RD536 - Data Matches, Fraud Prevention and Application Processing – December 2017

Executive Summary:

The Code of Virginia at §63 .2-503 requires the 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, House Bill 1918 was passed which clarified the responsibilities of the local departments of social services specifying the steps and information that must be verified in determining and renewing eligibility for public assistance. In determining eligibility, the Virginia Department of Social Services has interfaces with a number of other public and private databases which are used by local departments of social services to determine eligibility for assistance.

In the third quarter of State Fiscal Year 2017, the Department transitioned its eligibility determinations and case management from the Application Benefit Delivery Automation Project (ADAPT) system to the Virginia Case Management System (VaCMS); the Temporary Assistance for Needy Families (TANF), Medicaid, Supplemental Nutrition Assistance Program (SNAP), Low-Income Home Energy Assistance Program (LIHEAP), and the Child Care Program are now all housed in one enterprise system. This was a major accomplishment which allowed the Department to get off the UNISYS mainframe resulting in a significant savings in transaction costs.

Currently, there are 14 databases that local eligibility workers may access when determining eligibility for assistance; one additional database is currently not operational since the Department's conversion to the VaCMS. Some system matches are automatic, meaning the Department's automated eligibility systems, VaCMS, automatically send queries to these systems to verify statements made by the applicant/recipient. 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, the Systems Partnering in a Demographic Repository (SPIDeR), a web-based application which benefits its users by effectively facilitating communication between applications (systems). It allows local workers to access multiple systems from a single source.

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 2017, these fraud units completed 16,241 allegations of fraudulent receipt of public assistance throughout the Commonwealth; 2,333 were founded and sent for prosecution or administrative disqualification; a process for disqualifying an individual from receiving assistance.