Terms & Conditions

[Anonymous]

I’m wondering if anyone is familiar with the regs concerning decisions made by Fraud Officers.

The case I have is that they originally sent a closure memo stating that it was fraud not proven. The claim was amended accordingly and o/p’s classified as Claimant error.

About a month later they sent another closure memo stating that it was Fraud Proven and that it was a joint investigation with the DWP. Can anyone tell me if they are allowed to do this? And can you give me an indication of the applicable regs for this?

Thanks
Pauline 😕

[seanosul]

For subsidy purposes you do not need to worry as there is no difference between fraud overpayments and claimant error overpayments. In the long run for purposes of recovery there may be a difference as if the Court agrees about the overpayment being classed as fraudulent the claimant cannot include that debt in bankruptcy.

[Anonymous]

Thanks I was just concerned that they have changed their decision without having any additional evidence.

If it goes to court and the benefit assessor has classified it as Fraud they may be asked to explain the reason for this and to be honest would struggle to answer as the Fraud Officer has given no explanation for it, other than that they were offered the opportunity to say it had been a joint investigation.

[peterdelamothe]

I have a few comments.

Firstly, as an aside, we at HBINFO have been identifying some of the key prosecution High court judgements and these will be going on the site soon.

On your case, it struck me that you amended the case on the basis of “fraud – unproven”. On what basis I wonder? If it is not proven then how can it be fraud and what legal basis did you have to revise / supercede the claim?

I am of the firm opinion that Fraud Officers should not make decisions on claims, issue “closure” notices etc. They are too close, however well meaning. Instead they should present the evidence to an experienced Officer who has to present or has experience of presenting to Tribunal. If that person is satisfied, then fine.

[Anonymous]

Just a thought, but couldn’t the difference be along the lines of

“Here’s a discrepancy we’ve uncovered, we can’t at the moment determine that the discrepancy was a deliberate attempt to obtain/increase benefit by deception so Fraud unproven”

After the joint investigation that initial advice may then be changed to Fraud proven if the claimant then goes “It’s a fair cop guv’nor”

Perhaps any investigators out there can advise ?

[Anonymous]

Fraud Officers in this case had been making investigations with various sources regarding the claimants undeclared partner.

During this time, benefit assessors received an end of entitlement from DWP due to her partner moving in. Fraud said that in light of the cessation of her entitlement prior to her being aware of any investigation the closed in fraud not proven.

The entitlement was superseded due to her partner moving in.

However, a couple of weeks later DWP contacted our Fraud Officers asking if they wanted to count it as a joint investigation and they said yes. And so sent benefit assessors a new closure memo stating Fraud proven.

Any thoughts??

[peterdelamothe]

“Fraud proven” is surely a matter for a jury or a judge?

Secondly, I still do not see why you “closed” the claim? Did you not suspend the case and ask for the new circs? What about underlying entitlement over the OP period? A partner moving in might affect HB/CTB entitlement but it might not.

[corran]

[quote:938dab163a=”peterdelamothe”]”Fraud proven” is surely a matter for a jury or a judge?
.[/quote:938dab163a]

If that was the case then there would not be any need for administrative cautions/penalties. These only given when there is “proven fraud” but it doesn’t go to judge or jury.

Fraud proven just relates to the fact there is the sufficient evidence to take the case to prosecution if necessary.

That said, only reason I could see the change in mind is if more information came to light (DWP provide more evidence or was there further investigation after that point, ie a new fraud case basically which covered the same period). If there was more information that came up and it could be used to prove fraudlent activity then there is not an issue with changing the decision (or rather changing the recommendation as it would be here as Senior officer has final say).

Look at it in this context. The police conduct an investigation into a crime, whether it theft/murder etc. They can not find any evidence that the person commited the crime and write of the line of investigation. However a month later they gather further information that can be used to prove the same persons involvment in the crime, they are not bound to stick by there previous assessment that the person had done anything wrong.

