I am a Public Assistance (Food Stamps/Welfare/Medicaid) Fraud Investigator. Ask Me Anything!

I was at the supermarket on July 3rd last year. A couple had a cart full of meats, fish, soda, chips. It rang up to over $400. The woman swiped her food stamps card (this is mass, they get ATM cards). The remaining balance after the card was $75. The man looked at the woman and said "we have to pay for this? this is bullshit"

They had Gucci sunglasses, gucci purse. When she opened her wallet it was full of $100 bills. They got into a late model Escalade.

If this were reported to you, how would you go about finding out if the people are cheating the system?

If you just gave that description there was f**k all we could do because there is nothing that would give us a chance to narrow it down. If say you gave us the license tag number that would give us a starting point for an investigation.

Interesting. Do you have access to what people are buying that might lead to suspicion or just total amounts from where they bought something from? For example, someone blowing through a months worth of food stamps on rather luxurious food items in 1 day?

We have access to when, where, and how much the FS card was used but not the specific items

Regarding the Medicaid investigation, how do you investigate this since much of Medicaid and Medicare fraud cases are based on medical claims submitted to insurance? Have you ever had to investigate a clinic for services being charged that weren't actually taking place and how does a typical investigation work i.e. interviews, chart reviews, etc.?

On my side I only deal with cases where clients lied about income/HH comp to become eligible for medicaid. There is another entire unit that deals with cases where clinics fradulently bill medicaid/medicare.

In your estimate, who commits more fraud: service providers such as grocery stores, or recipients?

I'll give you this example. A lady lives in Ohio but applies in Kentucky for FS. She gets approved for Kentucky FS. She then uses her Kentucky FS card to buy groceries at an Ohio Wal-Mart. Who committed the fraud? Depending on the report they'll blame either the client or Wal-Mart. That's the kind of BS you have to sort through when looking at numbers,

TL/DR its a clusterf**k and I can't give you an honest answer

Could you give us an idea of how prevalent fraud is? What percentage of total recipients of public assistance actually commit some fraud?

As of right now approximately 12% of active cases have some kind of sanction on them in my state.

Can food stamps be used for pepsi, chips, beer and other non-essentials?

When people get caught cheating the system, what is the typical reaction?

They can't use it for paper products, hot foods, cigarettes, or alcohol.

Anything else in a grocery store is fair game.

Usually, most of the time people no show their rebuttal the first time and just keep reapplying hoping it'll go through.

How does something likes this happen?

It's an old clip from an Mtv interview with Old Dirty Bastard of Wu Tang, who rides in a limo to pickup his food stamps.

More often than you would think. An all too common occurrence I deal with are people who apply saying they're homeless and then after getting food stamps for 2 years we'll get a hit from unemployment saying they qualified for the max benefit.

Have you ever been assaulted by an individual that you were investigating?

One guy flipped over a table during an interview. That was the worst of it. One of my co-workers did have a gun pulled on them once.

So...my wife works for a gas station that sells ice cream here in Ohio. She constantly has people buying 7-8 milkshakes, and paying for them with their EBT card. Is there any way she can report this abuse?

Its perfectly legal sadly

I have an interview later this month for a field investigator position with a worker's comp/disability fraud TPA. My question is for selfish reasons. Was your job interview just a basic interview or did they ask industry-specific questions? Did the job require a degree or experience?

Also, at my current job I work in hospitals and actually apply uninsured patients for Medicaid. I've done many fishy interviews and I am sorry for giving you more work.

My interview was alot of common sense questions you should be able to think on your feet with. If nothing else, just make sure to sound confident and give as few specifics as possible.

Have the feds pretty much decided to support every person who does not want to work with a minimum income?

At the exponentiation rate SSI and SSDI cases are going up I would have to say yes