Minnesota Program Integrity Efforts 2008 Statistical Report

Transcription

1 Minnesota Program Integrity Efforts 2008 Statistical Report Minnesota Department of Human Services Program Assessment and Integrity Division May 2009

2 This information is available in alternative formats to individuals with disabilities by calling us at (651) or (800) TTY users can call through Minnesota Relay at (800) For Speechto-Speech, call (877) For additional assistance with legal rights and protections for equal access to human services programs, contact our agency s ADA coordinator.

3 2008 Minnesota Program Integrity Efforts The Minnesota Department of Human Services Program Integrity Section and county agencies share responsibility for prevention and control of recipient fraud in most of the state s cash, child care, health care and food programs. These responsibilities fall into the following categories: County fraud control efforts that pursue investigations by addressing welfare fraud as a crime of theft, through state civil or criminal justice systems. County Fraud Prevention Investigation (FPI) programs that are funded through state grants and focus on preventing or reducing overpayments by denying, terminating or reducing benefits to ineligible applicants and recipients. A state fraud investigation program that focuses exclusively on health care enrollment fraud in the MinnesotaCare Program. State coordination, research and resolution of community fraud complaints, nationwide out-of-state program benefit verifications and Food Support disqualification matches. State and county collection efforts to recover benefits recipients were not eligible to receive. Highlights of these efforts are summarized in this report and the attached charts. Note that while most results are based on calendar year data, the FPI cost efficiency ratio is based on state fiscal year data. COUNTY FRAUD INVESTIGATION EFFORTS Investigations FPI and criminal fraud investigators completed 8,887 investigations in 2008, 5% fewer than last year. Between 2007 and 2008 the number of FPI investigations declined by 7% while the number of criminal investigations increased slightly. Programs Worked Ninety percent of the county investigative workload is in TANF, Food Support and Medical Assistance. Of the remaining 10 percent, slightly more than half of the work falls into the Other State Program category, the rest into Child Care. Seventy-six percent of all cases investigated in the counties include a federal food component, either stand alone Food Support or the MFIP food portion. Overpayments There were over $7.2 million in overpayments identified as a result of county fraud investigations, 2% more than in That total is about 13% less than the high set in 2005.

4 Though overpayments identified through investigations increased slightly from 2007, actual fraud claims established on MAXIS were $1.4 million, a decrease of 6% from Administrative Disqualification Hearings (ADH) The ADH process remains the primary method for resolving fraud cases statewide. There were 958 cases with successful ADH outcomes in 2008, the same as in Overpayments associated with ADH actions of $1,771,858 were slightly higher than 2007 and averaged $1,850 per action. Criminal Convictions/Pre-Trial Diversion In 2008, 169 criminal convictions were reported along with 46 instances of pretrial diversion. The total of 215 is comparable to totals over the past three years. The average overpayment on a criminal related action was $8,037, an increase from the 2007 average of $6,491. FPI Cost Avoidance and Overpayment Identification In the FPI program, Minnesota employs a three month standard of cost avoidance when a caseworker reduces or terminates benefits because of information from an investigation. More than $12.8 million in cost avoidance and overpayment dollars were identified in This includes ADH disqualifications. While substantial, it is a 10% decrease from last year. FPI Cost Efficiency Ratio The FPI cost-efficiency ratio is calculated by dividing the total of cost avoidance and identified overpayments by the cost of program administration. The result is the benefit accruing from every dollar spent on program administration. In 2008 the cost-efficiency ratio was $4.44, a slight decrease from The best ratio ($5.12) was posted in FPI Days Per Investigation In 2008, the average county FPI investigation took 8 days from the date of caseworker referral to the return of investigative findings to that worker. This turnaround time continues to be consistent with prior years. MINNESOTACARE INVESTIGATIONS In 2008, 1,253 MinnesotaCare investigations were completed that resulted in the identification of $520,714 in cost avoidance and overpayments from premium adjustments and terminations. Completed investigations were up significantly from the 2007 total of 448. However, the total of cost avoidance and overpayment dollars for 2008 was down from the 2007 total of $584,000. Though 2008 cost avoidance dollars were higher, a backlog of overpayment determinations resulted in a decline in reported overpayments for 2008.

