Narrative: a. 5.

State Quality Service Plan (SQSP)

Integrity Action Plan (IAP)

State Name West Virginia – Fiscal Year (FY) 2024

Accountable Agency Official(s).

List the person or persons accountable for ensuring integrity in the state’s unemployment insurance (UI) program. 

Name:  William Scott

Title:    Acting Director, Unemployment Fraud & Integrity Unit

Email:  William.J.Scott@wv.gov

Phone:  (304) 558-7024

*Note: Unemployment Insurance Program Letter (UIPL) No. 09-23, issued on June 30, 2023, makes reference to UIPL No. 22-21, Change 2, throughout the guidance.  However, on July 13, 2023, the Employment and Training Administration (ETA) issued UIPL No. 10-23, which rescinded UIPL No. 22-21, Change 2.  UIPL No. 11-23, also issued on July 13, 2023, changed the amount of the integrity grant funding originally issued under UIPL No. 22-21, Change 2, but maintained the guidance on required and recommended fraud prevention and detection and overpayment recovery activities.   

• (Topic #1: National Priority) – Ensuring UI program integrity by assessing and evaluating fraud risks, implementing, and maintaining sufficient controls to effectively mitigate the likelihood and impact of fraud, and reducing improper payments.

• In evaluating fraud risks, states should consider both eligibility fraud risks and identity (ID) fraud risks. 

WorkForce West Virginia considers both eligibility and identity fraud risks throughout the claims process. All initial claims are reviewed by agency staff when filed and entered on the benefits system. All claims then have a second review, once entered on the benefits system, by trained staff in the recently established Integrity Unit. The Integrity Unit, established by legislation in 2022, empowers Workforce WV to now not only identify fraud and identity theft within unemployment claims, but to pursue those matters now independently through the investigation process as well as seek prosecution and restitution.  The fraud unit presents criminal investigations for both federal and state prosecution and utilize court ordered restitution included in these prosecutions to greatly enhance the recovery efforts for monetary loss.  The Integrity Unit can work in unison to accomplish multiple tasks to better protect the agency from fraudulent activity by identifying known fraud conduct and fraudulent schemes being used against the agency and be able to place checks and balances in place that are fluid and can quickly adapt to the everchanging attempts and efforts of fraudulent actors. The Integrity Unit also contains a dedicated cross match section, to review claims identified as potentially paid improperly due to unreported wages or incarceration.

• State plans to evaluate UI fraud risks and implement and maintain sufficient controls to effectively prevent fraud and reduce improper payments, including state actions to develop their own state-specific antifraud strategy.

• Key elements of an antifraud strategy include:
  • Who is responsible for fraud risk management activities?
    • Establish roles and responsibilities of those involved in fraud risk management activities, such as the antifraud entity and external parties responsible for fraud controls and communicate the role of the Office of Inspector General (OIG) to investigate potential fraud.
  • What is the program doing to manage fraud risk?
    • Describe the program’s activities for preventing, detecting, and responding to fraud, as well as monitoring and evaluation.
  • When is the program implementing fraud risk management activities?
    • Create timelines for implementing fraud risk management activities, as appropriate, including monitoring and evaluations.
  • Where is the program focusing its fraud risk management activities?
    • Demonstrate links to the highest internal and external residual fraud risks outlined in the fraud risk profile.
  • Why is fraud risk management important?
    • Communicate the antifraud strategy to employees and other stakeholders, and link antifraud efforts to other risk management activities, if any.

• See A Framework for Managing Fraud Risks in Federal Programs at https://www.gao.gov/assets/gao-15-593sp.pdf for additional information.

The Integrity Unit is primarily responsible for fraud risk management activities for WorkForce WV. The Integrity Unit is comprised of investigators, who are former law enforcement officers, a fraud intelligence section, investigative support section, and cross match section. The Integrity Unit works with and coordinates activities with USDOL-OIG, federal, state and local law enforcement agencies, the US Attorney’s Office for the northern and southern districts of West Virginia, as well as WorkForce WV agency staff.

