C—1011 OIG IEVS Process

Revision 21-4; Effective October 1, 2021

TANF, SNAP and Medicaid

The IEVS module within the Automated System for Office of Inspector General (ASOIG) automates the creation, distribution and clearance of IEVS matches for OIG staff. OIG staff review matches from certain IEVS worksheets (primarily Unemployment Insurance Benefits [UIB] and Wage) as a detection source to identify potential fraud, waste or abuse by current or former recipients. OIG uses the IEVS module to process and clear IEVS matches assigned to the OIG Program Integrity Intake unit within 45 days.

 

C—1012 Review the Case Record

Revision 21-4; Effective October 1, 2021

TANF, SNAP and Medicaid

When processing an IEVS match, OIG staff may review case data in Texas Integrated Eligibility Redesign System (TIERS) and the TIERS Historical Case Report (THCR) to determine application entries, interview responses, other eligibility factors and benefits issuance details and history.  

OIG staff research the complete action that occurred before the relevant IEVS income date(s). If the information associated with the match is not found for the period in question in the most recent eligibility action, OIG staff review all actions from the period in question through the current action.

OIG staff may:

• review Data Broker for sources of income by checking Texas Workforce Commission (TWC) Wage Detail, Unemployment Insurance Benefits (UIB) and the Employer New Hire Report (ENHR);
• review other available sources of income information; and
• document findings on the worksheet in the ASOIG IEVS module.

Related Policy

Employer New Hire Report (ENHR) and National Directory of New Hires (NDNH) Report, C-825.12
Texas Workforce Commission (TWC) Wage/Benefits, C-825.13

 

C—1013 Request Verification

Revision 21-4; Effective October 1, 2021

TANF, SNAP and Medicaid

OIG Benefits Program Integrity (BPI) staff request verification if the IEVS Match information on wages:

• was not reported or budgeted correctly in TIERS; or
• was budgeted in the case but the IEVS Match discrepancy amount for an individual employer is more than $300 per month or household income exceeds 130% of the federal poverty level (FPL).

In these situations, verification is required to determine if the income is ongoing and affects current benefits, the income causes an overpayment or both.
OIG BPI staff obtain verification by:

• calling the employer;
• accessing Data Broker; or
• sending an OIG verification letter to the individual and payer.

OIG staff allow at least 10 days from the print date of the letter for the person or payer to provide verification. The request for verification letter informs the recipient that the information is needed because OIG is reviewing the case to determine if benefits were issued correctly.

 

C—1014 OIG IEVS Income Action Messages

Revision 21-4; Effective October 1, 2021

TANF, SNAP and Medical Programs (Except TP 40, TP 43, TP 44 and TP 48)

OIG staff may create an income action message in the ASOIG IEVS module for the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF) program and Medicaid programs, except for TP 40, TP 43, TP 44 and TP 48. The income action message alerts interview staff that more action may be necessary because available information indicates that income is ongoing or resources exist that may affect current eligibility or benefits.

OIG staff summarize findings in the comment section of the income action message. Customer Care Center (CCC) staff view detailed information regarding the income from the automated IEVS match worksheet within ASOIG.

There are three different types of action or information messages that OIG may create in the ASOIG IEVS module.

OIG creates a(n)...	When...
Income Action Message Note: Action messages created based on IRS FTI are limited to those matches with a source listed as "Self" or "Earn."	verifying whether a matched person’s ongoing income affects current eligibility or benefits for the household; or the matched person fails to provide verification of ongoing income. (OIG creates an overpayment referral for the time period listed on the IEVS match if the worksheet indicates that resources affect prior eligibility.)
Resource Action Message	verifying whether a matched person’s resource affects current eligibility or benefits for the household (OIG completes overpayment referral, if appropriate); or the matched person fails to provide verification of existing or ongoing resources. (OIG creates an overpayment referral for the time period listed on the IEVS worksheet if the matched resources affect prior eligibility.)
Resource Information Message	the matched person’s resource is ongoing and is under limit or inaccessible; the matched person’s resource is ongoing, the TIERS case status as of the review date is ongoing denied; or the matched person did not provide verification to OIG and TIERS case status as of the review date indicates ongoing denied.

OIG staff summarize findings in the TW Comments section of the IEVS worksheet. View detailed information regarding the person’s income, resources or both on the IEVS worksheet in the ASOIG IEVS module.

C—1021 Reserved for Future Use

Revision 21-4; Effective October 1, 2021

 

C—1022 OIG IEVS Action Message Clearance Process

Revision 21-4; Effective October 1, 2021

TANF, SNAP and TP 08

Designated CCC staff conduct a daily review of the “MATCH TW Alert Details” in the ASOIG IEVS module and assign HHSC IEVS staff to review and take steps to clear each action message.

