3-Attachment B - Scope of Work.docx

Attachment B: Scope of Work WIC Compliance Buys and Private Investigations

Article 1

DEFINITIONS

1.1 Definitions. In this contract the following definitions apply:

“Compliance Purchase” means a single visit to a WIC vendor to purchase allowable and non-allowable foods and items by an Investigator to check for compliance with federal and state WIC transaction procedures.

“Compliance Investigation” means an investigation of a WIC vendor for compliance with federal and state WIC transaction procedures, made up of one or more Compliance Purchases.

“Fair Hearing” means a hearing, in accordance with federal WIC guidelines, requested by a WIC vendor that disagrees with the DHHS decision.

“Investigator” means Contractor personnel who conduct Compliance Investigations.

“WIC” means the federal Women, Infants, and Children program.

“WIC Food Instrument” means any authorized form of tender used to purchase WIC approved food items, including electronic benefits stored on a smartcard.

“WIC Vendor” means a grocery store that is authorized to accept WIC transactions in Utah.

Article 2

SERVICE REQUIREMENTS

2.1 Kick-off Meeting. Within 60 days of the contract effective date, the Contractor shall schedule and complete a meeting with DHHS to train the Contractor’s staff on:

(1) background of WIC nationally and in Utah;

(2) the concept of WIC Vendor Management in accordance with state and federal guidelines;

(3) this contract, including all instructions, policies and procedures for carrying out successful compliance purchases and investigations; and

(4) communicate expectations between DHHS and Contractor.

2.2 Contractor Responsibilities. The Contractor shall:

(1) conduct all Compliance Investigations;

(2) prepare a confidential case file on each vendor that will be investigated:

(A) at a minimum, each file will contain a copy of all documentation used in preparing the final report, including any additional investigative information that could be used in an administrative hearing; and

(B) all information gathered by Contractor is Confidential and should not be disclosed to anyone outside DHHS;

(3) when requested by DHHS, send Investigators to conduct Compliance Investigations:

(A) Compliance Investigations may include attempts to:

(i) purchase authorized WIC foods without attempting any specific violations;

(ii) purchase non-food items with WIC Food Instruments;

(iii) obtain cash from the vendor in exchange for the WIC products after the sale;

(iv) purchase WIC foods in excess of the quantity authorized;

(v) return the WIC foods for cash, credit, or another negotiable tender;

(vi) determine if WIC participants are being charged higher prices or charged for food not received;

(viii) defraud WIC through other activities.

(4) ensure that Investigators are qualified to complete Compliance Investigations:

(A) each Investigator must be familiar with WIC investigative procedures:

(B) ensure each Investigator is 18 or older and

(i) who would present to others as though they would meet the eligibility qualifications for the WIC program

(ii) dress like a local shopper at each store (rather than as an Investigator);

(iii) testify at a hearing when required;

(iv) be prepared with a cover story (in accordance with DHHS training and guidance);

(v) drive an inconspicuous vehicle, unmarked, and reflecting WIC participant demographics;

(vi) be familiar with how to use the Utah WIC card;

(vii) understand and avoid entrapment by not influencing or coercing store personnel to commit an illegal act that they would not have normally committed in the absence of such influence or coercion during an investigation; and

(viii) conduct each investigation without being belligerent, forcing violations, or attempting to create sympathy that might entice violations.

(C) ensure that Investigators:

(i) are not aggressive, threatening, or antagonistic in their mannerisms; and

(ii) do not have any criminal misdemeanors or felony convictions;

(D) have any conflicting interests in the outcome of the investigation, including employment with:

(i) DHHS or local WIC agencies; or

(ii) or owner of, WIC authorized stores.

(E) DHHS may reject any Investigator.

(5) Investigators must comply with DHHS guidelines when conducting Compliance Purchases including:

(A) approaching the vendor inconspicuously;

(B) walking through the store and mentally note (document in writing as soon as possible after the visit) any WIC food items the vendor may be lacking, as specified in the Utah WIC Vendor Agreement stocking requirements;

(C) selecting food items for purchase as contained on the WIC card;

(D) checking if prices are clearly marked on the shelf or, if not on the shelf, then marked on the individual item;

(E) not buying any other items for cash during the visit unless directed to do so by

DHHS;

(F) following any standard store procedures for WIC transactions, including any directions from store employees;

(G) documenting any procedures for WIC transactions that do not follow state WIC policies;

(H) not informing the cashier it is a WIC transaction;

(I) observing physical details of the store employee/cashier closely;

