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The Department of Human Services core values and mission is to strengthen Georgia families by providing individuals and families access to services that promote self- sufficiency, independence, and protect Georgia’s vulnerable children and adults (Department of Human Services, 2001).” One main essential of my job as a food stamp and Medicaid case manager is to provide access to resources that offer support and empower Georgians and their families. There are two types of referrals I have conducted since employed Fraud referral and a resource referral. For example, recently my client Mrs. Wells applied for Parent/Caretaker with children Medicaid for herself and her 7-year-old son. After screening the application, I made a telephone call to Mrs. Wells to conduct her Medicaid interview. During the interview she mentioned that she had recently lost her job after submitting the Medicaid application. At that point I am required by policy to check my interfaces such as Department of Labor to see if Mrs. Wells is potentially eligible to receive unemployment. By policy I am required to refer Mrs. Wells to apply for unemployment benefits and I also refer her to any other resources she would be eligible for such as: food stamps, childcare, child support, and TANF (temporary assistance for needy families). Next, I would have to inform Mrs. Wells of the all the resources available and send her out a verification checklist requiring her to provide proof that she has attempted or applied for these benefits. If the verification is not returned I am required by policy to close Mrs. Wells case until she corporate with Medicaid policy. Along with helping strengthen families we also must promote and encourage accountability, transparency and quality in all services we deliver and programs we administer (Department of Human Services, 2001).
Fraud referrals are created when an intentional program violation has occurred by the client (Department of Human Services, 2001). Common fraudulent actions by clients are failure to report receiving income from employment, unemployment compensation, veteran’s benefits, social security, child support, SSI, etc. Also, when client’s fail to report the correct number of household members in home or changes to the household, failing to report available resources such as stocks and bonds, and misuse of electronic benefit transfer card (EBT card) (Department of Human Services, 2001). As part of DHS policy when a case manager discovers fraud has been committed by a client the case manager must request for investigation, form 5667 (Department of Human Services, 2001). The form is submitted to the State Office of Investigative Services and is assigned to the OIS agent and region responsible for investigation. The referral is reviewed within 30 days of receipt and if it is found a client or clients have committed fraud they could possibly have to pay back all benefits or receive prison time. If the referral cannot be classified as suspected fraud the referral will be returned agency (Department of Human Services, 2001).
“Professional competence is the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and reflection in daily practice for the benefit of the individual and the community served (Johnson, Barnett, Elman, Forrest, Kaslow,2012).”As a case manager I feel that sometimes it is hard to do what is best for the client and apply policy at the same time. For instance, in the example I used about client Mrs. Wells denying her Medicaid case for not applying or attempting to apply for other resources seems like it hurts the client rather than help. On the other hand, my job is also to enforce accountability and not cripple the client. I want to help all my clients but receive the resources they need but I also must help client develop independence.
Department of Human Services. (2001, June 1). Policies. Retrieved from https://dhs.georgia.gov/policies-0 (Links to an external site.)
Johnson, W. B., Barnett, J. E., Elman, N. S., Forrest, L., & Kaslow, N. J. (2012, October). The competent community: Toward a vital reformulation of professional ethics. American Psychologist, 67(7), 557-566.