HHSC IEVS staff create a task to clear the action message for cases in TIERS within two business days of receiving the message. If these tasks are assigned to specific units, the unit supervisor or a designee (such as a clerk) assigns the task to the appropriate staff by the next business day following receipt. Staff must complete the change within 10 days after the date it is assigned. The date of assignment is day zero.

When an IEVS MATCH TW action message is generated based on IRS FTI, the action or resource message will be on a screen clearly labeled with an FTI warning. All information in the IEVS module containing FTI (such as payer name, account number or pay amounts) is considered IRS FTI. If staff print IEVS module worksheets, they must secure them according to IRS safeguard requirements.

Each worksheet with a message from OIG BPI will indicate the type of action required. OIG BPI staff process action messages if the household did not provide accurate information during the interview or application processing, or if the increase in income identified via IEVS caused the household income to exceed 130% Federal Poverty Level (FPL) for SNAP streamlined reporting (SR) households.

Upon receipt of an action message, HHSC IEVS staff must take the following action to clear the message based on the reason the message was issued.

If the ...	then HHSC IEVS staff ...
verification provided to OIG BPI indicates income affects current eligibility,	send manual Form H1017, Notice of Benefit Denial or Reduction, to deny or reduce the benefits based on income or resources. If staff do not receive verification from OIG, then document that OIG has the verification. Copies of verification received by OIG may be provided to Texas Works staff upon request. provide advance notice and process the denial or adjustment after the adverse action period expires.
person fails to provide verification to OIG BPI,	send a manual Form H1017 to deny the benefits for failure to provide the information. Note: A manual notice and denial is required because TIERS will not allow a denial for failure to provide information without previously issuing Form H1020, Request for Information or Action. for Non-FTI Alerts: In the comments section, document the information the person failed to provide and what the person can do to re-establish eligibility as specified in the Form H1017 instructions. If the person fails to provide the requested information within the adverse action time frame, process the denial for failure to provide information. for FTI Alerts: In the comments section, document the following message: "You failed to provide information to the Office of Inspector General. Contact [OIG investigator's name] at [investigator's phone number] if you have questions. You may reapply for benefits and will be required to provide the information previously requested." "Usted no presentó información a la Fiscalía General. Si tiene alguna pregunta, comuníquese con [OIG investigator's name] al [investigator's phone number]. Puede volver a solicitar beneficios, pero tendrá que presentar la información que se le pidió anteriormente." if the person fails to provide the requested information within the adverse action time frame, manually process the denial for failure to provide information. Note: A manual notice and denial is required because TIERS will not allow a denial for failure to provide information without previously issuing Form H1020. if verification is provided within the adverse action time frame, send an email to the OIG investigator notifying the investigator about receipt of the information and include a copy of the verification. Take action on the case based on the verification provided.

Notes:

• The investigator's name and phone number are listed on the automated worksheet in the IEVS module.
• If HHSC IEVS staff do not provide the case record within 10 days or upon OIG BPI request, OIG BPI staff will contact the regional director.

Additional Information Regarding IRS FTI MATCH TW Action Messages

If HHSC IEVS determines that the person does not have the resource or income for which OIG requested information, staff must request verification of the information (including IRS FTI) using a manual Form H1020, Request for Information or Action. If attaching a verification form, such as a bank verification form or Form H1028, Employment Verification, do not include any IRS FTI on the verification form. File the manual Form H1020 in the case record and secure the case according to the IRS safeguarding requirements, because the case record now contains IRS FTI.

When the person provides the information requested on the verification form, the information on the verification form is no longer considered IRS FTI. The file copy of Form H1020 remains IRS FTI and must be kept in the case record for the duration of the retention period.

When requesting more information that does not contain IRS FTI, staff may issue a second Form H1020 through TIERS or request the information on a manual Form H1020.

Note: If HHSC IEVS staff complete a manual Form H1020 because the only required verification is IRS FTI, TIERS will not allow a denial based on failure to provide verification, since Form H1020 was not generated via TIERS. Staff may generate Form H1020 indicating a manual Form H1020 was provided to the person. Do not provide the notice generated from TIERS to the person. Document the reason for generating an electronic pending notice in the case comments and reference the manual Form H1020 that was issued.

If the person fails to provide the information, issue a manual Form H1017 to deny the case for failure to provide information.

 

C—1023 Reserved for Future Use

Revision 21-4; Effective October 1, 2021

 

C—1024 Client Reapplies

Revision 21-4; Effective October 1, 2021

TANF, SNAP and TP 08

If a person reapplies after being denied for failure to provide information to OIG, interview staff must obtain the verification requested by OIG before recertifying the case. If the person indicates the verification was provided to OIG, contact the OIG investigator. Exception: If the person can reasonably explain why the requested information cannot be obtained or provided, use the best available information.

Note: For FTI-related information, if the person self-discloses the information on the application that was observed through an IEVS FTI action message, the information is no longer considered IRS FTI.

