Mission Statement
The Investigations and Fraud Management division has the responsibility for conducting investigations of internal matters at the direction of the Inspector General and for conducting investigations of suspected fraud and abuse within the programs the Department administers.
What is Investigations and Fraud Management?
The Investigations and Fraud Management (IFM) division of the OIG has the responsibility for conducting general investigations of suspected recipient misrepresentation primarily in the Department's Income Maintenance and Social Services Programs.
IFM also has the responsibility for pursuing Supplemental Nutrition Assistance Program (formerly known as Food Stamps) and cash assistance repayments.
The IFM has three Units to carry out its duties and responsibilities:
- Criminal Investigations
- Front-End Fraud
- Claims and Collections
In addition to the three units, IFM also conducts intra-agency internal affairs investigations involving allegations of inappropriate employee activity, which might result in administrative (disciplinary) action or referral for criminal prosecution.
These internal affairs investigations are conducted at the request and approval of the Inspector General. All such investigations are of a highly sensitive nature. Every effort is made to maintain confidentiality and to protect the individual privacy rights of all potential investigative witnesses and suspects.
Criminal Investigations Unit
The Criminal Investigations Unit investigates allegations of suspected welfare fraud or other criminal activity involving recipients of Department of Human Services benefits or services.
Other special investigations may include complaints involving non-Medicaid providers, vendors or grantees who receive program-related benefits or financial payments for services from the Department of Health, Department of Human Services, or the Departments of Health Facilities.
Findings are compiled in detailed written investigative reports which are delivered to county prosecuting attorneys to evaluate for further action.
Front-End Fraud Unit
The Front-End Fraud Unit performs a more thorough, pre-certification review of applicant or recipient eligibility on cases meeting certain criteria. This unit is currently operational in twelve West Virginia counties.
This effort is supported by federal agencies providing related, matching funds as a highly effective means of preventing recipient abuse or fraud before it occurs.
Claims and Collections Unit
The Claims and Collections Unit is responsible for determining certain recipient benefit overpayment claims; negotiating appropriate repayment agreements; imposing any applicable program sanctions for violators; collecting the overpaid benefit amounts; and the ongoing monitoring as to the status of the Department of Human Services debtor claims.
REPORT RECIPIENT WELFARE FRAUD
- COMPLETE THE ONLINE REPORTING FORM
- Call the TIPLINE at (304) 558-1970
- Write us:
Investigations and Fraud Management
State Capitol Complex
Building 6, Room 817
Charleston, WV 25305
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