Conn. Agencies Regs. § 19a-59c-6

Current through October 16, 2024

Section 19a-59c-6 - Program abuse

(a)Participant Abuse

(1) In cases of participant abuse of the WIC program, the local agency shall:

(A) issue all warnings either in writing or orally to the participant in the presence of at least one witness, and document the abuse in the participant's file by recording name, date, description of incident and name(s) of witness(es);

(B) if a decision is made to suspend the participant, hand deliver or mail, by certified mail, return receipt requested, a written notice of suspension indicating length of time and reason;

(C) mail a copy of the notice of suspension to the state WIC office within 15 days, and retain copies in the participant's file;

(D) should the participant request a hearing, have the participant complete the necessary hearing form, and forward it to the state WIC office;

(E) report threats or acts of violence against a person or property immediately to the police;

(F) if the abuse in question includes the sale of supplemental foods or checks or their exchange for credit toward the purchase of unauthorized food or other items by the participant,

(i) report by phone alleged or suspected abuse to the State WIC Office immediately, provide written documentation within 15 days, retain a copy in the participant's file, include name, date, description of the incident, names of witnesses, and other appropriate information, and

(ii) implement actions regarding the participant's WIC status as described in subparagraph 19a-59c-6(a) (1) (B) of Regulations of Connecticut State Agencies, as amended, unless given other instructions by the state WIC office, and maintain documentation of actions taken;

(iii) Claims Against Participants - The recovery of the cash value of program benefits which have been improperly issued to a participant due to the intentional misrepresentation or withholding of information may be initiated by the state agency in addition to imposition of the sanctions described in subsection 19a-59c-6(a) of Regulations of Connecticut State Agencies, as amended. The state agency may pursue recovery when the value of the overissuance exceeds $300.00.

(G) inform participant of the right to review termination, disqualification, or suspension from the WIC program in accordance with section 19-2a-1 through 19-2a-40, as amended, of Regulations of Connecticut State Agencies.

(2) Category I Violations

(A) Category I violations are actions related to misuse of checks, including but not limited to:

(i) refusal to follow proper redemption procedures such as signing checks,

(ii) failure to follow proxy procedures,

(iii) selection of unauthorized foods within an approved food category, or

(iv) selection of unauthorized quantities of authorized foods.

(B) Category I violations shall be subject to the following sanctions:

(i) a written or oral warning for the first occurrence within a 12-month period,

(ii) a one month suspension for the second occurrence within a 12-month period, and

(iii) a three month suspension for the third violation within a 12-month period.

(3) Category II Violations

(A) Category II violations are actions related to misuse of program benefits and participant rights, including but not limited to:

(i) verbal abuse of program, local agency or vendor staff,

(ii) redeeming checks which have expired or been altered, and

(iii) purchase of unauthorized foods, or returning WIC foods for cash.

(B) Category II violations shall be subject to the following sanctions:

(i) a written or oral warning for the first actual or attempted occurrence, and

(ii) a three month suspension for any subsequent, actual or attempted occurrence within a 12-month period.

(4) Category III Violations

(A) Category III violations are actions related to deliberate fraud or abuse of the WIC program, including but not limited to:

(i) physical abuse of program, local agency or vendor staff;

(ii) misrepresentation of eligibility for program benefits;

(iii) purchase of non-food items;

(iv) purchase of alcohol or tobacco products;

(v) exchanging checks for cash;

(vi) sale of WIC foods;

(vii) receipt from food vendors of cash or credit toward purchase of unauthorized foods or other items of value in exchange for checks; or

(viii) simultaneous participation in more than one local agency WIC program.

(B) Category III violations shall be subject to a three month suspension for any offense.

(b)Applicant Abuse - Sanctions shall be applied by the local agency when an applicant knowingly and deliberately misrepresents circumstances to obtain WIC benefits, or, when an applicant uses verbal or physical abuse or threat of physical abuse to local agency, clinic or vendor staff or property, or refuses to cooperate when asked for information.

(1) Penalty - Denial of participation in the WIC program.

(2) The local agency shall:

(A) issue a written Denial of Participation Notice stating the reason for the denial and the right to a hearing;

(B) mail a copy of the Denial of Participation Notice to the state WIC office within 15 days, which shall include a notice of the right of review, and retain copies in the participant's file;

(C) should the applicant request a hearing, have the applicant complete the necessary hearing form and forward to the state WIC office; and

(D) report threats or acts of violence against a person or property immediately to the police.

(c)Vendor Abuse - Sanctions are to be applied by the state WIC program against vendors based on the nature and severity of violations and the Vendor authorization agreement. Depending upon the offense, the state WIC program may impose the following:

(1) Warnings - A warning letter shall be sent to the vendor upon documentation of the first violation for abuses in accordance with the WIC vendor agreement for certain abuses.

(2) Fines and disqualifications - civil penalties-a civil penalty pursuant to Section 19a-59d of the General Statutes may be imposed on vendors in lieu of or in addition to disqualification. Disqualification may result upon documentation of certain abuses by a vendor in accordance with the following:

(A)Class A violations: An automatic three-year disqualification shall be assessed for the following violations:

(i) providing cash for redemption of a WIC check,

(ii) allowing cigarettes or alcoholic beverages to be purchased with a WIC check,

(iii) allowing any non-food items such as soaps, paper goods, etc. to be purchased with a WIC check,

(iv) not providing refunds or not paying fines by the due date as requested by the WIC program,

(v) using a counterfeit WIC vendor stamp,

(vi) receiving, transacting, or redeeming WIC checks outside of authorized channels or through unauthorized persons,

(vii) forging the signature of a WIC participant/alternate or a designee of the WIC program on any WIC document,

(viii) charging the WIC program for foods not received in exchange for a WIC check as determined during compliance purchases or check audits, or

(ix) charging the WIC program more for WIC foods than the lesser of the shelf or sale price at the time of purchase as determined during compliance purchases or check audits.

