18 Miss. Code. R. 28-8.6 - Waste, Fraud, and Abuse

The Mississippi Department of Human Services has a zero tolerance for the commission or concealment of acts of waste, fraud and abuse. Allegations of such acts will be investigated and pursued to their logical conclusion, including legal action when warranted.

A. Waste involves the taxpayers not receiving a reasonable value for money in connection with any government funded activities due to an inappropriate act or omission by players with control over or access to government resources.

B. Fraud is a type of illegal act involving the obtaining of something of value through willful misrepresentation or a false representation of a material fact, whether by words or by conduct, by false or misleading allegations, or by concealment of that which should have been disclosed, which deceives another so that he acts, or fails to act to his detriment.

C. Abuse involves behavior that is deficient or improper when compared with behavior that a prudent person would consider reasonable and necessary business practice given the facts and circumstances. Abuse also includes misuse of authority or position for personal financial interests or those of an immediate or close family member or business associate.

D. Types of Waste and Abuse include, but are not limited to:

1) Employee- Omitting client information, ghost clients, charging application fees, former employee having access to software, receiving kickback from vendor, etc.

2) Client- Misrepresenting household size or income, falsifying application, forging documents needed to complete intake, etc.

3) Vendor/Contractor- Charging a higher amount than the lowest allowable, doctoring delivery tickets, providing financial incentive to staff to overlook unallowable charges, double charges, incorrect pricing, etc.

E. Reporting Related to Waste, Fraud, and Abuse

1) Employee (MDHS) - Any employee who has knowledge of waste, fraud or abuse, or has a good reason to suspect that such conduct has occurred, shall adhere to this policy. When suspected fraudulent activity, waste, or abuse is observed by, or made known to an employee, the employee shall immediately report the activity to their direct supervisor. If the employee believes that the supervisor is involved with the activity, they shall immediately report the activity to the Division of Community Services' Director. If the employee believes that the Division Director may be involved with the activity, the employee shall report the activity to the Office of Inspector General at 1-800-299-6905.

2) Employee (Subgrantee) - Any employee who has knowledge of waste, fraud or abuse, or has a good reason to suspect that such conduct has occurred, shall adhere to the procedure in this policy. When suspected fraudulent activity, waste, or abuse is observed by, or made known to, an employee, the employee shall immediately report the activity to his/her direct supervisor. If the employee believes that the supervisor is involved with the activity, s/he shall immediately report the activity to the Executive Director. If the employee believes that the Executive Director may be involved with the activity, the employee shall report the activity to the Board of Directors. If it is believed that the Board is involved, it shall be reported to the Office of Inspector General at 1-800-299-6905.

3) Client or General Public - DCS cannot compel citizens and clients to report suspected instances of waste, fraud and abuse. DCS, however, strongly encourages citizens and clients to report such. Once management at the subgrantee level or at the state level has been informed of suspected waste, fraud or abuse, management shall provide the client with the established procedures for filing a report. The Office of Inspector General may be contacted at 1-800-2996905.

4) Vendor - Any citizens, customer, vendor or agency that has knowledge of waste, fraud or abuse, or has a good reason to suspect that such conduct has occurred should report the occurrence to the Office of Inspector General at 1-800-299-6905 and may result in an investigation being conducted.

5) A confidential report may be submitted through the Virtual Roma website found on https://virtualroma.mdhs.ms.gov. If the reporting party does not have access to this system, reporting may be completed at the following contact information:

Call toll free number: 1-800-299-6905

Fax number: 601- 359- 5047

Address: Office of Inspector General

200 South Lamar Street

Jackson, MS 39201

6) Providing specific occurrence details of suspected waste, fraud, and abuse will expedite investigative efforts. There is no requirement to submit identifying information from those who wish to report suspected waste, fraud, and abuse.

7) Tips will be investigated in the order that they have been received with no preference given to those who provided identifying information.

F. Penalties for Substantiated Waste, Fraud, and Abuse- Once an investigation has been completed and reviewed by MDHS Office of Inspector General, penalties may be enforced as follows:

1) Employee - Employees of MDHS or Subgrantee who have been found guilty of waste, fraud and abuse are subject to prosecution and/or recoupment of any benefits provided, following due process as defined in subgrantee regulations and may be terminated.

2) Client - If it is the client's first offense they will be ineligible for services for an entire year from the date of the decision and benefits recouped. If it is the client's second offense, they will be disqualified permanently from the program and is subject to prosecution and/or recoupment of any benefits provided, following due process as defined in agency regulations.

3) Vendors and Contractors - Vendors/Contractors suspected of fraud and/or misrepresentation may be suspended from participation and may be subject to prosecution and/or recoupment of any benefits provided, following due process as defined in agency regulations.

Notes

18 Miss. Code. R. 28-8.6

Miss. Code Ann. § 43-1-2(4); Miss. Code Ann. § 43-1-4 Revised: May 2022

Adopted 9/18/2022