However as it was said there was no additional information then I am not sure about the change in decision unless something had been overlooked and only your fraud officers can tell you what changed their mind.

edit: All that said I do believe that it should not be classed as fraud until a successful sanction gets issued. Be it successful prosecution or acceptance of a caution/penalty

[Andy Shanks]

Our Fraud give is a report with all the info that they have discovered and a recomendation, this then goes to a senior officer who see’s if there is enough proof to make any revision/supersesion or termination. If there is not enough proof we send it back with a memo saying what is needed. If there is enough proof and we change the claim the senior officer notifies fraud with the outcome and the amounts and dates of any overpayment and that this overpayment has been classified as fraud. They can then go and do whatever they need to do [sanction, court, etc] and we wait for any evidence requested in the notification letter so u/e can be applied.
At no time should fraud be telling a benefits section the outcome on Hb or CTB of an investigation.
In the example the change in circs was not the result of investigation and so should go through the normal coc’s action, if fraud come back with more info then the whole situation has to be looked at again from the start based on the new proof.

OR am I missing something here and now appear a complete fool?

[Kevin D]

The only issue on which I’d diverge from Peter is the definition of “fraud”.

If there is deception intended to result in financial or personal gain, the dictionary definition is satisfied. However, for HB purposes, I thought that an overpayment could only be classified as “fraud” if there had been a successful prosecution, or a caution / adpen?

As for the other points raised by Peter, I think they are extremely pertinent. If the claim has not be lawfully superseded (you must have grounds), or terminated (claim must have been suspended), any half-awake rep is highly likely to get a successful outcome at Tribunal. Especially if the clmt has not been asked for the info / evidence to allow a calc for underlying entitlement. If the clmt fails to respond to requests for info/evidence, or fails to provide it all, then fine; an inference can be drawn. But the clmt must be given the opportunity.

Hope the above helps.

[peterdelamothe]

Corran – you make a good point on penalties etc. I think the point I am making is that a “fraud”, suspected or proven is not some form of magic wand that instantly overides the HB legislation. Nor can a claim be “closed” (as the Commisioners have said time and time again). After all, convicted prisoners or those on remand are entitled to HB for a limited time and underlying entitlement must be considered in ALL cases, including where fraud is proven. I know many fraud staff do not care for the latter (and I sympathise as I thought the old caselaw on reg 104 was very fair as most fraudsters COULD be excluded but thats just my opinion).

[Hilly]

I think you’ll find the word “closure” used here relates to the Fraud investigation, not the claim.

[corran]

[quote:4dac3236bd=”peterdelamothe”]Corran – you make a good point on penalties etc. I think the point I am making is that a “fraud”, suspected or proven is not some form of magic wand that instantly overides the HB legislation. Nor can a claim be “closed” (as the Commisioners have said time and time again). After all, convicted prisoners or those on remand are entitled to HB for a limited time and underlying entitlement must be considered in ALL cases, including where fraud is proven. I know many fraud staff do not care for the latter (and I sympathise as I thought the old caselaw on reg 104 was very fair as most fraudsters COULD be excluded but thats just my opinion).[/quote:4dac3236bd]

Understand what you say about it not being a magic wand, but if the fraud officer done their job properly then you will have everything you need to create the overpayment etc. But it depends on the sort of case. Undeclared capital for instant makes it easy if it been over £16000 and they got the bank statements etc for the whole period. Claimant cant argue that they were not entitled to at ever in that period, but your point becomes a big issue in living togethers like this one if you cant prove reasonably when the change should be issued from or how much difference the situation would actually have made on the claim.

I take a harsh outlook personally, if you commited fraud against the system in anyway then all future entitlement should be void. That would prevent most people that know they will need it at some point from abusing it. But at the moment in general all it equates to is “have a £100 fine and a £20’000 interest free loan”. However I know better then to take this point of view to work with me so that I am not being predijuce towards anyone. This though is why it best fraud has nothing to do with benefit admin side, just simply send “X has been discovered and can you re-evaluate the claim based on this and provide overpayment schedule to fraud”

[Author]

Posts