Current through Reg. 49, No. 38; September 20, 2024
(a)
Participants and parents, guardians, client-designated proxies, state
agency-appointed proxies, or caretakers of participants identified and
documented as having abused the WIC Program shall be sanctioned.
(b) If the state agency or the Office of
Inspector General, Health and Human Services Commission, determines that a
participant or parent, guardian, client-designated proxy, state
agency-appointed proxy, or caretaker of a participant has received benefits
unlawfully due to WIC Program abuse, including but not limited to dual
participation, the matter may be referred for criminal prosecution.
(c) Program violations means any intentional
act of an applicant, participant, parent, guardian or caretaker of an infant or
child applicant or participant, client-designated proxy, or state
agency-designated proxy that violates Federal or State statutes, regulations,
rules, policies or procedures governing the WIC Program. Violations include,
but are not limited to, intentionally making a false or misleading statement;
intentionally misrepresenting, concealing, or withholding facts to obtain
benefits; exchanging food instruments or food for cash, credit, non-food items,
or unauthorized foods, including foods in excess of that authorized;
threatening to harm or physically harming local agency, vendor or state agency
staff; and simultaneous participation in the Program in one or more than one
WIC clinic or participation in the Commodity Supplemental Food Program during
the same period of time.
(d) The
state agency, or local agency as directed by the state agency, shall initiate
sanctions which may include disqualification from the Program for up to one
year.
(e) Upon a final
determination by the Office of the Inspector General, Health and Human Services
Commission, that a program violation has occurred, the following mandatory
disqualifications shall apply.
(1) For an
offense where a claim of $100 or more is assessed, the participant shall be
disqualified for one year.
(2) For
an offense where a participant illegally received benefits at more than one WIC
office and the state agency or the Office of the Inspector General, Health and
Human Services Commission, assesses a claim for such dual participation, the
participant shall be disqualified for one year.
(3) When the state agency or the Office of
the Inspector General, Health and Human Services Commission, assesses a second
or subsequent claim of any amount, the participant shall be disqualified for
one year.
(f) If after
finding that a program violation has occurred, the Office of Inspector General,
Health and Human Services Commission, further determines that the program
violation does not warrant a one year mandatory disqualification, the following
sanctions shall apply.
(1) When a participant
or a parent, guardian, client-designated proxy, state agency-appointed proxy,
or caretaker of a participant exchanges food instruments or food for cash or
credit, the participant shall be disqualified for a period of six months for a
first offense and 12 months for a second or subsequent offense.
(2) When a participant or a parent, guardian,
client-designated proxy, state agency-appointed proxy, or caretaker of a
participant exchanges food instruments or food for firearms, explosives,
ammunition, controlled substances, alcohol, or tobacco products, the
participant shall be disqualified for a period of six months for a first
offense and 12 months for a second or subsequent offense.
(3) When a participant or a parent, guardian,
client-designated proxy, state agency-appointed proxy, or caretaker of a
participant exchanges food instruments or food for non-food items not listed in
paragraph (2) of this subsection, the participant shall receive a warning for
the first offense and shall be disqualified for a period of 12 months for a
second or subsequent offense.
(4)
When a participant or a parent, guardian, client-designated proxy, state
agency-appointed proxy, or caretaker of a participant exchanges food
instruments or food for unauthorized food including foods in excess of that
authorized, the participant shall receive a warning for the first offense to
and shall be disqualified for a period of 12 months for a second or subsequent
offense.
(5) When a participant or
a parent, guardian, client-designated proxy, state agency-appointed proxy, or
caretaker of a participant threatens to harm local agency, vendor, or state
agency staff, the participant shall be disqualified for a period of six months
for a first offense and 12 months for a second or subsequent offense.
(6) When a participant or a parent, guardian,
client-designated proxy, state agency-appointed proxy, or caretaker of a
participant physically harms local agency, vendor, or state agency staff, the
participant shall be disqualified for a period of 12 months for a first offense
and 12 months for a second or subsequent offense.
(g) Exceptions to disqualification:
(1) The state agency may decide not to impose
a disqualification if, for violations which resulted in a claim assessed by the
state agency against the participant, parent, guardian, client designated
proxy, state agency-appointed proxy, or caretaker of a participant, full
restitution is made within 30 days of receipt of a letter demanding repayment
or a repayment schedule is agreed on.
(2) The state agency may permit a
disqualified participant to reapply for the program before the end of a
disqualification period if, in the case of a violation where a claim was
assessed by the state agency against the participant or parent, guardian,
client-designated proxy, state-agency appointed proxy, or caretaker of a
participant, full restitution is made or a repayment schedule is agreed
upon.
(3) The state agency may
issue a waiver to appoint a person as a special proxy to transact food
instruments and receive nutrition education for an infant, child, or
participant under age 18 when the infant, child, or participant under age 18
will incur a serious health risk from the suspension of benefits.
(h) The state agency may attempt
to recover, in cash, the value of the benefits received by a participant or the
parent, guardian, client-designated proxy, state agency-appointed proxy or
caretaker of a participant as a result of participant abuse. The state agency
may request and authorize the Office of the Inspector General, Health and Human
Services Commission, to perform this recovery on its behalf.
(1) The state agency or the Office of the
Inspector General, Health and Human Services Commission, may determine the
amount of the benefits improperly received by a participant through an
independent review of local agency records and such other procedures as the
state agency considers necessary under the specific circumstances. The state
agency may request and authorize the Office of the Inspector General, Health
and Human Services Commission, to perform this recovery on its
behalf.
(2) In cases involving
criminal prosecutions for violations of law, repayment of cash value of
benefits improperly received may become a part of any restitution agreement
with the prosecutor and approved by the court. In such cases, the participant
shall not have the right to a fair hearing by the department.
(3) In cases involving an administrative
claim but no criminal prosecution, the Office of the Inspector General, Health
and Human Services Commission, shall notify the participant or parent,
caretaker, or guardian of a participant in writing that a financial claim has
been established and shall request repayment of an amount equal to the value of
the benefits improperly received. The written notification shall include the
reasons for the claim, the value of the benefits improperly received, the
participant's right to a fair hearing, and shall state that the participant or
parent, caretaker, or guardian of a participant may be subject to
disqualification.
(i)
Collection of a financial claim assessed against a participant by offset of
future benefits is not authorized.
