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Issue Alert - 04-10-07

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Date:

Oct 21, 2004

Issue Summary:

Recipients and their Authorized Representatives can be found responsible for an Intentional Program Violation (IPV) by and Admininstrative Law Judge (ALJ) conducting an IPV or Debt Establishment Hearing

Persons Affected:

Individuals and their Authorized Representatives who may have been overpaid Medicaid or Childcare benefits.

For More Information:

Center for Civil Justice320 S. Washington, 2nd Floor Saginaw, MI 48607 (989) 755-3120, (800)724-7441 Fax: (989) 755-3558E-mail: info@ccj-mi.org


Background

Medicaid (MA), Child Development and Care Program (CDC)<BR> PAM 820

What's Happening?

For the Medicaid and Child Day Care programs, an IPV exists when the client or Authorized Representative (AR)
  • is found guilty of fraud by a court, or
  • signs an FIA-4350 and the prosecutor, herself or through the Office of Inspector General (OIG), authorizes recoupment in lieu of prosecution, or
  • is found responsible for the IPV by an administrative law judgeconducting an IPV or Debt Establishment Hearing.
Prior regulations did not allow for the finding of a Medicaid or CDC IPV by an Administrative Law Judge.

What Should Advocates Do?

Even though many suspected IPVs turn out to be simple mistakes, individuals accused of fraud are often afraid or embarrassed to seek help. If you work with individuals who receive Family Independence Program (FIP) benefits, Food Stamps, Child Day Care, State Emergency Relief or State Disability Assistance (SDA), talk with them about this issue. Explain that many suspected instances of fraud turn out to be simple mistakes and that it is important to seek legal advice if they or others they know are accused of fraud. <BR><BR>Even though the Office of Inspector General (OIG) may only request an administrative hearing in limited circumstances, clients referred to the OIG for a fraud investigation may still find themselves called in and pressured to sign disqualification and repay agreements. Individuals should NEVER SIGN ANYTHING without first seeking legal advice!<BR><BR>ยท If an individual you know receives a letter suspecting them of committing an Intentional Program Violation (fraud) and requesting their attendance at a meeting to discuss the suspected fraud, make sure that individual seeks legal advice BEFORE attending the meeting. If necessary, s/he should call and ask to postpone the meeting.

What Should Clients Do?

If you or someone you know receives a letter suspecting you of committing an Intentional Program Violation (fraud) SEEK LEGAL ADVICE. If the letter asks you to attend a meeting to discuss the alleged fraud, seek legal advice BEFORE attending the meeting. If necessary, you should call and ask to postpone the meeting. <BR><BR>Talk with other individuals you know about the importance of seeking legal advice if you are accused of fraud. Very often the suspected fraud turns out to be a mistake. People should not be embarrassed or afraid to get help.

Finding Help

Most legal aid and legal services offices handle these types of cases, and they do not charge a fee. You can locate the "free" legal services or legal aid office that serves your county on the Michigan LawHelp web site (http://MI.LawHelp.org) or look in the yellow pages under "attorneys" or call the toll-free lawyer referral number, (800) 968-0738.