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Eligibility and Credentialing Schemes

Eligibility and credentialing schemes, though different, are related because they both involve misrepresentation of a person or vendor’s qualifications.

  • Eligibility Schemes: Governments dispense large amounts of money to the poor, the indigent, the aged, the unemployed and the disabled. To qualify to receive these funds, individuals have to meet certain established criteria as to property, earnings, medical condition, age, number of dependents, employment, etc. In some cases, as is the case with health insurance coverage provided by governments to employees, eligibility fraud involves fraudulently claiming a dependent. In other cases, fabricating a disability or misrepresenting one’s attempts to secure employment, can result in governments inappropriately footing the bill. In all such situations, eligibility fraud involves the false representation of one’s qualifications in order to get financial benefits to which the fraudster is not entitled.
  • Credentialing Schemes: In letting contracts, governments often require that bidders possess certain skills, experience, education or certification. A bidder might have to be a CPA or possess a doctorate in his or her field to qualify for an award. Perhaps the bidder is required to have designed bridges or prisons. In hiring personnel, governments may also require of job applicants a certain level of education, length of experience or type of skill. A fraudster who falsely represents his or her education, experience, skill set, licensure, etc., in order to get a position or a contract is guilty of credentialing fraud.
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General Guidance

Failure to produce required documents when requested.

Documents that appear to be "handmade." Signals may include documents that lack or have ineligible seals, are photocopies, or otherwise appear to be inauthentic.

Inconsistencies in curricula vitae and resumes.

Inability to contact references.

Inability to contact corroborators.

Inability to verify contents of applications.

References should be checked and resumes verified. If representations appear invalid, management should be notified.