Participants or vendors are subject to the sanctions outlined
below if determined by contract agency or department staff to be guilty of
abusing the WIC program or its regulations.
(1)
Participant violation.
Violations may be reported by contract agency staff, vendors, the public, FNS
staff, or department staff. All suspected cases of fraud will be investigated
by the department. All sanctions will be administered by the department.
Contract agencies will be notified of any actions taken against WIC
participants by the department.
a. Whenever
possible, the participant is contacted via telephone concerning the violation.
Documentation is maintained according to procedures set forth in the Iowa WIC
Policy and Procedure Manual.
b.
Participants who violate WIC program regulations are subject to sanction in
accordance with the schedule below:
|
Violation
|
Sanction Action
|
|
1.
|
Intentional false statement(s) or misrepresentation of
income, name, residence, family size (including receiving and using benefits
for children no longer in the family), medical data, pregnancy, and/or date of
birth to obtain WIC benefits.
|
One-year disqualification and pay full
restitution
|
|
2.
|
Return of WIC foods to vendor for unapproved food
items, nonfood items, credit or cash (attempted or actual). Claim amount less
than $100.
Buy, trade, exchange, transfer, sell, or offer to buy,
trade, exchange, transfer, sell, or allow any other person to buy, trade,
exchange, transfer, sell or offer to buy, trade, exchange, transfer or sell
eWIC card/benefits for unapproved food items, nonfood items, cash or favors.
Claim amount less than $100.
|
Two-month disqualification and pay full
restitution
Subsequent violation of any claim amount: one-year
disqualification and pay full restitution
|
|
3.
|
Return of WIC foods to vendor for unapproved food
items, nonfood items, credit or cash (attempted or actual). Claim amount
greater than $100.
Buy, trade, exchange, transfer, sell, or offer to buy,
trade, exchange, transfer, sell or allow any other person to buy, trade,
exchange, transfer, sell or offer to buy, trade, exchange, transfer, or sell
WIC foods for unapproved food items, nonfood items, cash or favors. Claim
amount greater than $100.
|
One-year disqualification and pay full
restitution
|
|
4.
|
Creating a public nuisance or disrupting normal
activities through verbal misconduct or physical disruptions at the local WIC
agency, farmers market, or vendor location.
|
First violation: Education/counseling
Second subsequent violation: Warning letter
Third subsequent violation: Two-month
disqualification
Fourth subsequent violation: Any subsequent
violation(s) will result in a one-year disqualification.
|
|
5.
|
Verbal abuse or harassment of WIC staff, vendors,
farmers market vendors and/or other WIC participants. This includes verbal
abuse or harassment in person, on social media, or over the telephone.
|
Two-month disqualification
Subsequent violation will result in a one-year
disqualification.
|
|
6.
|
Physical abuse (directly or indirectly carrying out the
actual harm or threatening to do harm) of WIC staff, vendors, vendor staff,
farmers market vendors, farmers market vendor staff, and/or other WIC
participants.
|
Any violation will result in a one-year
disqualification.
|
|
7.
|
Destruction of property, theft of eWIC card(s) or theft
from a local WIC agency, vendor, vendor staff, farmers market vendor, farmers
market vendor staff, and/or another WIC participant.
|
Any violation will result in a one-year
disqualification.
|
|
8.
|
Collusion with staff to improperly obtain
benefits.
|
One-year disqualification and pay full
restitution
|
|
9.
|
Dual participation resulting from intentional
misrepresentation.
|
One-year disqualification and pay full
restitution
|
|
10.
|
Trafficking WIC food benefits, WIC benefits, or WIC
items and/or collusion with an authorized vendor.
|
One-year disqualification and pay full
restitution
|
|
11.
|
Other violations of this chapter or the Iowa WIC Policy
and Procedure Manual.
|
As appropriate per this chapter or the Iowa WIC Policy
and Procedure Manual
|
c.
Local law enforcement may be notified in appropriate cases.
d. Fifteen days' notice must be given prior
to all disqualifications. In all cases, the participant must be informed of the
reason for the disqualification, of the right to appeal the decision through
the fair hearing process, and of eligibility to receive WIC services at the end
of the disqualification period.
e.
