RD518 - Report on Data Matches, Fraud Prevention, and Application Processing - December 2016


Executive Summary:
Section § 63.2-503 of the Code of Virginia requires the local director of each local department of social services to conduct an investigation to determine the correctness and completeness of every application for public assistance. In conducting such an investigation, the local director shall ascertain all of the facts supporting the application to determine whether the individual is eligible to receive assistance.

During the 2015 session of the Virginia General Assembly, passage of House Bill 1918 clarified the responsibilities oflocal departments of social services by specifying the steps and information that must be verified in determining and renewing eligibility for public assistance. In determining eligibility, the Department of Social Services has interfaces with a number of other public and private data bases which are used by local departments of social services to determine eligibility for assistance.

Currently, there are 15 data bases that local eligibility workers may access when determining eligibility for assistance. Some system matches are automatic, meaning the Department's automated eligibility systems, the Application Benefit Delivery Automation Project (ADAPT) and the Virginia Case Management System (VaCMS) automatically send queries to other systems to verify statements the applicant has made. The Department's third eligibility system, the Energy Assistance System (EAS), does not conduct automatic data matches. For information from other systems, the eligibility worker must request or "call" the service. Most of these requests are made through a system developed by the Department, Systems Partnering in a Demographic Repository (SPIDeR), a web-based application which benefits users by effectively facilitating communication between applications (systems). It allows local workers to access multiple systems from a single source.

In the second quarter of State Fiscal Year 2017, the Department will transition the Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP) and the Low-Income Home Energy Assistance Program (LIHEAP) from their respective systems (ADAPT and EAS) to the VaCMS, creating a single enterprise eligibility determination and case management system for the Medicaid, TANF, SNAP, LIHEAP and Child Care programs. In October 2016, LIHEAP was converted and all eligibility for the 2016-2017 fuel, crisis and cooling components ofLIHEAP will be determined in VaCMS. When TANF and SNAP are converted, it will be a major accomplishment, as never before has there been one integrated eligibility system for all of the Department's major public assistance programs. It will also get the Department off the UNISYS mainframe, resulting in a significant savings in transaction costs.

The Code of Virginia also requires local departments of social services to investigate allegations of public assistance fraud. Specifically, § 63.2-526 requires the establishment of a statewide fraud control program. Each local department of social services is required to have a fraud prevention and detection unit. These fraud units are responsible for:

(i) developing methods to prevent the fraudulent receipt of public assistance administered by the local board and (ii) investigating whether persons who receive public assistance through the local board are receiving it fraudulently. The fraud unit shall provide whatever assistance is necessary to attorneys for the Commonwealth in prosecuting cases involving fraud.

During State Fiscal Year 2016, these fraud units completed 16,241 allegations of fraudulent receipt of public assistance throughout the Commonwealth. Of those, 2,333 were founded and sent for prosecution or administrative disqualification (process for disqualifying an individual from receiving assistance).