After claims are filed and submitted, there are automated indicators that are placed on claims when identified “red flags” are present. Claims are reviewed and entered by agency staff, at which time staff can place a potential fraud indicator on a claim if necessary. All initial claims are reviewed by Integrity Unit staff after claim entry and all claims are submitted to the IDH. Claims are also reviewed when additional or re-opened claims are filed as well as when any change is made to payment methods. In addition, all adjudication of identity theft or fraud related non-monetary issues is performed by Integrity Unit staff. Fraud risk management activities continue through the entire claim cycle. 

The Integrity Unit is constantly evaluating and monitoring activities, to maintain appropriate response and to be able to react to changes in fraudulent activities. Fraud risk management activities are focused primarily on identity theft, fictitious employer schemes, and cross match activities.

Integrity Unit staff meet with the agency’s executive team, claims and tax staff, and external stakeholders such as employers, law enforcement, and other government institutions to provide information on risk management activities and the importance of protecting the integrity of UI programs.  

• State use of tools, services, strategies, process improvements, and/or procedural changes adopted by the state to combat fraud, verify identities, and enhance recovery efforts.  States must identify which tools, solutions, and service provider(s) are used in the state’s fraud management operations, including but not limited, to the following areas: data analysis, risk-based ID verification, fraud prevention and detection, and cybersecurity.

• Include strategies, solutions, and/or activities using funds the Department has made available to states for combatting fraud and strengthening UI program integrity under UIPL Nos. 28-20; 28-20, Change 1; 28-20, Change 2; 28-20, Change 4; 22-21; 11-23; and 02-22.
• Provide details on overpayment recovery efforts including:
  • Actions with banks, financial institutions, and with Federal law enforcement’s forfeiture and seizure efforts.  
  • Information on how the state is using waivers of recovery of overpayments both for regular UI and temporary UC programs created by the CARES Act, including if the state is using approved blanket waivers as described in UIPL No. 20-21, Change 1.
  • How the state is using the Treasury Offset Program (TOP) for benefit overpayment recovery, how the state is ensuring covered debts are being submitted, and any barriers/challenges in working with TOP.   

Workforce WV information technology support staff are engaged in the fraud detection process, and they also work with Diamond Technologies, the agency’s cyber vendor, to use creative ways of utilizing captured data to prevent and detect fraud.  The information technology support staff also work independently within the Workforce WV mainframe to diligently identify fraudulent patterns, indicators, known threats, etc.…, to be prepared to adjust operations of the mainframe to address identified issues in real time.

Recovery efforts are being greatly enhanced through prosecution/restitution related to fraudulent conduct and identity theft.  The fraud unit is working closely with the United States Attorney’s offices in both districts of WV, while also working with Homeland Security, FBI and US Secret Service to increase efforts in pursuing and recovering monetary loss.  The fraud unit is working with US Bank, who is the financial institution responsible for ACH payments made in response to claims filed with Workforce WV, to recover fraudulent payments made via debit card or direct deposit. 

WV is still processing the backlog of overpayment waivers but are no longer accepting new overpayment waiver applications. WV does not have any barriers/challenges in working with TOP.

• State use of UI Integrity Center resources, with a particular focus on state connection to the Integrity Data Hub (IDH) and use of its datasets to cross-match unemployment compensation (UC) claims and aid in the prevention and detection of fraud and improper payments (see Training and Employment Notice (TEN) No. 24-21);

• Discuss the state’s connection to the IDH, including frequency of IDH use.
  • Does the state submit all initial and continued claims for IDH cross-matching? If not, what is preventing the state from sending all claims?
• If the state is not connected to the IDH and/or is connected but not regularly submitting UI claims data through a webservice/real-time connection to IDH, provide details on the state’s plan for how to increase usage and an anticipated timeline to: 
  • Connect to the IDH.
  • Increase frequency of IDH use.
  • Fully leverage all available IDH capabilities.  IDH capabilities include:
    • Suspicious Actor Repository (SAR)
    • Multi-State Cross-Match (MSCM)
    • Identity Verification (IDV)
    • Bank Account Verification (BAV)
    • Fraud Alerting
    • Foreign Internet Protocol (IP) Address Detection
    • Suspicious Email Domains and Patterns
  • Update the IDH connection to a webservice/real-time connection.
  • Identify barriers to using any of the available IDH capabilities.
• If the state has not executed IDH Participation Agreement - Version 5.0 (see TEN No. 24-21), provide details on the anticipated timeline to update to IDH Participation Agreement – Version 5.0.  
• Discuss the state’s use of the UI National Integrity Academy’s virtual trainings and/or eLearning lessons. 
• Discuss the state’s use of UI Integrity Knowledge Exchange Library resources, including the Behavioral Insights Toolkit (see TEN No. 15-21).
• Discuss the state’s participation in State Consultative Services.