5 COMPLAINT AND BENEFIT RESOLUTIONS In 2008, the process for evaluating state welfare fraud hotline complaints was changed from a paper to an electronic process. New data bases were developed for tracking and resolving both complaints and out of state benefit verifications requests. A total of 778 fraud hotline complaints were received and evaluated, with 315 of those complaints referred to counties as potential fraud and overpayment recovery issues. Other states requested 2,521 benefit verifications involving Minnesota recipients who moved out of state and were applying for benefits in that state. A monthly Food Support fraud disqualification match identified 55 clients in a fraud disqualification status from another state who failed to report that status while on assistance in Minnesota. RECOVERY EFFORTS The efforts of county and state collection workers complete the loop in maintaining the program integrity of state cash, child care, food and health care programs. Overpayments are identified through a variety of means including investigations, computerized matching and quality control findings. For an overpayment to be formally identified in the MFIP, Food Support and other cash programs, county staff create a claim on MAXIS, the state s computerized eligibility and claims system. Recovery Highlights and Trends In 2008, claims totaling $11.4 million were established in MAXIS, a six percent decrease from Over the last three years there has been a decline in the number of MFIP cash claims established while the number of Food Support claims established has increased. Recoveries for all programs totaled $10.9 million in 2008, about $570,000 more than collected in Total Food Support recoveries for 2008 were $6 million, an increase of 14 percent compared to This includes state recoveries through the Treasury Offset Program (TOP). o TOP intercepts federal payments and tax returns to recover Food Support debt. o In 2008, TOP recoveries were $2.6 million. o TOP collections for the 13 years Minnesota has participated in the program total $23.8 million. o State staff received an award from the United States Department of Agriculture for record 2008 TOP recoveries.

6 Of the 10.9 million recovered in 2008, county staff was responsible for the recovery of $3 million in MFIP cash, $2 million from other cash programs and $3.3 million in non-top Food Support recoveries. A claims review component of the Management Evaluation (ME) process continued in Six counties were selected from the 2008 ME schedule for a review of claims establishment and collections to identify both deficiencies and best practices. Attachments (2) Summary Data Charts of FPI and Fraud Control and Claims and Recoveries

7 For inquiries or comments contact: Brian Shields Program Assessment and Integrity Division 444 Lafayette Road North, P.O. Box St. Paul, MM (651) state.mn.us May 15, 2009

8 Selected FPI and Criminal Fraud Data Calendar Years 2005 to Completed FPI investigations Completed Fraud Control investigations Total investigations FPI cost avoidance $10,334,500 $10,105,257 $10,445,581 $9,422,709 Overpayments identified (FPI) Amount $3,256,735 $3,366,567 $3,774,504 $3,393,194 Overpayments identified (C) Amount $5,082,872 $4,582,459 $3,420,428 $3,848,668 Total overpayments identified Amount $8,339,607 $7,949,026 $7,194,932 $7,241,862 ADH waivers and upheld hearings (FPI) Amount $883,843 $1,119,459 $1,040,408 $886,908 ADH waivers and upheld hearings (C) Amount $1,168,104 $1,400,059 $716,365 $884,950 Total ADH waivers and upheld hearings Amount $2,051,947 $2,519,518 $1,756,773 $1,771,858 Pre-trial diversion Amount $359,121 $264,832 $213,023 $417,228 Convictions Amount $1,674,205 $1,213,794 $1,163,045 $1,310,829 Total criminal actions Amount $2,033,326 $1,478,626 $1,376,068 $1,728,057 Cost-Benefit ratio (FPI - state fiscal years) $5.12 $4.46 $4.53 $4.44 Days per investigation (FPI)

9 Selected Claims and Recovery Data Calendar Years 2005 to Amount of Claims Established Food Support (Includes MFIP Federal Food) $ 5,690,130 $ 5,803,398 $ 5,880,382 $ 6,446,068 MFIP Cash $ 4,990,939 $ 4,197,425 $ 3,456,540 $ 3,207,186 All Other MAXIS Programs $ 1,351,166 $ 1,415,303 $ 1,444,072 $ 1,773,984 Total $12,032,235 $11,416,127 $10,780,995 $11,427,239 Fraud Claims Established $ 2,791,443 $ 1,749,424 $ 1,507,356 $ 1,420,068 Dollar Amount Collected by State Food Support (Includes MFIP Federal Food) $ 4,841,037 $ 4,995,354 $ 5,263,700 $ 5,984,827 MFIP Cash $ 3,119,188 $ 3,230,242 $ 3,065,448 $ 2,993,956 All Other MAXIS Programs $ 2,450,123 $ 2,213,001 $ 2,009,418 $ 1,925,031 Total $10,410,349 $10,438,599 $10,338,568 $10,903,815 * TOP Recoveries $ 1,800,291 $ 1,839,503 $ 2,026,866 $ 2,574,437 * State staff administered TOP recoveries are also reflected in the Food Support - MFIP-Federal Food amounts. * Other MAXIS Programs Include DWP, GA, FGA, MSA & RCA