Fraud decisions

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  • #38672
    fionacowan
    Participant

    Hi – can anybody tell me who in their authority decides when an overpayment is fraud?

    We are trying to establish who does each part of the whole fraud machine and currently:

    Investigated – fraud team
    decided as fraud and calculated – team leader

    but.. there is a leaning towards splitting the fraud decision (team leader decides it’s fraud) from the actual calculation (processor creates the over.

    I don’t see how this can work – both would have to potentially go to court and the assessor who has created the over without considering itcould end up having to justify the calculation.

    Does anybody have procedures for this bit of the process, and wouldn’t mind sharing them?

    Thanks

    #109167
    Rob Hawes1
    Participant

    The problem is that Benefit teams create overpayments for the whole period where somebody’s circumstances are incorrect. Fraud teams don’t always want to take the whole of that overpayment to Court because they then have to prove that an offence has been committed over the whole of the period, which they don’t always want to do.

    Our Fraud team completes their investigation, provides the Benefits Team with the details and, if they only intend to prosecute in respect of part of the period, asks the Benefits Team to tell them how much of the overpayment has been created in respect of ‘x’ date to ‘y’ date. The Benefits Team then advises the customer of the full amount of the overpayment and Fraud take their case to Court attributing a specific amount to the alleged offence. It won’t always prevent the assessor having to go to Court to explain the calculation, but that would happen anyway and it oughtn’t be beyond an assessor to explain a calculation. It’s up to the Fraud team to prove the alleged offence occurred.

    #109174
    jamcon
    Participant

    I was under the impression an overpayment could only be classified as a fraudulent overpayment when a sanction has been applied to that overpayment i.e. caution, ad pen or prosecution, or the claimant has admitted the offence in an interview under caution. I can’t remember where I read that, I’m sure it was in a circular a year or two ago.

    #109176
    craigworc
    Participant

    [quote=jamcon]I was under the impression an overpayment could only be classified as a fraudulent overpayment when a sanction has been applied to that overpayment i.e. caution, ad pen or prosecution, or the claimant has admitted the offence in an interview under caution. I can’t remember where I read that, I’m sure it was in a circular a year or two ago.[/quote]

    This is my understanding as well. In these cases our fraud team notify the assessor that this is the case and only then is it classified as a frauulent overpayment.

    #109177
    Rob Hawes1
    Participant

    James and Craig are both right re the classification of an overpayment as ‘fraud’ only once a sanction has been applied, but it remains the case that Fraud teams don’t always want to present the full HB/CTB overpayment in Court as allegedly fraudulent. They prefer to say something along the lines of ‘the offence (either action or omission) happened at this point and this overpayment is the result of that offence’.

    #109178
    fionacowan
    Participant

    Is it in any reg or anything that once an iuc has been held and an offence admitted that the resulting overpayment is classified as fraud?

    We have had cases where, for example, the claimant has admitted to a non-dep for a period but the investigator has information and therefore recommends that there is a fraud overpayment for longer than the period of the admission. This is then passed to the benefits team to be calculated and it is the decision of the team leader what period the overpayment is for and how it is classified.

    Rob – i agree that any assessor should be well able to answer to a calculation, but who is making the decision to call the overpayment fraud, and who answers to that in court if the assessor is simply “doing what they are told”. I’m trying to understand why we might need another person/stage in there if the fraud investigator is maiking the decision that the faud has occured.

    cheers

    #109183
    Rob Hawes1
    Participant

    The definition of fraudulent overpayment is Reg 18(5) of the Income Related Benefits (Subsidy to Authorities) Order 1998. It was inserted wef 1/4/09 by SI 2481 of 2010.

    The fraud investigator suspects that a fraud has occurred. They provide the assessor with sufficient information to re-assess the claim and a determination is made that an overpayment has occurred, which is open to all the usual avenues for appeal. This must be coded as claimant error in the first instance if there has not been an admission/successful prosecution. I didn’t mean to suggest that an assessor simply stands up in Court and says they were doing what they were told to do. Obviously, they should be able to say that they’ve made a determination on the basis that new information has come to light and it’s caused a reduction in the benefit they were previously entitled to, which has been calculated in such and such a fashion.

    The real reason why you’re in Court is that you’re trying to prove that an offence has been committed and, in my opinion, it is up to the Fraud team to answer those questions. The overpayment will be the same whether or not it’s deemed to have come about as a result of fraud or not, if the information that the calculation was based on is accurate. It’s just that the subsidy coding will change if Fraud are successful in proving that an offence was committed.

    #109185
    fionacowan
    Participant

    thanks Rob – very helpful. just trying to analyse our overs and get my head round all the different bits so I’m probably not asking the right questions!

    cheers

    #109187
    Rob Hawes1
    Participant

    Hi Fiona,

    No worries, sorry if I wasn’t clear. There is, of course, another problem in that occasionally you come across Fraud staff who think that every payment of benefit is fraudulent in the first place. But that’s a different issue!

    #109588
    markg
    Participant

    G5/2009 deals with this:

    http://www.dwp.gov.uk/docs/g5-2009.pdf

    #112909
    BDC
    Participant

    Just found this and if OK can I ask Local Authorities about their procedures regarding asking Benefit officers to write out for further information/evidence after a case has been opened and being investigated by Fraud? Is it aceptable for the fraud officer to ask the benefit officer to write out for further info as this is seen as less intrusive means or would this be seen as entrapment?

    #112926
    Kevin D
    Participant

    If the LA follows the provisions of HBR 86, how can it be entrapment? That regulation plainly limits requests to info / evidence to what is reasonably required in order to determine entitlement. So long as the request is for THAT purpose, there is nothing wrong in the approach. What happens all too often is that either Investigators obtain info / evidence that isn’t handed on to the decision maker or, alternatively, don’t even try to obtain evidence that may produce a lower overpayment (e.g. underlying entitlement / diminution of capital etc).

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