A disqualification may apply to all members of a family who are on the WIC
program.
f. Violations are
cumulative. However, a participant will not have sanctions assessed for
committing a second violation when the second violation occurs before the
participant receives notice of the first violation and the second violation is
the same as the first. A participant who commits the same violation a second
time following receipt of a notice for the first violation is subject to a
one-year disqualification.
g. When
a participant improperly received benefits as a result of intentionally making
a false or misleading statement(s) or intentionally misrepresenting,
concealing, or withholding facts or sells or attempts to sell benefits the
participant received from the WIC program and is disqualified from the WIC
program, the participant may be required to make restitution of the cash value
of the improperly received or used WIC benefits. The department may establish a
claim against the participant for the full value of the improperly received
benefits.
The department shall issue a written notice of restitution and
disqualification.
If the participant chooses a repayment plan for claims, the
department will assist in developing a payment schedule. If the participant has
not paid the department directly within 30 days of the notice of restitution
and disqualification, the department will pursue collection of the dollar
amount owed and benefits will be discontinued until the claim is paid.
h. The department may decide not
to impose a mandatory disqualification if a family makes full restitution for a
monetary claim, establishes a repayment schedule within 30 days of receipt of
the letter demanding repayment, makes full restitution or agrees to a repayment
schedule or, in the case of a participant who is an infant, a child, or under
the age of 18, the state or local agency approves the designation of a proxy.
The department may permit the participant to receive WIC services before the
end of a mandatory disqualification period if full restitution is made or a
repayment schedule is agreed upon or, in the case of a participant who is an
infant, a child, or under the age of 18, the department or local agency
approves the designation of a proxy. All decisions are at the discretion of the
department.
i. When a
disqualification period has ended, the individual disqualified may be
reinstated if the individual's certification period is still current. If the
individual's certification period is not current, the individual will need to
complete a certification appointment.
j. The department shall maintain a master
list of all participant violation notices, disqualifications, and statements of
restitution. The participant's notice of violation must also indicate when it
is a second offense.
(2)
Vendor violations. There are five types of sanctions that are
applied to vendors for violations of WIC program regulations: nonpayment of
food instruments, issuance of violation points, temporary disqualification,
permanent disqualification, and civil money penalties.
a. Nonpayment of food instruments. If the
vendor has been terminated from the WIC program and submits a claim, it will be
fully denied.
b. Administrative and
procedural violation points. Administrative and procedural violations are
offenses to the provisions of the WIC vendor agreement that do not rise to the
level of fraud against the WIC program or its participants.
These violations are an indication of a vendor's inattention to
or disregard of the requirements of the WIC vendor agreement. It is in the
department's interest to record and consider these violations when considering
whether to continue its contractual relationship with the vendor.
One or more transactions prior to notification of the vendor
constitute only one violation if they contain the same error.
The assignment of violation points does not limit the
department's right to effect stronger penalties and sanctions in cases in which
there is evidence of an intentional or systematic practice of abusing or
defrauding the Iowa WIC program.
|
Violation
|
Points Per Event
|
|
1.
|
Developing and using promotional materials including
stickers, tags, labels, or channel strips with the WIC service mark to identify
WIC-approved foods.
|
5
|
|
2.
|
Developing and using vendor-created WIC vendor
identification decals to indicate vendor is an authorized vendor.
|
5
|
|
3.
|
Failure to allow WIC participants to leave the vendor
with WIC foods that were debited/removed from their eWIC account during a WIC
transaction.
|
5
|
|
4.
|
Failure to post eWIC signs in the cash register lane
that has a working WIC terminal if the vendor is not integrated.
|
5
|
|
5.
|
Failure to provide vendor ECR system participant
receipts to WIC participants during each WIC transaction.
|
5
|
|
6.
|
Failure to reimburse department for potentially
overpaid food instrument or provide reasonable explanation for the cost of the
food instrument.
|
10
|
|
7.
|
Refusal to accept valid WIC food instruments from
participants.
|
10
|
|
8.
|
Discriminatory treatment of WIC participants, such as
requiring WIC participants to use special checkout lanes or provide extra
identification, or disallowing the use of coupons or other vendor discounts in
WIC transactions that are allowed in non-WIC transactions.
|
10
|
|
9.
|
Treating WIC customers differently by offering them
incentive items, vendor discounts, coupons, or other promotions that are not
offered to non-WIC customers.
|
10
|
|
10.
|
Providing to WIC participants incentive items not prior
authorized by the department.
|
10
|
|
11.
