Health and Family Services Cabinet
OIG D.E.T.E.R Program Targets Fraud and Abuse in Family Support Programs
OIG, DCBS Anti-Fraud Program result in a Net $550,000 in Savings
The Cabinet for Health and Family Services’ Office of the Inspector General (OIG) announced today that its newly created D.E.T.E.R. (Determining Eligibility Through Extensive Review) program already has created a $550,000 in actual cost avoidance for Kentucky taxpayers. This adds up to a three-year projected savings in excess of $17.3 million, with a $9.9 million projected savings in the Medicaid program alone.
The program, a cooperative effort between the OIG and the Department for Community Based Services, is designed primarily to prevent the fraudulent issuance of welfare or public assistance benefits. OIG implemented D.E.T.E.R. in April 2005 and at this time targets Louisville, Daviess, Boone, Kenton and Campbell counties. The OIG plans to place investigators in additional locations this year, as well as develop a team of investigators that will rotate through different county offices across the state.
“As this program grows, we expect to see fewer and fewer instances of people making fraudulent claims to obtain family support benefits. Those who come to the cabinet intending to make a false or fraudulent application for public assistance benefits should do so knowing that OIG investigators are working behind the scenes to ensure applicants are not attempting to mislead DCBS workers during the application process,” said CHFS Inspector General Robert J. Benvenuti III. “The work of our D.E.T.E.R. investigators and family support staff is highly commendable. By preventing fraud on the front end, their efforts strengthen vital programs that impact the lives of thousands of Kentuckians truly in need of assistance.”
D.E.T.E.R. helps prevent and identify fraudulent receipt of public assistance benefits such as Medicaid, Food Stamps and Kentucky Transitional Assistance Program or welfare payments.
D.E.T.E.R. reduces on-going fraud; prevents claims that may be difficult to collect; identifies possible over-issuance of previous benefits; and refers such cases to OIG special investigators and other appropriate agencies for further investigation, establishment of claims, collection and prosecution.
Family support staff, a part of the Department for Community Based Services, makes referrals to D.E.T.E.R. based on cases that appear suspicious or incongruent. The cases can be pending, active cases or recertification cases.
D.E.T.E.R. revives a previous program, known as C.O.R.E. (Cooperative Review of Eligibility), a program set up between the OIG and DCBS on a contractual basis that had been canceled under the previous administration.
“One of the first things OIG staff asked of me was to work to re-establish the program. They told me it would be a slam dunk and the numbers speak for themselves,” said Benvenuti, who joined the cabinet in February 2004 under the Fletcher administration.
The program began March 2005 in Jefferson County; Kenton and Daviess counties were added later. An additional pilot site was added a few months ago, bringing in an investigator to cover Boone and Campbell counties.
Becky Bowling, who supervises the Jefferson County office, and Melissa Hayes, branch manager for D.E.T.E.R., administer the program. Other investigators include Connie Ferguson, Covington; Nickole Meade, Covington; Teresa Lowe, Louisville; and Olevia Clark, Owensboro.
“The success of the program is a direct result of our investigators and the family support staff members who make the referrals and take action on the cases,” said Hayes. “We are fortunate to have employees who are so dedicated to ensuring public assistance benefits are administered appropriately.”
Since its inception, D.E.T.E.R. has received 335 case referrals. Of those, 277 have been completed. To report fraud and abuse to the Inspector General, please call (800) 372-2970.