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DJFS cracking down on fraud

January 18, 2014
By ROBERT A. DEFRANK - Times Leader Staff Writer , Times Leader

ST. CLAIRSVILLE The Department of Job and Family Services is cracking down on instances of fraud and overpayments.

Interim Director Lisa Fijalkowski, related the recent report from the state of the department's collection rate for the fourth quarter of 2013, when they collected $168,634 in medical collections, surpassing the next county in the state with $68,000 for the quarter.

"We work very hard here," she said, adding that the total collections for the year came to $499,000.

Article Photos

THE?BELMONT?County Department of Job and Family Services staff members are pictured checking into reports of fraud and overpayment.

"This results money back to Belmont County with our incentive money to $90,907.05. That's our incentive because when you collect money the state gives you a reward back."

She added that the state gives about 18 percent.

Joyce Bosold and Annette Witchey, case managers/fraud and recovery investigators, noted a typical investigation is 30-60 days. The process begins with the suspicions of a case manager, who reports the matter to investigators.

"They investigate either the fraud or any time we would be overpayed or anytime that a client would underpay us," said Fijalkowski. "Any unreported income one of our customers would have."

Fijalkowski noted the importance of cooperation among all staff to efficiently investigate all claims and see funds used appropriately.

"We make this to be a joint effort to be responsible with taxpayers' money and we want to make sure we have people that are eligible for assistance that receive the assistance they're eligible for, and anyone who wouldn't be eligible for assistance we want to make sure that they're not getting payments they're not entitled to," she said.

They said 2013 saw 175 fraud complaints investigated.

"Sometimes this involved food stamp trafficking. It could also involve someone working and not reporting it. It could involved household composition of who resides in the household. But to be successful in our department it takes a lot of combined working together," Bosold said, adding that Fijalkowski had served as their supervisor before taking on the chair of interim director. "The combined effort of all of us working together makes successful investigations. When some cases end up in court we've collected back. We have good relations with the prosecutor's office along with the sheriff's department and between all of us working together we're successful in being able to recoup tax dollars that are overissued."

Other instances of complaints include people forgetting to report they are working or forgetting to report a new resident in their home. Other issues involve an oversight by residents of nursing homes.

"It's sometimes not any fault of the person because they may have sold a house but now they're in excess resources," Bosold said. "It's always blatant fraud. Sometimes it's just a matter of circumstances, but we make every effort to make sure people are eligible for our assistance that they receive."

They noted that they have been getting more calls regarding food stamp trafficking.

Fijalkowski added that the agency makes every effort to handle issues within the agency rather than going to court.

"We've had really good success with that also," she said.

They ask that residents using their services be conscientious in reporting any household changes to their case manager.

A typical year sees a total recovery of $589,954 with different incentive percentages from the state.

In the immediate future, they will begin adjusting to new Medicaid system with OIS. By 2015 the system DJFS currently uses for food stamps and benefit recovery processes will be switched to the OIS system.

"Working here calls for multi-tasking and adjusting to change," said Fijalkowski. "Change is a part of our business. You've got to do the best that you can and follow the directives that the state gives us."

Fijalkowski added that the operations have continued smoothly despite layoffs and a shift to case banking.

The department can be reached at 1 800 494-1616

DeFrank can be reached at rdefrank@timesleaderonline.com

 
 

 

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