Division of Special Investigations

Assistant Director
Craig Birdwhistell

Phone (502) 564-2815
Fax (502) 564-7876 

The Division of Special Investigations investigates eligibility-based welfare fraud among its responsibilities. Welfare fraud involves intentional misrepresentation of one or more eligibility factors, such as income, resources and household residents, by an applicant for, or recipient of, public assistance. Such cases of fraud also may involve false or inaccurate statements, presentation of false documentation or failure to report changes in circumstances.

Rhonda Williams, Branch Manager
Phone: (502) 564-2815
Fax: (502) 564-7876

This branch is responsible for conducting various special investigations; investigating complaints of recipient and provider fraud and abuse in the state’s Medicaid program (Medicaid preliminary investigations), including a number of privately managed care programs that are part of the Medicaid program; and referring cases for criminal prosecution and administrative collection.

Special Investigations covers a wide array of investigation issues, including offenses against patients in Cabinet for Health and Family Services facilities; theft of Cabinet property; fraud and abuse by Cabinet contractors and vendors; and various personnel matters.

Medicaid preliminary investigations include a wide range of abuse and fraud in the state’s Medicaid program which frequently involve false billing by providers and misuse of the Medicaid card by recipients.

Melissa Milby, Branch Manager
Phone: (502) 564-2815
Fax: (502) 564-7876

This branch is responsible for the Determining Eligibility Through Extensive Review (DETER) program, a collaborative effort between the Office of Inspector General and Department for Community Based Services. The primary goals of the branch are both to stop waste, fraud and abuse of public assistance programs and prevent these crimes before they happen. The DETER program helps DCBS staff by investigating the accuracy of information used to determine eligibility for food stamps, Medicaid, the Kentucky Transitional Assistance Program and child care assistance programs.

While the DETER program focuses primarily on preventing fraudulent receipt of benefits, DETER staff also may investigate active cases when information is questionable or suspect. DETER investigators conduct field investigations to verify eligibility factors that are not routinely available to eligibility workers. These investigations are completed within a 15-day timeframe to provide DCBS staff the information needed to process benefits accurately and promptly.

Stephanie Berry, Branch Manager
Phone: (502) 564-2815
Fax: (502) 564-7876

The Surveillance, Review and Investigations Branch detects, reviews and investigates fraud and abuse by recipients of state welfare, food stamp, child care and Medicaid assistance; establishes claims due the commonwealth; and refers cases for criminal prosecution and administrative collection.

The branch also operates the Medicaid and Welfare Fraud and Abuse Hotline, processes and reviews complaints received on the hotline and from other sources and computer matches with other agencies.

The Division of Special Investigations conducts the following types of investigations:

• Fraud and abuse by physicians, dentists and other Medicaid providers
• Fraud and abuse by recipients in the Medicaid, KTAP, food stamp and child care benefits programs
• Fraud and abuse by grocery stores and other vendors participating in the WIC Program
• Fraud, abuse and other misconduct by CHFS employees and contractors

Because public assistance fraud is a crime, substantiated investigations are referred for criminal prosecution or administrative sanctions.

You Can Help

If you know or suspect that someone is defrauding or abusing one or more of the programs that we investigate, please tell us. While many of our cases are the result of routine computer matches, many others could not have been detected without the help of conscientious and concerned citizens and taxpayers, like you.

To report Medicaid and welfare fraud, please call:
1-800-372-2970

The call is free and you may call any time. If you want to talk to an investigator, please call weekdays, 8 a.m.- 4:30 p.m. Eastern time. At other times you may leave a message.

When you call, please have as much information as possible, including:

• Name(s), address(es) and any alias(es) of the person(s) you are reporting;
• The name(s) and address(es) of any other person(s) who are pertinent to the allegation, including those spouses and children;
• Social Security number(s) and birth date(s) for such person(s);
• A factual statement of the allegation; and  
• The name(s), address(es) and telephone number(s) of anyone who can provide information to us.

You do not have to give your name when you call. However, providing your name and a daytime telephone number will help us if we need clarification or additional information about your complaint. If you give us your name, we will still respect your anonymity.

You may also send your complaint to us by mail. Our address is listed at the top of this page.

Please Note: Our investigative authority is limited to the areas discussed above. We do not investigate matters involving child or adult abuse (except those involving residents of some state facilities); Social Security, SSI or Section VIII fraud; or welfare programs administered by other states. Please report abuse and fraud complaints of this type to:

• Abuse or neglect of a Kentucky resident – 1-800-752-6200
• Food Stamps trafficking in kentucky – 1-800-372-2970
• Food Stamps trafficking in other states – 1-800-424-9121
• Social Security and SSI fraud – 1-800-269-0271
• Section VIII (subsidized housing) fraud – 1-800-347-3735

To report child or adult abuse of a resident of another state, contact the social service agency for the state or county where the person resides.

To report Medicaid or welfare fraud in another state, contact the state or welfare agency for the state or county where the person resides. The United Council on Welfare Fraud maintains links to numerous sites for reporting welfare fraud.