May 9, 2019
The Office for Family Independence determines eligibility for three major public assistance programs: MaineCare, the Supplemental Nutrition Assistance Program (SNAP), and Temporary Assistance for Needy Families (TANF).
An important piece of the administration of these services is ensuring program integrity. OFI has a Fraud Investigation and Recovery Unit (FIRU) that conducts a variety of activities that help ensure accurate and appropriate administration of benefits. It starts with referrals from people who suspect inappropriate usage of benefits and report by either calling a tip line or filling out an online form. All referrals are tracked in an electronic system and a case review is completed. Reviews that find a credible concern are then pursued by investigators who build cases that are submitted to the Attorney General's office for resolution.
Other activities that FIRU conducts to ensure responsible stewardship of benefits are review and referrals of erroneous benefit payments to participants. A team of eligibility specialists looks into payment errors that are referred by regional staff, to determine if the error was our own, an unintentional client error, or an intentional program violation. In all scenarios, the payment error is corrected, but intentional program violations are then handled by FIRU investigators.
The FIRU uses a variety of technology tools to assist with investigations and gather analytics that can help predict and detect fraudulent activities. This team also participates in annual conferences sponsored by the federal government, such as the Food and Nutrition Services (FNS) agency that oversees the Supplemental Nutrition Assistance Program. These conferences keep Maine current and provide opportunities to learn new ways to detect trends and prevent fraud. A most recent takeaway from conference participation lead Maine FIRU to apply for an FNS grant that would provide funding for new fraud-detection software and a data analyst to further improve predictive analytics. FIRU also frequently collaborates with the federal FNS program integrity unit on retailer fraud investigations. One of the most common forms of SNAP fraud involves a recipient selling some or all of their electronic benefit card balance to a complicit retailer at a discount. FIRU spends many months building retailer fraud cases that lead to convictions and recovery of significant amounts of tax dollars, and shares information with FNS when they identify new trends in retail fraud in Maine.
Other areas in OFI also contribute to robust program integrity. The Program Integrity Unit conducts a multitude of daily, weekly, and monthly tasks, including review of death records from the Center for Disease Control and Prevention (CDC) and lottery winnings data from the Bureau of Alcoholic Beverages and Lottery Operations. A Quality Assurance team randomly samples food supplement cases to ensure timely and accurate benefit issuance and the collaborative Payment Error Rate Measurement unit between OFI and the Office of MaineCare Services (OMS) ensures correct MaineCare determinations and claims payment.
Behind all of these anti-fraud efforts are over 60 OFI staff committed to ensuring program integrity and appropriate stewardship of public assistance benefits in Maine.