(J) watching for nametags and listening for any name that might be called out;

(K) attempting to remember or record all conversations between the Investigator and the cashier;

(L) if the cashier refuses to sell ineligible or non-food items, following the cashier’s instruction and using the WIC card as directed by the cashier;

(M) leaving the store if threatened or if other significant problems occur;

(N asking politely for receipts if not offered;

(O) saving all receipts to include with the Compliance Investigation Report;

(P) photographing the items purchased in the Compliance Purchase and include the photos in the investigation documentation;

(Q) photographing the store front at completion of each Compliance Purchase and include the photos in the investigation documentation;

(R) preserving all perishable foods according to safe food handling practices, using a cooler with ice for storage of perishable foods in the investigator’s vehicle;

(S) donating all items purchased during the Compliance Purchase to a local food bank or pantry within 24 hours of purchase;

(T) including the donation receipt in the Compliance Investigation Report;

(U) providing the original copy of the Compliance Investigation Report to DHHS within five working days;

(i) the Investigator shall retain a copy of the Compliance Investigation Report;

(V) for every Compliance Purchase, submitting all required documentation accurately;

(W) if subsequent Compliance Purchases are required, using a different cashier from the first visit during the check-out procedure, when possible, and;

(X) a minimum of two and a maximum of three Compliance Purchases per store after a previous violation, unless otherwise directed by DHHS;

(i) DHHS may require that special Compliance Purchases are conducted based on violations and;

(ii) in these cases, only one Compliance Purchase may be necessary.

2.3 Written Reports. The Contractor shall:

(1) include the following in the Compliance Investigation report:

(A) name and address of the store investigated;

(B) Investigator name;

(C) time Investigator entered and left the store;

(D) a general, brief description of the subject store, including general the store’s appearance;

(E) a brief description of the cashier including name on tag and other identifying features;

(F) whether the cashier provided the Investigator with multiple receipts;

(G) the food items purchased, including container size, brand name, and the prices marked on the shelf or food item;

(H) whether the cashier appears to be familiar with Utah WIC redemption procedures;

(I) if the Investigator overheard any conversations or observed any actions relevant to the investigation (such as negative comments about the Investigator being a WIC participant, civil rights violation, or other negative comments about the WIC program);

(J) any conversation the Investigator may have with the cashier or overhears between store personnel regrading, selling the WIC Food Instruments for cash or purchasing unauthorized or non-food items, and;

(K) signatures of the Investigator and any assistants who participated in the Compliance Investigation.

(2) provide the Compliance Investigation report to DHHS once all Compliance Purchases are complete after every Compliance Investigation visit;

(3) understand the Compliance Investigation report may be introduced as evidence at a Fair Hearing, along with the Investigator and any assistant’s personal testimony.

2.4 Fair Hearings.

(1) DHHS shall notify the Contractor of the scheduled Fair Hearing date; and

(2) The Contractor shall be responsible for ensuring the Investigator appears at the Fair Hearing.

2.5 Compliance Investigation Schedules for Compliance Investigations. DHHS shall:

(2) require the first Compliance Investigation is conducted within 90 days of the Contractor receiving the list of stores from DHHS:

(A) any subsequent visits must be within ten days of the recommended dates for follow-up visits as specified by DHHS, preferably on a different day of the week and time of day than the first visit.

(3) assign 15-25 stores for Compliance Investigations between January and the end of August each year;

(4) expect that each store selected shall receive two or three Compliance Purchases between January and August, annually;

(5) require documentation and written reports be received by DHHS upon completion of each round of Compliance Investigations; and

(6) require that all Compliance Investigations are completed by August 31st each year.

3.6 Investigator Training. The Contractor shall:

(1) coordinate with DHHS to prepare each Investigator;

(2) provide each new Investigator with training on Utah WIC vendor compliance policies

(3) coordinate with DHHS to receive training in advance of the first compliance investigation;

(4) discuss any suspected or potential violations with the Investigator;

(5) familiarize the Investigator to prepare a cover;

(6) provide the Investigator with the WIC card used to make the purchases; and

(7) provide training and assistance in documenting all information to the Investigator.

Article 4

OUTCOMES

4.1 Outcome. The intended outcome of this contract is to fulfill federal requirements to evaluate 5% of WIC authorized vendors annually to prevent fraud, waste, or abuse of WIC funds.

4.2 Performance Measure. The Contractor will meet the deadlines for all compliance and investigations work annually.

4.3 Reporting. The Contractor shall provide a written report to the DHHS after each round of Compliance Investigations are completed.