OSI - Potential Fraud Referral Requirements
(01/01/23 – 12/31/23)
FAA may refer a participant for investigation when the participant is suspected of program violations and potential fraud exists.
Before submitting an Office of Special Investigations (OSI) Investigation Referral, determine whether the referral should be sent to OSI. Use the DBME Referral Guide for OIG (internal use only), found in the FAA Policy Support SharePoint Site Doc Library, to make this determination.
Referrals for investigation need to support an allegation of potential fraud. OSI does not conduct verification investigations. The verification process is to be used to verify mandatory eligibility factors.
Situations that do support a referral for investigation include, and are not limited to the following:
Frequent changes in budgetary unit, including people moving in and out.
A newborn child has an absent parent (AP) and the participant claims to have no information about the AP’s whereabouts.
Reported expenses consistently exceed stated income (See Expenses Exceed Income (EEI)).
The accuracy or validity of the participant’s residential or mailing address is questionable.
There are inconsistencies between the current application and the information in case file(g) that cannot be resolved by the FAA staff.
The participant’s verbal or written statements are contradictory.
When a QC-100 review indicates potential fraud exists.
When 10% of cash assistance usage has occurred out of state within the past six months. ( See Cash Assistance Out of State Usage Procedures.)
When excessive EBT card replacement occurs (See EBT/NA Replacement Cards)
Situations that do not support a referral for investigation, include and are not limited to the following:
Medical Only (MAO) Cases: Do not submit referrals for cases that are active MAO, without any other open programs.
Closed cases: Refrain from submitting referrals for cases that have already been closed, except in cases where there is a potential for overpayment.
Single-person homeless cases with a PO Box: Do not refer cases involving individuals who are homeless and have listed a PO Box as their address.
Request to establish paternity: Do not submit referrals solely for requests to establish paternity.
Request to check household preparation: Refrain from making referrals for cases where the primary concern is checking when households purchase and prepare meals together.
Situations not affecting benefit eligibility: Avoid submitting referrals for situations that do not directly impact the eligibility for benefits or that do not involve potential fraud.
Not for verification purposes: Do not rely on the Office of Special Investigations (OSI) to verify information already known or reported to the program such as income, expenses, or budgetary unit composition.
Submit the OSI Investigation Referral via the DES Intranet when evidence of potential fraud exists and any of the following apply:
CA only case
NA only case
Case involves more than one program.
(See OSI Investigation Referral for instruction on completing the referral form)