North Carolina Administrative Code
Title 10A - HEALTH AND HUMAN SERVICES
Chapter 71 - ADULT AND FAMILY SUPPORT
Subchapter P - STATE/COUNTY SPECIAL ASSISTANCE FOR ADULTS
Section .0500 - PAYMENT PROCEDURES
Section 71P .0508 - FRAUD

(A) makes a false statement or misrepresentation;

(B) fails to disclose a material fact; or

(C) does not report any Change in Situation that affects the amount of the State/County Special Assistance Program payment; and as a result obtains or continues to receive a payment.

(A) Intentional misrepresentation: An applicant or recipient engages in intentional misrepresentation when he or she gives incorrect or misleading information in response to either oral or written questions which the applicant or recipient knows is incorrect, misleading, or incomplete.

(B) Unintentional misrepresentation: An applicant or recipient engages in unintentional misrepresentation when he or she gives incomplete, incorrect, or misleading information because he or she does not understand the eligibility requirements or his or her responsibility to provide the County Department with required information and there is no proof that the applicant or recipient acted willfully and knowingly to obtain more State/County Special Assistance Program payments than those to which he or she was entitled.

(A) Obtain the correct social security number for the applicant or recipient;

(B) explain the obligation of the applicant, recipient, or Authorized Representative to report any Change in Situation within five calendar days after they occur;

(C) inform the applicant, recipient, or Authorized Representative of the consequences of failing to report a Change in Situation, stressing the penalties for fraud and misrepresentation;

(D) provide the applicant, recipient, or Authorized Representative with a copy of the pamphlet entitled Public Assistance Fraud, available at all County Departments, and explain to the applicant, recipient, or Authorized Representative the meaning of fraud as described in this Rule;

(E) inform the applicant, recipient, or Authorized Representative how to report a Change in Situation; and

(F) ask the recipient or Authorized Representative about any Change in Situation since the application or last review.

(A) the name of the applicant or recipient and his or her date of birth and social security number;

(B) a description of the suspected fraudulent act;

(C) a description of the evidence substantiating the applicant's or recipient's intent to defraud;

(D) a description of the evidence substantiating the amount of the overpayment; and

(E) background information, such as the applicant's or recipient's current situation, educational background, and competency.

(A) willfully and knowingly misstated or provided incorrect or misleading information in response to oral or written questions;

(B) willfully and knowingly failed to report a Change in Situation affecting eligibility for the State/County Special Assistance Program or the amount of payment; or

(C) willfully and knowingly failed to report the receipt of payments to which the recipient knew he or she was not entitled.

(A) Administrative action:

(B) Civil court action;

(C) Criminal court action;

(D) Take no action for unusual or hardship circumstances, as set forth in 20 C.F.R. 404.508(a) and 20 C.F.R. 416.553(a), in which a payment reduction would deprive the recipient of necessary income for:

(A) Involuntary payment reduction. Payment reduction shall be required only if the recipient has disregarded earned income determined as set forth in 20 C.F.R. 416.1112 or resources greater than the overpayment amount. The amount of the payment reduction shall not exceed the amount available as disregarded earned income or resources greater than the overpayment amount. If the recipient has no resources, the County Board shall direct the County Department to require the recipient to sign a statement that he or she will repay the overpayment if he or she acquires resources in the future, pursuant to Rule .0504(b) of this Subchapter.

(B) Voluntary State/County Special Assistance Program payment reduction and voluntary recipient refund. The amount of the voluntary payment reduction shall not exceed the amount available as disregarded earned income or resources greater than the overpayment amount.

(A) providing a clear and concise summary of the suspected fraud case;

(B) compiling information gathered during the investigation;

(C) explaining the specific eligibility factors involved in the case;

(D) explaining in detail how the overpayment amount was computed and the time requirements on the County Department's actions, such as the notice requirement as set forth in Rule .0705 of this Subchapter and the five calendar day Change in Situation reporting requirement as set forth in Rule .0602(5)(c) of this Subchapter; and

(E) if necessary, appearing as a witness.