5.9.2 Factors to consider | Compensation and Support Reference Library, Overpayment Management Manual, Ch 5 Investigation, 5.9 Fraud Investigations

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5.9.2 Factors to consider

5.9.2.1The following factors should be considered in determining whether it is likely that fraud has occurred. If the answer to any of the following questions is 'yes', the case must be considered to be potentially fraudulent:

  • was the person in a position to have sufficient knowledge to know that the statements and actions being made were unlawful, misleading or deceitful? It should be considered:
  • whether the person was being represented by an agent who may have made incorrect or misleading statements without the person's knowledge
  • whether the person had previously carried out dealings with DVA in an appropriate manner
  • whether the person seemed to be mentally and physically capable
  • whether the rules are clearly available.
  • did the person engage in a course of conduct in order to obtain a benefit, or a higher rate of payment? e.g. false statements
  • did the person deliberately withhold information which should have been presented to DVA?
  • did DVA make a payment or provide a benefit to the person, or would it have done so if the suspected fraud had not been detected?

5.9.2.2A basic guide for determining whether fraud exists is to evaluate the following questions:

  • Was deceit employed?
  • Was the action unlawful?
  • Will it result in money/benefits being received to which the person had no entitlement?
  • Was an attempt made to do any of the above?
  • Was the action intentional?