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Extraído del Informe Consolidado

Esta investigación fue publicada originalmente como parte de un informe consolidado más amplio que contiene múltiples investigaciones. Consulte el PDF consolidado para ver el documento completo.

Los Angeles County Grand Jury • 1992-1993

Review of the Processes for Detection & Prevention of Welfare Fraud in the Los Angeles

12 pages
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Findings 4 findings

F1
DPSS does not make full use of the IEVS abstracts to review and verify social security numbers, unreported wage earnings, and duplicate aid benefits during the application process. In addition, DPSS does not have a method for determining which applications for aid are approved without an IEVS Abstract or IEVS On- Line Printout. The IEVS Applicant System creates a history associated with the applicant's social security number. This history, called an Abstract, includes prior wage earnings, interest, dividends, and other welfare benefits received. Abstracts are generated automatically from the IEVS Applicant System once the applicant's name and social security number have been entered into the IEVS Applicant System. DPSS policy states that the Intake Eligibility Worker (Intake EW) is responsible for verifying and processing all Applicant System information received before the case is transferred to an Approved file. IEVS matches received after the case is approved must be processed by a second Eligibility Worker (Approved EW) who is responsible for verifying and processing all Applicant System information received after the case is transferred to an Approved file.3 DPSS policy 20-006 states that all IEVS information (i.e., Abstracts) received after aid has been approved must be processed within 30 days for AFDC and 45 days for GR.4 The Grand Jury's auditors found that there is no systematic method to confirm that an Intake or Approved EW verified and processed IEVS Applicant System information within the required 30- (AFDC) or 45- (GR) day timeframe as required by DPSS policy. The Department does not enforce its requirement that a PA 26-2 form be affixed to case files approved prior to the arrival of IEVS Applicant System information. Furthermore, even if this requirement were enforced, the Department has no procedure to ensure the Approved EW processes the IEVS Applicant System information. Without verification of IEVS match applicant information, DPSS cannot adequately detect and prevent fraud during the application process. Weaknesses in controls to ensure IEVS information is verified may be the reason for DPSS's very low number of cases suspected of fraud identified by the IEVS Applicant System. For example, between January and June of 1992 there were 419,796 applications for aid. Of these 3DPSS Operations Handbook, Division 20-006, Section III.E. *IB., 20-006 III-B. 30
F2
DPSS does not have management controls in place to prevent Eligibility Workers from bypassing the IEVS Applicant System in approving cases. In order to access the IEVS Applicant System to create a history of earnings, supplemental security income, assets, and prior welfare aid the EW completes a form called a face sheet. When the EW approves an application he/she must determine the amount of aid the applicant is eligible to receive by completing a form called an approved budget face sheet. If these face sheets are entered into the IEVS Applicant System simutaneously, IEVS will not provide any IEVS Applicant System information. This process is often called a "simulsub". DPSS does not have a procedure mandating when the approved budget face sheet should be entered into the Integrated Benefits Payment System (IBPS) and/or Case Data Management System (CDMS). Without such a procedure, the IEVS Applicant System fraud controls can be circumvented by submitting the applicant face sheet and the budget face sheet on the same day. For example, of the 20 GR and AFDC cases reviewed at the Metro East District office, we found three cases where the "simulsub" occurred. This means that the initial face sheet required to initiate the IEVS Applicant System information and the approved budget face sheet, authorizing the amount of aid to be granted, were entered simultaneously. As a result, no IEVS Applicant System information will be activated. In order for the IEVS Applicant System to produce an Abstract, the face sheets must be entered sequentially. The lack of a specific procedure mandating when the approved budget face sheet be submitted significantly weakens the Applicant/Intake fraud controls. DPSS Intake Eligibility Workers are not sufficiently trained on the use of WCMIS
F3
and IEVS as fraud prevention and detection systems. According to DPSS, training is provided to all newly hired Eligibility Workers (EWs). In addition, EWs receive training when they are transferred between an Intake assignment and an Approved assignment. Other than this induction and transition training, IEVS refresher training is provided by Staff Development at the Bureau/District's request for all classifications. During the period January 1990 through April 1993, Staff Development provided only 97 EWs (of approximately 3000 EWs) with refresher IEVS training. No refresher WCMIS training was provided during this period.5 5DPSS response to April 23, 1993, Price Waterhouse Questionnaire. In December 1991, the Los Angeles County Chief Administrative Office (CAO) recommended DPSS provide additional training to eligibility staff regarding fraud prevention and detection activities. The Grand Jury's auditors found no evidence that the CAO's recommendation has been implemented. Recipient Process В.
F4
GR cases unnecessarily delay prompt recovery of overpayments. DPSS policy requires an Eligibility Worker to send a Notice of Action (PA 2418) to a recipient when IFDS identifies a recipient who may be ineligible. The recipient is given 10 calendar days to respond or refute IFDS information before negative case action can be taken. If the recipient denies the IFDS information, an affidavit must be obtained from the recipient and an IFDS Employer Notification Letter (PA 2419) sent to the employer listed on the IFDS Abstract. Current instructions allow the IFDS EW to send the PA 2419 after the recipient denies all previous and current employment.14 As a result, DPSS may continue to issue overpayments while awaiting the employer's response. For GR cases, DPSS policy requires that two separate Notices of Action and two separate hearings may be required when IFDS information impacts an active case. DPSS is delaying prompt recovery of overpayments as well as affording the recipient multiple opportunities to appeal the factual basis of the overpayment, in spite of a recent audit completed by the Federal Department of Health & Human Services, which stated: "There is no Federal regulation to support the agency's practice of issuing two Notice of Actions, especially when it results in multiple hearings on the same issue and a delay in overpayment recovery."15 C. Management Process Management of DPSS has not developed an adequate plan to respond to the

Recommendations 11