Section 465-2-004 - FRAUD, ABUSE, AND INTENTIONAL PROGRAM VIOLATIONS Department employees must report cases of suspected fraud, abuse, and intentional program violations to the individuals designated by the Department to receive such reports or to conduct investigations. The following definitions apply:
004.01FRAUD. Fraud includes, but is not limited to, obtaining, or attempting to obtain, or aiding or abetting any person in obtaining, by means of a willful false statement or representation, or by impersonation, or other fraudulent device:(A) Any commodity, food stuff, food coupons, or payment to which the individual is not entitled;(B) A larger amount of payment than that to which the individual is entitled;(C) Any other benefit administered by the Department to which the individual is not entitled; or(D) Public assistance in violation of any lawful provision relating to programs administered by the Department of Health.004.02INTENTIONAL PROGRAM VIOLATION. Intentional program violation consists of any action by an individual to purposely: (A) Make a false statement, either verbally or in writing, or conceal information to obtain, or attempt to obtain, benefits to which the household is not entitled;(B) Use or receive supplemental nutrition benefits in a transaction involving the sale of a controlled substance;(C) Use or receive supplemental nutrition benefits in a transaction involving the sale of firearms, ammunition, or explosives;(D) Traffic supplemental nutrition benefits for an aggregate amount of $500 or more; or(E) Make a fraudulent statement or representation with respect to the individual's identity or place of residence to receive multiple supplemental nutrition benefits simultaneously.004.03PROGRAM ABUSE. Provider practices that do not meet the definition of civil or criminal fraud under applicable state law, but nonetheless are inconsistent with sound fiscal, business, or medical practices.465 Neb. Admin. Code, ch. 2, § 004
Amended effective 9/17/2024