CR: 10 Participant Violations and Sanctions

Effective Date: 08/92 Downloads: PDF Version    Revised Date: 03/12
   

Policy

To ensure the enforcement of program rules and regulations, and to provide equitable guidelines for identifying, reporting, and investigating alleged WIC Program abuse by participants and sponsors. All suspected and reported abuse by a participant or sponsor must be reported by the local agencies to the State agency for investigation.

Procedure

The State of Nevada WIC utilizes WIC Electronic Benefits Transfer (EBT) cards that contain food prescriptions that allow program participants to purchase specific WIC-approved foods in specific authorized quantities. The Nevada WIC EBT Cards also contain cash value benefits (CVBs) that provide a program participant a specific dollar amount to use towards the purchase of fresh fruits and vegetables. The term food instrument(s) is inclusive of all WIC EBT benefits and cash value benefit(s) contained on the WIC EBT card, unless noted otherwise.

Definition of Program Violations

Participation Violation means any intentional action of a participant, parent or caretaker of an infant or child participant, or proxy that violates Federal or State statutes, regulations, policies, or procedures governing the Program.  Participant violations include intentionally misrepresenting, concealing, or withholding facts to obtain Food Instruments, or supplemental foods for cash, credit, non-food items, or unauthorized food items, including supplemental foods in excess of those listed on the participant’s Food Instrument Grocery List (the grocery list includes a list of all benefit amounts that have been issued onto the participants EBT Card. The grocery list also includes the total dollar amount the participant has been issued for their CVB purchases); threatening to harm or physically harming clinic or vendor staff; or dual participation.

Participant abuse of the program includes any of the following reported program violations due to the intentional actions of a participant, alternate, proxy, parent, guardian, caretaker, or representative of the participant.

Examples of program abuse include but are not limited to:

  • Making false or misleading statements or misrepresenting, concealing, or withholding facts to obtain Program benefits.
  • Exchanging food instruments or supplemental foods purchased with WIC food instruments for cash, credit, non-food items, or unauthorized food items.
  • Exchanging food instruments (Deleted EBT and CVB) for more than the specified amount of supplemental foods listed on the food instrument.
  • Theft of food instruments.
  • Physically harming, or threatening to harm WIC clinic or food vendor staff.
  • Redeeming more than the number of food instruments for which the participant is eligible.
  • Allowing WIC foods to be used by or giving away WIC foods for other than the participants
  • The sale of, or intent to sell WIC foods(or allowing someone else to do so), benefits and or EBT cards verbally, in print or online through websites such as craigslist, Facebook, Twitter, eBay, etc.

Dual Participation means either:

  • Simultaneous participation by the same person(s) in more than one WIC local agency or more than one WIC clinic site within a local agency, or Participant(s) receive benefits from both the WIC program and the Commodity Supplemental Food Program (CSFP) during the same time period.

Reporting and Documentation of Program Abuse or Dual Participation

Once program abuse by a participant, alternate, proxy, parent, guardian, caretaker, or representative of the participant is suspected or a complaint has been received, the local agency is required to notify the State agency immediately. 

  1. Provide the State agency with all of the information you have received from the complainant and/or witnesses. This includes documentation of the date, time, brief explanation of the facts, and witness statements etc. any information that will be pertinent to the case.
  2. Confirm that all participant information is current in the system.
  3. Local agency staff must report the abuse and/or complaint to the State agency within 2 working days.
  4. Notify the State agency if the participant has any previous warnings, sanctions, or claims noted in their files.
  5. Local agency staff must cooperate fully with the State agency with regards to getting information, contacting participant or proxy if necessary, providing letters etc.
  6. State agency staff must complete the investigation within 120 days after receipt from the clinic and report any findings, claims, sanctions, or disqualifications to the local agency.

Disqualification Procedures for Dual Participation

Each month local agencies receive a copy of the Dual Participation report. If it is discovered that a participant had dually participated the local agency will:

  1. Complete the Dual Participation Report within 30 days and return to the State Office (refer to RR:3)
  2. Follow the procedures listed above for documentation of the investigation.

Dual Participation within the Nevada WIC Program: 

  • Ask the eligible participant to choose one clinic site from which to continue to receive benefits, regardless of whether or not the dual participation was intentional.
  • The local agency will inform the second clinic site of the participant’s decision.
  • The local agency that the participant does not choose to participate at will immediately terminate the participant without 15 days notice and without benefits.
  • The local agency the participant chooses to participate will determine if the participant was informed of and understood that dual participation is a program violation.
  • The local agency will then report all of the information to the State agency so a determination can be made regarding intentional dual participation.

