CCM17050 - Discrepancy Examinations and Enquiries: Information: How are Discrepancy cases identified?

Pre-award cases - when claims are received they undergo automated risk assessment. Claims scoring above the pre-award threshold will be risk assessed by the CCRO to decide whether all the risks can be cleared or whether a claim requires a pre-award examination. If the CCRO can clear all the risks they will put the case into payment, if they are unable to clear the risks they will create an e-SIP and transfer the case to an interventions team. The CCRO will also look for and deal with any organised fraud cases at this stage. Cases with discrepancy risks only will be referred for working as pre-award discrepancy examinations.

Post-award cases are identified by the Risk Team using reports within Business Objects and by undertaking other data matches where necessary.

The types of cases the Risk Team identify are likely to fall into one of the following categories:

• our databases show that the claimant has not declared the previous year income from all their jobs or other relevant sources, e.g. social security benefits, or a benefit in kind
• the previous year income declared by an employed claimant does not match the figure returned by the employer
• the previous year income declared by a claimant who is also an SA taxpayer does not match the income declared on the relevant SA return.
• our information suggests a 16-20 year old is no longer entitled to support
• the claimant has claimed the disability element or severe disability element for themselves and/or their child(ren) but they are not in receipt of the relevant qualifying benefit
• a check with the childcare provider indicates a discrepancy in the amount of average weekly child care costs.

This list is not exhaustive and other cases may be appropriate for discrepancy examinations and enquiries.

Before you get the cases they are checked for accuracy by the Primary Office (PO) risk teams and therefore come with a high degree of assurance of the accuracy of the information.

For examinations, where possible, the PO risk team also check that:

• the case is not already under examination in another office
• the case is not being considered for full examination.

For enquiries, where possible, the PO risk team will also check that:

• the case is not already under enquiry in another office
• the award has not already had an enquiry opened and closed on it
• the case is not being considered for full enquiry
• the case has not been selected for random enquiry
• SA has not closed the enquiry window, see CCM17150.

If the risk team has not completed these checks, you must do so before opening the examination or enquiry.