Appendix D.3 Investigations

All reports of suspected fraudulent activity shall be investigated, as outlined in this procedure, by DVR staff or by CDLE leadership. The following steps are to be followed:

1. DVR staff suspecting fraud notifies their immediate supervisor in writing of their suspicions and the reasons for concern. They also notify the District Supervisor overseeing the office where the individual receives services.

a. The DVR Counselor, or other appropriate DVR staff, and the individual shall review and complete the DVR Fraud Claim form, informing them of the concern and the reason(s) fraud is suspected.

b. The DVR Counselor and individual shall review the Rights and Responsibilities form, Appendix D and the Fraud section of the Introduction to DVR’s Service Delivery Policy Manual, and DVR Fraud Procedures in detail.

c. Ask the individual to sign the DVR Fraud Claim form to indicate they have discussed the allegation of fraud and have been informed of their rights and responsibilities and DVR’s Fraud Procedures. The completed form (or documentation of the refusal to sign) shall be saved in the electronic service record.

2. The District Supervisor notifies the Regional Manager of the suspicion in writing and reviews the DVR Claim form. The Regional Manager notifies the Deputy for Field Services of the investigation in writing.

a. The DVR staff person or District Supervisor, in collaboration with the Regional Manager, estimates the value (i.e., loss to the DVR) of the suspected fraud based on the information available in the case record. A loss estimated to be less than $500 can be investigated by the local office in consultation with the Regional Manager and Deputy for Field Services.

b. Any loss estimated to be $500 or above is investigated by the Deputy for Field Services in coordination with the Finance and Operations Unit.

3. The investigation shall be documented using the DVR Fraud Investigation form. The completed form shall be saved in the electronic service record.

a. A final determination of fraud is made by DVR’s Finance and Operations Unit. If applicable, the amount owed to DVR will be determined and may include a calculation of state-purchased goods to be returned. All supporting documentation shall be sent to the DVR Finance and Operations Unit, to include:

i. DVR Fraud Claim form

ii. DVR Fraud Investigation form

iii. All associated authorizations and payment packets (e.g., authorizations, invoices, reports, Receipts of State-Purchased Goods, travel logs, etc.) supporting payments made on behalf of the individual and determined to be misused

iv. All documents considered during the investigation illustrating which goods or funds were misused or gained through misrepresentation

b. For investigations of fraud estimated to be less than $500, the District Supervisor, in consultation with the Regional Manager, will complete the investigation and make a recommendation as to whether the fraud is founded or unfounded. This recommendation, and the required supporting documentation, will be forwarded to the Finance and Operations Unit for final determination.

c. For investigations of fraud estimated to be $500 or more, the Finance and Operations Unit will complete the investigation and make a final determination of fraud.

d. The Finance and Operations Unit will notify the Deputy for Field Services and the Regional Manager of the final determination, including the amount owed/state-purchased goods to be returned.

4. Investigation results shall be documented in writing using the DVR Fraud Final Determination, Repayment, and Resolution form and indicate whether or not a violation has occurred. Investigation results shall be complete and documented before additional action can occur.

5. Services provided to applicants or eligible individuals shall not be suspended, reduced, or terminated during an investigation of fraud.

If DVR staff identify a misuse of funds or state-purchased goods with a cumulative value of less than $25 (e.g., an individual uses the balance of an authorization for books and supplies to purchase a soda or t-shirt at the school bookstore), the DVR Counselor shall notify the individual of the misuse of funds, counsel them on the appropriate use of state funds, and request that they pay the misused funds. The DVR Counselor shall document the situation and resolution on the DVR Fraud Claim Form, but no formal investigation shall be required. The form shall be saved in DVR’s electronic case management system and copied to the Finance and Operations Unit, along with any repayment of funds received.