Unintentional Dual Participation: The State agency will Issue a Warning that will need to be placed  in their file.

Dual Participation with Commodity Supplemental Food Program  

  • Ask the participant which agency they wish to continue to receive benefits.
  • If they choose to participate with CSFP, immediately terminate the participant without 15 days notice and without benefits.
  • If the participant chooses to remain with the WIC program the local agency will instruct the participant to obtain a notice of disqualification from CSFP before issuing benefits. The local agency may assist the participant with this matter by contacting CSFP and requesting a fax confirmation.
  • The local agency the participant chooses to participate or terminate will determine if the participant was informed of and understood that dual participation is a program violation.

Unintentional Dual Participation: The State agency will Issue a Warning that will need to be placed in their file.

  1. The State agency will complete all Dual Participation investigations within 45 days of receipt of report.

Examples of Possible Sanctions for Participant Abuse

Warning (Local Agency may administer)

  •  A warning will be issued to a participant, alternate, proxy, parent, guardian, caretaker, or representative of the participant if there is not sufficient evidence for a reasonable person to conclude that the participant committed an act with the intent to violate program rules or for participants that fail to properly comprehend training and unknowingly violates policies or procedures.
  • Local agencies may administer warnings to participants.  Local agencies must contact the State agency to verify that a violation has occurred and they will be issuing a warning. This will be documented in the participant file.
  • Participants who are accused of violations but through investigation cannot be verified should be informed of the close of the investigation and given a written warning that if a violation was to occur again, the possibility of 1 year disqualification and repayment of benefits.

Disqualification (State Office to administer)

  • Program Participants shall receive written warning or be disqualified when documentation verifies that participant abuse has occurred. The State agency reserves the right to disqualify participants for other actions not listed herein if the participant violates program polices and regulations.
  • Serious violations of program integrity, such as selling or the intent to sell WIC food instruments (EBT cards, benefits or foods purchased using WIC benefits verbally, in print or online, will result in disqualification without any warning.
  • Three (3) documented violations, beyond the warning letter(s), of any combination of the violations listed below will result in one (1) year disqualification. The (3) documented violations, must be committed within a 12-month period.
  • If there are less than (3) combinations of violations with different sanctions, the participant shall receive the maximum sanction.
  • The State agency may decide not to impose a mandatory disqualification if, within (30) days of receipt of the notice of repayment, full restitution is made or a repayment schedule is agreed upon.
  • A participant may reapply for the Program at the end of a disqualification period or the full repayment of a claim. However they must meet eligibility criteria before recertification
  • When the participant being disqualified is an infant or child, the Authorized Representative is the one to be disqualified. The infant or child can continue to receive benefits and participate during disqualification if another Authorized Representative can be designated.  If the Authorized Representative represents multiple infants and/or children all infants and children can remain on the program under the preceding conditions. If there is any question as to whether intent has been established, the State WIC Office should be consulted.

Intention

To qualify for a one year suspension, the Participant violation must be an “intentional act of noncompliance committed by the participant.” There must be a preponderance of evidence to show intent before a one year suspension will be imposed.

Among the items that help show intent on the part of the participant includes:

  • previous instances of dual participation
  • making false or misleading statements or misrepresenting, concealing or withholding information about themselves or their family to obtain Program benefits
  • previous warnings on dual participation
  • exchanging food instruments or supplemental foods for cash, credit, non-food items or unauthorized food items, including supplemental foods in excess of those provided on their EBT card
  • threatening to harm or physically harming clinic, farmer or vendor staff
  • making a verbal offer to sale to another individual or posting WIC foods, benefits and/or EBT cards for sale in print or online, or allowing someone else to do so

A warning will be given to a participant where an investigation of an alleged violation shows that the participant committed an act described above, but there is not sufficient evidence for a reasonable person to conclude that the participant committed the act with intent to violate program rules.

Claims

Any form of participant fraud or abuse, such as using WIC benefits in any way other than the method and purpose for which they were intended, violates Federal WIC regulations and constitutes a participant violation under 7CFR 246.2. Making a verbal offer of sale to another individual or posting WIC foods, benefits and/or EBT cards for sale in print or online, or allowing someone else to do so, is evidence that the participant committed a participant violation.  FNS expects all State agencies to sanction and issue claims against participants for all participant violations.

If the State agency determines that program benefits have been obtained or disposed of improperly as the result of a participant violation, the State agency will establish a claim against the participant for the full value of such benefits. 7CFR 246.23(c)(1) In addition to establishing a claim, the State Agency will determine whether disqualification is required.