Related Policy

Questionable Information, C-920

 

C—1025 Appeals

Revision 21-4; Effective October 1, 2021

TANF, SNAP and TP 08

If staff receive a request for an appeal based on action taken by:

• OIG, contact the OIG via the Benefits Program Integrity (BPI) mailbox on the same day the request is received.
• Eligibility staff as a result of an action message, file the appeal. Complete Form H4800, Fair Hearing Request Summary, and Form H4800-A, Fair Hearing Request Summary (Addendum). On Form H4800-A, Section 2, Materials Attached, indicate under Other Related Materials, that action messages generated by OIG need to be considered in the appeal. Enter the OIG Investigator's name and phone number on Form H4800, indicating the OIG investigator as potential resource witness.

If OIG receives a request for an appeal based on action taken by eligibility staff, OIG will notify the Central Representation Unit (CRU) the same day. CRU will coordinate with the eligibility staff person who took the action based on the action message. If the appeal is related to an IRS FTI match, OIG may assist by providing more information to the hearing officer according to IRS requirements for safeguarding FTI.

 

C—1026 HHSC IEVS Information Message Review Process

Revision 21-4; Effective October 1, 2021

TANF, SNAP and TP 08

At the region's discretion, staff may contact HHSC IEVS staff to review the messages in the IEVS module before certification of benefits. Information messages serve as a case clue to eligibility staff to identify potential resources not reported by the person applying for benefits.

When a MATCH TW Message is generated based on IRS FTI, the action or resource message will be on a screen clearly labeled with an FTI warning. When based on an FTI match, consider all associated information on the IEVS module such as payer name, account number and pay amounts, as IRS FTI. While eligibility staff are not prohibited from printing IEVS module worksheets with MATCH TW Messages, staff must secure these worksheets per safeguarding requirements.

C—1030 Reversed for Future Use

 

C—1040 Reversed for Future Use

Revision 21-4; Effective October 1, 2021

C—1051 Retention and Distribution of IRS FTI

Revision 21-4; Effective October 1, 2021

TANF, SNAP and TP 08

HHSC IEVS staff are required to retain electronic IEVS worksheets for five years. Staff may log and destroy any printed IEVS module records using IRS safeguarding requirements as soon as they are no longer needed, as the electronic records are available and retained in ASOIG for the applicable retention period.

The following list of forms must be retained for five years from the date of the last entry on the form:

• Form H1861, Federal Tax Information Record Keeping and Destruction Log;
• Form H1862, Federal Tax Information Transmittal Memorandum;
• Form H1863, Federal Tax Information Removal Log;
• Form H1864, Federal Tax Information Fax Transmittal; and
• Form H1866, Federal Tax Information Visitor Access Log.

 

C—1052 Discovery of Existing IRS FTI in HHSC Offices and Records

Revision 21-4; Effective October 1, 2021

TANF, SNAP and TP 08

Staff review information in each case record to identify any IRS FTI as cases come up for recertification or review. Examples of IRS FTI include, but are not limited to, hard copies of old IEVS alerts, copies of the manual Form H1020, Request for Information or Action, and notices requesting verification of IRS FTI. If IRS FTI is in the case record, staff must evaluate if the retention periods are met. If information can be destroyed, complete Form H1861, Federal Tax Information Record Keeping and Destruction Log, before destroying the information according to appropriate FTI safeguard standards. If the information must remain in the case record to support documentation or verification, secure the case record in a two-barrier secure environment until it is okay to purge the case. Regions may elect to separate IRS FTI and place it in a secure centralized location. If the local office does not file the IRS FTI in the case record, note in the case record that IRS FTI exists and is in the centralized location.

Related Policy

Retention and Distribution of IRS FTI, C-1051

 

C—1053 Purging Records

Revision 21-4; Effective October 1, 2021

TANF, SNAP and TP 08

When staff purge paper-based case records, review the records for IRS FTI. If it is okay to remove FTI information from the paper file, complete Form H1861, Federal Tax Information Record Keeping and Destruction Log, and destroy the information. If the record indicates that IRS FTI is filed separately in a secure location, destroy the IRS FTI at the same time the file is purged. Refer to the IRS FTI retention and distribution periods.

Follow appropriate IRS security protocol as adopted in regional or local office procedures for storage and purging of IRS FTI.

Related Policy

Retention and Distribution of IRS FTI, C-1051

Revision 21-4; Effective October 1, 2021

Upon discovery of an actual or possible compromise of IRS FTI or an unauthorized inspection or disclosure of IRS FTI, including breaches and security incidents, the person observing or receiving the information must immediately contact the HHSC IRS coordinator by sending a secure email to the HHSC IRS FTI Safeguards Mailbox.

The HHSC IRS coordinator reports the incident by:

• contacting the office of the appropriate special agent-in-charge, Treasury Inspector General for Tax Administration (TIGTA); and
• the IRS Office of Safeguards, as directed in Section 10.2 of IRS Publication 1075.