|
Failure to carry out corrective action plan developed
as a result of monitoring visit.
|
10
|
|
12.
|
Accepting the return of food purchased with WIC food
instruments for cash or credit toward other purchases.
|
10
|
|
13.
|
Issuing "rain checks" or credit in exchange for WIC
food instruments.
|
10
|
|
14.
|
Stocking out-of-date, stale, or moldy WIC foods.
|
10
|
|
15.
|
Failure to submit vendor price assessment reports as
requested.
|
10
|
|
16.
|
Failure to train all employees and ensure their
knowledge regarding WIC program procedures set forth in the vendor's current
agreement and in the current publication of the Iowa WIC program's vendor
instruction booklet.
|
10
|
|
17.
|
Requiring WIC participants to purchase a particular
brand when other WIC-approved brands are available.
|
10
|
|
18.
|
Not allowing WIC participants to use discount coupons
or promotional specials to reduce the WIC food instrument amount.
|
10
|
|
19.
|
Requiring to enter the PIN for the participant and/or
asking for the participant's PIN.
|
10
|
|
20.
|
For vendors that have special WIC prices, failure to
post WIC prices on the shelf or on the package.
|
15
|
|
21.
|
Contacting WIC participants in an attempt to recover
funds not paid by WIC.
|
15
|
|
22.
|
Providing false information on the price assessment
report.
|
15
|
|
23.
|
Knowingly entering false information or altering
information on the eWIC receipt/benefits.
|
10
|
|
24.
|
Requiring other cash purchases to redeem WIC food
instruments.
|
15
|
|
25.
|
Failure to obtain infant and/or special needs formula
from an approved source listed by the Iowa WIC program.
|
15
|
|
26.
|
Offering incentive items with a value of more than
$1.99.
|
15
|
|
27.
|
Scanning any UPC code that is not affixed to the actual
item being purchased by the WIC participant.
|
20
|
|
28.
|
Failure to allow purchase of up to the full amount of
WIC foods authorized on the food instrument if such foods are available and
desired by the WIC participant.
|
20
|
|
29.
|
Other violations of this chapter or the WIC vendor
agreement or the Iowa WIC Policy and Procedure Manual.
|
As appropriate per this chapter, the WIC Vendor
Agreement and Handout, or the Iowa WIC Policy and Procedure Manual
|
c.
One-year disqualification. With an administrative finding of the following
patterns of sanctions, the vendor will be disqualified for one year.
(1) A pattern of allowing purchase of
nonapproved food items in exchange for WIC food instruments or for foods
provided in excess of those listed on the WIC food instrument, (federally
mandated sanction)
(2) Accumulation
of 45 or more violations points within a single federal fiscal year of the
agreement period, (department sanction)
(3) Failure to provide access to vendor
premises or in any manner to hinder, impede or misinform authorized WIC
personnel in the act of conducting an on-site education, monitoring or
investigation visit, (department sanction)
(4) Loss of Iowa department of inspections
and appeals license, (department sanction)
(5) Submitting for payment a WIC food
instrument redeemed by another authorized vendor, (department
sanction)
(6) Threatening or
verbally abusing WIC participants or authorized WIC program personnel in the
conduct of legitimate WIC program transactions, (department sanction)
(7) Submitting for payment WIC food
instruments known by the vendor to have been lost or stolen, (department
sanction)
(8) Participating with
other individuals, including but not limited to WIC employees, vendors, and
participants, in systematic efforts to submit false claims for reimbursement of
improper WIC food instrument, (department sanction)
d. With an administrative finding of the
following federally mandated sanctions, the vendor will be disqualified from
being a WIC vendor for three years.
(1) A
pattern of charging WIC participants more than non-WIC customers or charging
WIC participants more than the current shelf price.
(2) A pattern of charging for items not
received by the WIC participant or for foods provided in excess of those listed
on the WIC food instrument.
(3) A
pattern of providing credit or nonfood items, except for alcohol, alcoholic
beverages, or tobacco products, in exchange for WIC food instruments.
(4) One incidence of allowing the purchase of
alcohol, alcoholic beverages, or tobacco products with a WIC food
instrument.
(5) A pattern of
receiving, transacting, or redeeming WIC food instruments outside authorized
channels, including through unauthorized vendors or persons.