  • For all claims, the State agency will issue a letter demanding repayment. A copy of the letter will be provided to the participants clinic.
  • At the time the State agency issues the demand letter, the State agency will advise the participant of the procedures to follow to obtain a fair hearing and that failure to pay the claim may result in disqualification.
  • If full restitution is not made or a repayment schedule is not agreed on within 30 days of receipt of the letter, the State agency will take additional collection actions until restitution is made or a repayment schedule is agreed on, unless the State agency determines that further collection actions would not be cost-effective.
  • The State agency will document the disposition of all participant claims.
  • The Local Agency will be notified if any claims are issued against their participants by the State agency.

Proxies

The State has the option for participants under the age of 18, infants and children who face disqualification due to their own actions or the actions of their sponsor to approve proxies in lieu of disqualification on a case by case basis. To be approved the proposed alternate must be a responsible adult (other than the individual who committed the program violation) who is knowledgeable of the child’s eating habits and health status, capable of bringing the child to the required WIC appointments, capable of redeeming food instruments at the grocery store, and willing to comply with program regulations. Local agencies who feel participants qualify for this exception (violator no longer living with family, social worker involved, etc) should include this information within their documentation.

Written Correspondence

Copies of all written correspondence will be provided to the Local agency that the participant was participating in at the time of the violation. If any written correspondence is returned undeliverable from the USPS/FedEx, UPS the Local agency will be required to present the participant with the written correspondence at the participant’s next appointment or if the appointment is scheduled out more than 30 days, the Local agency is required to make every effort to contact the participant so the participant can provide a current address or pick up the correspondence at the Local agency.                                                                     

 

VIOLATIONS SANCTIONS
Creating a public nuisance, threatening harm, or disrupting normal activities at a clinic, State Agency or Vendor 1st Offense = 30 day disqualification

2nd Offense = 1 year disqualification

Intentionally making a false or misleading statement, or intentionally misrepresenting, concealing or withholding facts to obtain benefits: to include the misrepresentation of income, residency, family size, health status, falsification of medical data or health, misrepresentation of date of birth so as to (a) appear categorically eligible or (b) to undetected as a dual participant 1st Offense = 90 day disqualification & repayment

2nd Offense = 1 year disqualification & repayment

Exchanging food instruments (EBT Card & PIN#) or benefits for credit on non-food items 1 year disqualification & repayment
Selling Food Instruments (EBT Card & PIN#) 1 year disqualification & repayment
Selling, Attempting to sell, trading or giving away supplemental food that was purchased with WIC food Instruments (EBT Card) 1st Offense = 90 day disqualification & repayment

2nd Offense = 1 year disqualification & repayment

Stealing or attempting to steal Food instruments (EBT Cards) 1 year disqualification, repayment and reported to local law enforcement agency
Threatening physical abuse of WIC or vendor staff (includes throwing something in the direction of WIC or vendor staff) 1st Offense = Education & warning letter & Participant MUST change WIC clinic or vendor

2nd Offense = 90 day disqualification (with re-application participant must change WIC clinic or vendor)

Verbally abusing or harassing WIC staff or vendor staff (includes throwing something though it is not directed toward WIC or vendor staff) 1st Offense = Education & warning letter

2nd Offense = 30 day disqualification

3rd Offense 90 day disqualification

Physical abuse of WIC or vendor staff. Physical abuse of WIC clinic or vendor property. Theft of WIC clinic or WIC staff property. 1 year disqualification and reported to local law enforcement agency
Dual Participation: using food instruments (EBT Cards) from two Local Agency locations in the same month including ITCN or any other bordering State WIC Program Immediate removal from all but (1) program, repayment of the dual benefits, and disqualification for the number of months the dual benefits were received
Intentional Dual Participation 1 Year disqualification from all programs and repayment of benefits
Assessed claim for $100 or more. A claim is the amount of a repayment 1 year disqualification & repayment
Assessed second or subsequent clam for any amount 1 year disqualification & repayment
Altering Nevada WIC Medical Documentation Form for the purpose of showing false or misleading information. 1st Offense = 30 day disqualification

2nd Offense = 90 day disqualification

3rd Offense = 6 Month disqualification

Exchanging or attempting to exchange food or formula purchased with food instruments (EBT Card) for unauthorized food or formula 1st Offense = Education & Warning Letter

2nd Offense = Education & Warning Letter

3rd Offense = 1 month disqualification