is to detect fraud before the applicant is granted any assistance (i.e., before it occurs). In addition, it is believed that FRED will reduce the number of overpayment/overissuance calculations and collections.

Referrals for early fraud investigations on Medi-Cal only cases at the point of Intake are not processed by the SIU investigative staff. Medi-Cal-only referrals are submitted using the Confidential Medi-Cal Complaint Form (MC 609). These referrals are processed by Investigators from the Department of Health Care Services (DHCS) Investigations Branch in Sacramento.

Refer to “Overpayment Rules,” pages 49-23 of the Medi-Cal handbook, for detailed information on the process for MC overpayments.

Prior to Referral

Prior to making a referral to FRED, the EW must refer to Pre-Referral Requirements, When to Refer, and Possible Criteria for FRED/General On-Going Fraud Referral. This ensures that the referral is appropriate based on reasonable suspicion and prevents erroneous referrals that are based solely on eligibility problems or administrative errors.

Time Frames

A referral to FRED should be made immediately and prior to completion of the application or prior to the granting of benefits. The SIU shall investigate these cases as a priority to resolve any questions of possible fraud in time for the county to complete the determination of eligibility within the time limits imposed by the particular program. The information concerning a referral to the SIU shall not be disclosed to any unauthorized persons. Investigators are to be allowed five (5) days from the receipt of the referral to complete a FRED investigation.

SIU will have three days (72 hours) to complete the FRED investigation if a client is eligible for CalWORKs Immediate Need (IN), Homeless Assistance (HA), CalFresh Expedited Service (ES), or Medi-Cal Immediate Need (client is pregnant or needs immediate medical care). It is not intended that a FRED referral delay the eligibility determination process. However, a one- to two-day delay in approving and issuing benefits may occur in certain situations, subject to approval by the EW Supervisor or manager.

Initiating A Referral

There are two methods that may be used to initiate a FRED referral.

If the referral is for... . Then the EW must. . .
CalWORKs, General Assistance, IHSS, CalFresh, or Child Care
  • Make an online referral via the CalSAWS Special Referral Inventory subsystem.
    • Select the Special Investigations drop-down from the Special Units menu.
    • Refer to Chewable Bytes 2023-71 for detailed CalSAWS instructions.
  • Document in the case journal that a FRED referral was initiated.
Medi-Cal only,
  • Refer to [Refer to Chapter 38, Section 38.3 "Medi-Cal Fraud Referrals,” page 12]

Note: If the fraud investigator requires any additional information, they will contact the EW. The EW must take immediate action to comply with the Investigator’s request.

EW Action - Pending Investigations

After the referral for investigation is made, the Intake EW is expected to reply promptly to requests for case information from the Investigator and continue to take action as follows:

IF IT IS DETERMINED THAT: THEN...
The applicant is ineligible, and the investigation is still pending.
  • Deny the application, and
  • Inform the Investigator on the same day that the application has been denied.
Apparent eligibility for CalWORKs exists, and the applicant meets the specific requirements for Immediate Need (IN).
  • Issue an IN payment, and
  • Inform the Investigator of the IN issuance on the same day the IN is issued.
Apparent eligibility for CalWORKs exists, and the applicant meets the specific requirements for Homeless Assistance (HA).
  • Issue an HA payment, and
  • Inform the Investigator of the HA issuance on the same day the HA is issued.
Apparent eligibility for CalFresh exists, and the applicant meets the specific requirements for Expedited Services (ES).
  • Issue ES benefits, and
  • Inform the Investigator of the ES issuance on the same day the ES is issued.
Apparent eligibility for Medi-Cal exists, and the applicant meets the specific requirements for Immediate Need (pregnant or needs Medi-Cal within two days).
  • Issue a Benefits Identification Card (BIC), and
  • Inform the Investigator of the issuance on the same day the BIC is issued.


The Intake EW must immediately (i.e., no later than the close of that business day) inform the Investigator, either verbally or in writing, of any other case changes relevant to the investigation. For referrals, if the Investigator is unavailable, the EW must contact the SIU Justice System Clerk.

It is essential for the assigned EW to understand the role of the SIU Investigator. The Investigator's role is NOT to determine eligibility—that is the role of the assigned EW. The Investigator is responsible for confirming or denying the accuracy of the information provided by the applicant when applying for benefits.

Note: Eligibility determinations should not be delayed past the program processing timeframe due to a pending investigation. If the household has complied with all requirements, benefits must be approved without delay. 

Investigator Action - SIU

Upon receipt of the FRED referral, the SIU support staff will enter it into the SIU database and assign it an SIU case number. The Supervising Welfare Fraud Investigator (or designee) will assign the referral to a SIU Investigator.

Upon receipt of the FRED referral, the SIU Investigator will:

  1. Notify the EW that the referral has been assigned and ask if there is any change in the situation.
  2. Conduct an investigation to gather facts that prove or disprove the allegations.
  3. Inform the EW verbally of the findings of the investigation.
  4. Complete an investigation report with all information that supports their findings, within 7 working days.
    1. Email a copy of the report to the EW and cc the EW's supervisor.
    2. If the case has been transferred to the bank caseload, the SIU investigator emails the report to the office's priority email address. 

Investigator Action - DHCS

Upon receipt of the referral, the DHCS Investigator will:

  1. Conduct an investigation to gather facts that prove or disprove the allegations.
  2. Inform the EW via telephone call (within 10 days) of the results of their investigation.
  3. Send to the EW (within three days of the telephone call) the Investigator's Report with all information that supports their findings.
  4. Attach a “FRED Eligibility Action Report” to the Investigator's Report, for completion by the EW.

EW Action on Completed Investigations

Once the investigation is completed, a Fraud Referral Report (DEBS/IMB 574) will be sent to the client's assigned EW for action.

  1. Evaluate the investigation report as it affects case/person eligibility. Seek clarification from the Investigator, if needed.
  2. Review all eligibility factors.

  3. Attempt to resolve any inconsistencies resulting from the investigation that may affect eligibility/ineligibility.
    ExampleExample

    The client applies for CalWORKs on behalf of herself and her two children due to the absence of the children's father. The investigation places the unemployed father in the home. The EW shall contact the client and explore U-Parent deprivation.

  4. Take appropriate action to approve, deny, or discontinue the case or any ineligible person, and document the action taken in the case journal.
  5. Complete the SSA Action section of the SIU report regarding the actions taken on the case, and email this page back to the assigned investigator with the EW supervisor copied.
     
    1. For Medi-Cal only cases, complete the Confidential Medi-Cal Complaint Form (MC 609) and forward it to DHCS.
  6. Submit the completed investigation report for scanning following District Office procedures.
  7. Attach a copy of the investigation report to the Department of Child Support Services (DCSS) referral if the information is connected to the Absent Parent referral. If a DCSS referral has previously been made, send a copy of the Investigator's report to DCSS using the SSA/DCSS Communication Form (SCD 1603).

SIU Investigator Disagreement With EW Action

IF... THEN...
The SIU Investigator disagrees with the action taken by the EW. The SIU Investigator shall bring the issue to the Supervising Investigator for resolution.
The Supervising Investigator is unable to resolve the issue with the investigator.

The Supervising Investigator will discuss the issues:

  • First, with the EW Supervisor, and then
  • With the appropriate District Office Manager.