Unemployment Insurance Agency making progress in reviewing insurance fraud determinations
May 03, 2017
LANSING, Mich. – The Unemployment Insurance Agency is making progress in reviewing about 28,000 fraud cases determined between 2013 and 2015, confirming about 52.5 percent of the cases and reversing about 47.5 percent of the cases reviewed this year.
Director Wanda M. Stokes of the Talent Investment Agency said UI expects to have all of the remaining cases reviewed by the end of July. UI is part of the Talent Investment Agency.
“We need to be a resource for people during a difficult time in their lives, and the agency is working hard to rebuild trust,” Stokes said. “We are addressing these serious problems from the past while looking forward to improve customer service and restore confidence.”
In all, the agency is reviewing roughly 50,000 cases involving about 40,000 people determined between October 2013 and August 2015 when a computer program was used to identify fraud and assess penalties.
More than 20,000 cases that were auto adjudicated by the computer were reviewed in 2016. The agency is now reviewing the roughly 28,000 cases that were identified by the computer, but had some level of staff involvement.
The agency ceased auto adjudicating potential fraud cases in August 2015, and now only trained staff make such determinations.
Stokes said 14,454 of the 28,000 cases have been reviewed, and expects the process to be completed by the end of July. Of the fraud cases reviewed, the original decision was affirmed in 7,582 cases. The agency overturned 6,872 fraud determinations, a 47.5 percent reversal rate.
Reasons cases were reversed include:
- Quarterly wage information. In 72 percent of the reversals, the agency originally averaged wages over an entire quarter, which led to a fraud finding. This practice to establish that a claimant worked during a period that he or she did not claim wages was subsequently disallowed by U.S. Department of Labor. These cases are reversed during the review process, unless an employer provides the agency with a weekly breakdown of wages. Often, it is difficult to get the employers to comply.
- New Information received. In 15 percent of the reversals, the agency was able to contact a claimant and obtain additional information that was not previously available.
- Information was on file, but arrived after the decision. In 7.5 percent of the reversals, the agency had information that was received after the original decision was made. It is now being considered during the review of the cases.
- No overpayment. In 5 percent of the reversals, the agency determined that there was no overpayment of UI benefits in the original case. A fraud decision cannot be supported without an overpayment of benefits.
- Michigan Administrative Hearing System returned cases. In 0.5 percent of the reversals, MAHS returned the case for a reconsideration of the agency’s original decision.
A refund was owed in 13 percent of the reversed fraud cases, and the agency has paid out $722,093. In many cases the agency did not collect anything on the penalty owed by the claimant.
Stokes in January announced a three-point plan to address challenges at the UI, including a review of the leadership and organizational structure. Michelle Beebe of Utah was selected to be senior deputy director for Unemployment Insurance, tapped after a national search. She begins on Monday.