Note: The IDH Team has a one-page dashboard report for each state summarizing current IDH utilization and areas where IDH use might be expanded.  Please reach out to IDHTeam@naswa.org to request a copy of your state’s IDH utilization dashboard report.

The state submits every claim through the IDH weekly.  Workforce West Virginia is fully participating in all available IDH capabilities.  The state has executed the Version 5.0 participation agreement. The Assistant Director of our Integrity Section is an Integrity Steering Committee member, and each member of the Fraud team in the Integrity section has completed, or will complete, the National Integrity Academy’s IDH certificate by the end of September 2023.  The Agency has received approval from the West Virginia Department of Personnel, to provide pay increases to staff upon completion of the National Integrity Academy’s Fraud certificate

• State use of required and recommended integrity controls and overpayment recovery activities as outlined in UIPL No. 11-23, including any additional effective cross-matching and overpayment recovery activities and identified best practices. 

• Provide details regarding the state’s use of each cross-match/integrity control and overpayment recovery activity (required and recommended) as outlined in UIPL No. 11-23.  Include details on the frequency of crossmatch/integrity controls use (e.g., conducted on all initial claims, all continued claims, only when suspicious activity is identified?) and frequency of overpayment recovery activities. 
• Cross-matches/integrity controls and recovery activities include:

Cross-matches/Integrity Controls

• ID Verification; 
• National Directory of New Hires (NDNH); 
• Quarterly Wage Records Cross-match;
• Systematic Alien Verification for Entitlement (SAVE);
• Referral of allegations reasonably believed to constitute UC fraud, waste, abuse, mismanagement, or misconduct to DOL-OIG;
• UI Integrity Center’s IDH;
• Digital Authentication, such as Multifactor Authentication (MFA);
• Device Fingerprint/Reputation Management;
• Fraud Risk Scoring (i.e., Case Management Prioritization);
• Comparisons and cross-matches that detect shared characteristics;
• Social Security Administration cross-matches (i.e., Unemployment Insurance Query (UIQ), Prisoner Update Processing System (PUPS), Death Master File);
• Federal, state, and local incarceration cross-matches;
• Deceased Records cross-matches;
• Vital Statistics cross-matches; 
• State Directory of New Hires (SDNH);
• Department of Motor Vehicle cross-match;
• Interstate Benefits (IB) cross-match;
• State Identification Inquiry (SID) and IB8606 enhancements made to the Interstate Connection (ICON) network cross-match to prevent concurrent claim filing in multiple states;
• Use of a unique identifier to identify claimants instead of using the full SSN; 
• Fictitious employer cross-matches;
• Periodic IT security assessments and audits consistent with National Institute of Standards and Technology (NIST)-compliant information technology security guidelines;
• Adequate internal controls to protect the integrity and security of state assets; 
• Implement a cross-functional integrity task force to develop and implement state-specific action plans to reduce UI improper payments.

Overpayment Recovery Activities 

• Benefit Offsets; 
• TOP;
• Cross Program Offset Recovery Agreement (CPORA); 
• Interstate Reciprocal Offset Recovery Arrangement (IPORA); 
• Negotiating repayment plans;
• Accepting repayments through various methods (e.g., online, via debit/credit card);
• State Income Tax Offset Program;
• Wage garnishments;
• Property liens and assessments;
• Offsets of lottery winnings, homestead exemptions, and other benefits;
• Active participation in probate and/or bankruptcy proceedings;
• Skip tracing; 
• Work proactively and collaboratively with banks and financial institutions;
• Civil actions;
• Credit bureau referrals; 
• State/federal prosecution;
• Penalties and interest on overpayments in compliance with state and federal law;
• Collection agency referrals;  
• Implementing a voluntary fraud self-disclosure program;
• Other recovery methods as determined by state law or policy.
• Identify any additional integrity controls or recovery activities the state uses that are not listed in UIPL No. 11-23. 
• Provide promising practices.
• Identify challenges with cross-matches or in overpayment recovery activities.
• If the state does not currently use one of the integrity controls or recovery activities listed in UIPL No. 11-23, provide the state’s plan and anticipated timeline to request and obtain access to the cross-match/integrity control or to implement the overpayment recovery activity.  