(B)Class B violations: A six-month disqualification or a five hundred dollar ($500.00) fine in lieu of disqualification shall be assessed for each occurrence of the following violations. Upon the fifth Class B violation within a one-year period, a two-year disqualification shall be imposed. The option to pay a fine shall not be available at that time:

(i) the inability to justify WIC redemptions through documented WIC food item purchases,

(ii) pricing a WIC check by type rather than by the actual purchase price of the foods,

(iii) not providing information as requested by the WIC program within the time frame that is stated,

(iv) not having the participant enter the purchase price in ink on a WIC check at the time of the purchase, or

(v) redeeming a WIC check for any food not specified on the WIC check or WIC food list.

(C)Class C violations: A three-month disqualification or a two hundred fifty dollar ($250.00) fine in lieu of disqualification shall be assessed for each occurrence of the following violations. Upon the fifth Class C violation within a one-year period, a one-year disqualification shall be imposed. The option to pay a fine shall not be available at that time:

(i) accepting a WIC check before the approved WIC foods have been provided or for credit, iou's or rain checks,

(ii) redeeming an altered WIC check,

(iii) not attending assigned training sessions,

(iv) allowing the return of any WIC purchases, or

(v) providing false information on any WIC document or on any WIC request for information.

(D)Class D violations: A one hundred twenty-five dollar ($125.00) fine shall be assessed for each occurrence of the following violations. Upon the Fifth Class D violation within a one-year period, a six-month disqualification shall be imposed. The option to pay a fine shall not be available at that time:

(i) not checking the WIC program identification card or folder at the time of purchase,

(ii) not verifying the WIC participant/alternate signature at the time of purchase,

(iii) not posting all WIC food prices on the item itself or on the shelf or door in front of the item,

(iv) not having the minimum inventory of WIC-approved foods on shelves at all times,

(v) not providing savings to WIC participants/alternates through the use of coupons or store offered promotions that include WIC authorized foods, or

(vi) accepting a WIC check before the "first day to use" or after the "last day to use" as specified on WIC checks.

(E) FNS Programs- whenever a vendor is disqualified from participation in any other FNS (Food and Nutrition Service) program such as the Food Stamp Program, the vendor shall also be disqualified from participation in the WIC program for the same length of time up to a maximum of three (3) years. Also, if a vendor is assessed a civil money penalty in lieu of disqualification from a FNS program, that vendor shall be disqualified from the WIC program for the same length of time that the FNS program would have disqualified the vendor up to a maximum of three (3) years. In addition, if a vendor is assessed a settlement fine, or any other monetary penalty or fee relating to a disqualification from the Food Stamp Program, a WIC civil penalty shall be assessed the vendor equal to the lesser of the FNS penalty or two thousand five hundred dollars ($2500.00).

(F) Intent to pay- if the option to pay a fine in lieu of disqualification for Class B or Class C violations is elected, the total amount of the fine is payable on or before the date the disqualification would have been effective. The notification of intent to pay the fine shall be received at the department of Public Health within seven (7) days of receipt of the WIC program sanction letter. Any fines levied for Class D violations are payable fifteen (15) days from receipt of the WIC program sanction letter.

(G) Undue hardship - if the WIC program determines that there shall be undue hardship for WIC participants if a vendor is disqualified, the store shall be allowed to remain on the program until such time that undue hardship no longer exists. A fine of two thousand five hundred dollars ($2500.00) shall be paid by the vendor to continue to accept WIC checks. A hearing may be requested to determine if the disqualification is warranted. At such time that the WIC program determines that undue hardship no longer exists, the vendor shall be notified that the original disqualification shall be effective fifteen (15) days from receipt of the letter. The vendor may request a hearing for the sole purpose of arguing the issue of undue hardship.

(H) Aggregate fines - any store that has paid more than two thousand five hundred dollars ($2500.00) in fines in the last three (3) years shall not be selected for authorization.

(3) Expiration - records of violations shall be erased after related disqualification periods have been served. However, warnings shall remain active during the entire term of the store's current ownership.

(4) Termination. The right to terminate the Agreement may be exercised by either party upon not less than fifteen (15) days advance written notice. Neither the State of Connecticut, Department of Public Health nor the vendor has any obligation to renew the Vendor Agreement.

(5) Waiver of Sanctions - The state WIC program may waive the action against the vendor if such action would significantly impair the ability of the state WIC program to meet its goals and objectives.

(6) Notice of review: Any person aggrieved by an order issued by the state WIC program may request a review of the order by the commissioner. Expiration of the agreement is not subject to review. The request for review shall be received by the commissioner within seven (7) days of the date of issuance of the order. If the seven (7) day period expires on a day which is not a normal business day for the department, the time period for making a request for review shall be extended through the close of business of the first regular business day following.

The request for review shall state:

(A) the name of the person claiming to be aggrieved;

(B) the nature of the claimed aggrievement;

(C) the order being reviewed; and

(D) the grounds for review.

Conn. Agencies Regs. § 19a-59c-6

Effective March 2, 1993; Amended April 3, 1998