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The Office of Program Integrity (OPI) consists of several units which function to ensure the eligibility of Social Service customers, the integrity of Social Service programs and the prevention of Welfare fraud. It is important to report suspected fraud to ensure that County tax dollars are being used for the intended reason -- to help those in need.

Fraud Unit
The Fraud Unit receives and investigates allegations of Welfare fraud made by the community as well as agency staff. Evidence of criminal conduct is referred for prosecution by the District Attorney. An administrative law process exists which seeks repayment and disqualification if Temporary Assistance and/or SNAP benefits are obtained improperly, but the situation does not meet the criminal prosecution standards. Every incorrect issuance of Temporary Assistance, Medical Assistance, SNAP, and Child Care benefits must be evaluated as to the cause and a repayment must be pursued. Payments may be the result of a recoupment against future benefits, voluntary payment, or may result from an offset against a tax refund or gambling and lottery winnings.

Allegations of Welfare fraud may be reported to the unit in a variety of ways:

E-mail:
Phone:(888) DSS-0009 or (888)-377-0009 or (914) 995-5643
Fax: (914) 995-5658
Online: Fraud form

U.S. Mail:

OPI
112 East Post Rd,, 6th Fl.
White Plains, NY  10601
   
Intentional Program Violation
An Intentional Program Violation (IPV) is an act of any person who applies for or receives assistance (Temporary Assistance, SNAP, Medicaid) and who intentionally misrepresents, conceals or withholds facts for the purpose of establishing or maintaining eligibility or the level of benefits. A person found guilty of committing an IPV by a civil, criminal or administrative court can be subject to court ordered penalties including being disqualified from receiving benefits. Westchester OPI reviews, investigates and refers cases for the determination of Intentional Program Violations and also monitors the implementation of the resulting penalties.

FEDs Unit
The Front End Detection Unit or FEDs, conducts investigations and office interviews on applications for child care and cash assistance, including those from families, single adults, or married couples.

Computer Matches Unit
This unit uses computer matches with participating states' databases to identify potential duplicate assistance on behalf of an individual or family. The process monitors Cash Assistance, SNAP and Medical Assistance benefits. Computer matches with criminal justice databases yield information on customers that may be currently incarcerated or have outstanding warrants which render them ineligible for public benefits.  Coordination exists with all levels of law enforcement to ensure timely closing of ineligible cases.

Field Investigations and Child Care Audit (FICCA) Unit
As the name suggests, the FICCA Unit does most of their work in the field; making visits to both recipients and vendors of Child Care Subsidies (CCS) benefits. They investigate allegations of CCS recipient fraud as well as conduct FEDS investigations on CCS applications and applicants. Further, they support the TA FEDs staff by performing investigations where field visits may be necessary to verify an applicant’s receipt of temporary assistance.

 

REACH Westchester a new state-of-the-art technologyREACH Westchester is an automated application system that has transformed the county's paper recertification process for Temporary Assistance customers into a more efficient, streamlined process. This innovative process enables customers to complete their recertification interview independently through the use of a user-friendly, in-office kiosk.

REACH is a secure system that will not reveal any personal or confidential information.

Bottom line, REACH Westchester will change the way we do business over the next several years:

  • A large portion of our workload such as Medicaid recertification and Temporary Assistance applications can be automated through the expansion of REACH, provided we receive the proper state approvals,
  • REACH Westchester can also be expanded to include online access over the Internet and can be used remotely by anyone in need of Social Services.
  • Other areas under consideration for the remainder of 2011 and beyond are Temporary Assistance, Food Stamps and Medical Assistance household changes (the case maintenance issues that come up between recertifications such as moves, family changes, employment, etc.).
  • Additionally, once REACH is accessible on the Web, DSS would like to partner with local community-based organizations, in addition to contractual vendors. This will allow mutual customers, in most instances, to use those organizations' facilities to access a computer and the Internet. 

New York State has health insurance programs for all uninsured children up to 19 years of age and some uninsured adults. Children ineligible for Medicaid may receive health services under Child Health Plus available from providers throughout Westchester. Services covered by Child Health Plus are:

  • well-child care
  • physical examinations
  • immunizations
  • diagnosis and treatment of illness and injury
  • X-rays and lab tests
  • outpatient surgery
  • emergency care
  • prescription drugs
  • inpatient hospital medical or surgical care
  • short-term therapeutic outpatient services (chemotherapy, hemodialysis)
  • limited outpatient treatment for alcoholism, substance abuse, and mental health

To apply for a child, call (800) 698-KIDS, that is (800) 698-4543, the Westchester County Department of Health (914) 813-5048 or you can obtain information online from Child Health Plus.

Family Health Plus provides coverage to adults who do not have health insurance but have income too high for Medicaid. Parents and childless adults aged 19 through 64 are eligible if they live in New York State, have no health insurance and meet income and resource guidelines. There is no cost to apply for Family Health Plus and no deductibles once you are enrolled. Once enrolled you may be asked to co-pay part of the costs of some medical care services. Health care is provided through managed care plans. Family Health Plus will do its best to help participants continue to see their current doctor.

Services covered by Family Health Plus

  • physician services
  • inpatient and outpatient hospital care
  • prescription drugs and smoking cessation products
  • X-rays and lab tests
  • vision, speech, and hearing services
  • rehabilitative services (some limits apply)
  • durable medical equipment
  • inpatient hospital medical or surgical care
  • emergency room and emergency ambulance
  • drug, alcohol, and mental health treatment (some limits apply)
  • diabetic supplies and equipment
  • radiation therapy, chemotherapy and hemodialysis 
  • dental services (if offered by the plan)
  • family planning and reproductive health services

Enrollment

Enrollment facilitators and social service district offices answer questions and help you choose a health plan. Call (877) 9FH-PLUS (934-7587) or call the Westchester County Department of Health at (914) 813-5048 or visit Family Health Plus online.

Applications for medical assistance should be filed at the district office serving your area.

Community Certification (914) 813-6129
Home Care (914) 813-6080 or 813-6204
Nursing Home (914) 813-6080 or 813-6195

You can also contact the Department of Health at (914) 813-5048 or go through a facilitated enroller at one of several community-based organizations listed below. 

Hudson Health Plan  (800) 339-4557
Fidelis Care  (888) 343-3547
Affinity Health Plan  (800) 553-8247 
HIP Health Plan  (888) 447-0221 
United Healthcare (800) 493-4647

If you need help in selecting a managed care plan, call New York Medicaid Choice at (800) 505-5678.

Hospitalized or nursing home applications for Medicaid
The Department of Social Services has a deputized worker program for hospitals and most nursing homes in Westchester. This program allows people who are hospitalized or admitted to a nursing home to apply for Medicaid at that facility instead of applying at one of the four social services district offices or at the Institutional Office at (914) 813-6618. For questions regarding the Medicaid program, call (914) 995-5468.