(6) A pattern of claiming reimbursement for
the sale of a quantity of a specific food item which exceeds the vendor's
documented inventory of that food item for a specified period of
time.
e. With an
administrative finding of the following federally mandated sanctions, the
vendor will be disqualified for six years.
(1)
One incidence of buying or selling food instruments for cash
(trafficking).
(2) One incidence of
selling firearms, ammunition, explosives, or controlled substances (as defined
in Section 102 of the Controlled Substances Act ( 21 U.S.C.
802 )) in exchange
for WIC food instruments.
f. With a conviction in a criminal court of
law for trafficking in WIC food instruments or selling firearms, ammunition,
explosives, or controlled substances (as defined in Section 102 of the
Controlled Substances Act ( 21 U.S.C.
802 )) in exchange for WIC food
instruments, the vendor will be permanently disqualified from the Iowa WIC
program. The department may impose a civil money penalty (CMP) in lieu of a
disqualification when it determines, in its sole discretion, that:
(1) Disqualification of the vendor would
result in inadequate participant access; or
(2) The vendor had, at the time of the
violation, an effective policy and program in effect to prevent trafficking;
and the ownership of the vendor was not aware of, did not approve of, and was
not involved in the conduct of the violation.
g. The following does not have a point value,
but shall result in or extend a disqualification period:
For each month in which a vendor accepts WIC food instruments
during a disqualification period, the disqualification period shall be extended
by 30 days.
h. The above
sanctions notwithstanding, the state of Iowa reserves the right to seek civil
and criminal prosecution of WIC vendors for any and all instances of dealing in
stolen or lost food instruments, trading cash and other inappropriate
commodities for food instruments, or cases in which there exists evidence of a
clear business practice to improperly obtain WIC funds, or other practices
meeting the definition of fraud as defined in 7 CFR Part
246 or the Iowa
Code.
i. A vendor shall not be
entitled to receive any compensation for revenues lost as a result of any
temporary or permanent disqualification.
j. A minimum of 15 days' notice is provided
prior to all disqualifications, except for permanent disqualifications assessed
under paragraph 73.19(2)"f" which are effective on the date of
receipt of the notice of administrative action. When the department determines
that an offense has occurred, a disqualification letter with supporting
documentation is prepared for the WIC director's signature. The
disqualification letter identifies the specific offenses that the vendor is
charged with and the procedures for filing an appeal. Voluntary withdrawal from
the WIC vendor agreement to avoid a sanction is not allowed.
k. The department is responsible for issuing
all warning and disqualification letters. Contract agencies are informed of all
vendor correspondence regarding violations. In situations where participant
violations are also involved, the contract agency is responsible for follow-up,
as detailed in subrule 73.19(1).
l.
Federal Supplemental Nutrition Assistance Program (SNAP) regulations require
automatic disqualification from SNAP for vendors disqualified by the WIC
program for certain types of violations. When a vendor is disqualified from the
WIC program, the disqualification letter to the vendor will include the
following statement: "This disqualification from WIC may result in
disqualification as a retailer in the Supplemental Nutrition Assistance Program
(SNAP). Such disqualification may not be subject to administrative or judicial
review under SNAP." For all vendor disqualifications from the WIC program,
notice will be sent to the United States Department of Agriculture for
appropriate action.
m. The
department shall disqualify a vendor who has been disqualified from SNAP. The
disqualification shall be for the same length of time as the SNAP
disqualification, may begin at a later date than the SNAP disqualification, and
shall not be subject to administrative or judicial review under the WIC
program. If the department determines that disqualification of a vendor would
result in inadequate participant access, it will impose a civil money penalty
(CMP) in lieu of disqualification.
n. Civil money penalties.
(1) When the department determines that a
civil money penalty (CMP) shall be imposed in lieu of disqualification for
reasons specified under paragraph 73.19(2)
"f" or 73.19(2)
"m," it shall use the civil money penalty formula in
accordance with Title
7 CFR
246.12(k)(l)(x) to determine
the CMP.
(2) If a vendor does not
pay, only partially pays, or fails to timely pay a CMP, the department will
disqualify the vendor for the length of the disqualification corresponding to
the violation for which the CMP was assessed. "Failure to timely pay a CMP"
includes the failure to pay a CMP in accordance with an installment plan
approved by the department.
(3)
Money received by the state WIC agency as a result of civil money penalties or
fines assessed against a vendor and any interest charged in the collection of
these penalties and fines shall be considered as WIC program income.