Note: If the state does not plan to obtain access to a cross-match/integrity control or implement a specific recovery activity, please explain. 

Currently WorkForce West Virginia performs manual ID verification of claimant ID documents uploaded through the initial application or presented in-person and utilizes the IDV functionality of the IDH. The agency has started the process to implement ID verification offering through Login.gov and the United States Postal Service. . The state also administers a weekly National New Hire, daily State New Hire, and Quarterly Wage Crossmatch. The state has a unit solely dedicated to the crossmatch process. West Virginia utilizes the Systematic Alien Verification for Entitlement (SAVE) program for initial claims, when appropriate. The state’s Unemployment Integrity Unit refers allegations reasonably believed to constitute UC fraud, waste, abuse, mismanagement, or misconduct to DOL-OIG. WorkForce WV also fully utilizes in all capabilities of the Integrity Data Hub. 

WorkForce WV utilizes Multifactor Authentication (MFA) for staff access to certain systems, but currently does not utilize MFA for claimants.  However, WorkForce WV is working towards securing claimant login and the use of MFA, which is one of the highest priority Tiger Team initiative recommendations for the state.   The state does not currently use device fingerprint, reputation management or fraud risk scoring.

The WorkForce WV benefits system is programmed to identify multiple active claims with shared characteristics, such as email, phone number, and address. Each new claim entered is cross matched through the Social Security Administration Unemployment Insurance Query (UIQ) and the Death Master File cross match is also used.  Workforce WV currently performs state incarceration cross matches and is working towards implementing the Prisoner Update Processing System (PUPS). The agency does not currently have cross match for Vital Statistics or the Department of Motor Vehicles, however some staff have access to the DMV system and can query the DMV information.

Staff review the State Identification Inquiry (SID) on ICON while entering new initial unemployment claims to prevent concurrent claim filing in multiple states and the Benefit Payment control unit uses the IB8606 Intestate Overpayment Reports to crossmatch claimant’s Open/New claims in other states against open/new claims in West Virginia. Each claimant filing unemployment claims is issued a unique claimant identification number, consisting of letters and numbers. Identifying fictitious employers is currently a manual process for WorkForce WV.  The Agency’s internal controls for security are described in detail in Topic #5 of this plan.

WorkForce WV has a dedicated Integrity Unit, created by legislative action,  which is tasked with maintaining the integrity of West Virginia’s unemployment system.  The Integrity Unit contains investigators, who are former law enforcement officers, a fraud intelligence section, investigative support section, and cross match section. The Integrity Unit works closely with unemployment benefits, tax, and front-line staff to reduce improper unemployment payments.

WorkForce West Virginia negotiates repayment plans with claimants and accepts repayment of overpayments in-person or via mail. Claimants may repay their overpayment with a personal check, cashier’s check, or money order made payable to WorkForce West Virginia. One challenge WorkForce West Virginia faces is the inability to accept electronic payments from claimants, but this is something we would like to work towards in the future. 

WorkForce West Virginia adds penalties and interest on overpayments in compliance with state law. When the benefit payment system identifies a claimant with a fraudulent overpayment, the 20% penalty is automatically applied. 

WorkForce West Virginia utilizes the offset of current benefits to recover improper payment of benefits.  When the benefit payment system identifies a claimant with a current claim who also has an overpayment established, current benefits are used to offset the pre-existing overpayment(s).  The benefit payment system then prepares and mails a notification to the claimant which discloses the amount of the overpayment, the current benefits which are withheld and applied to that/those overpayment(s), and the balance of the overpayment remaining after application of the offset of current benefits.

WorkForce West Virginia is enrolled and utilizes the Treasury Offset Program (TOP).  When the benefit payment system detects an overpayment that is eligible to be recovered through TOP a notice is sent to the claimant.  If the claimant’s balance remains unpaid, the debt is submitted to the Department of Fiscal Services servers.  When TOP matches the claimant’s name and SSN to a debt on TOP’s servers, certain payments to the claimant are intercepted and electronically sent to the agency, or programming is notified, who in turn notifies the Benefit Payment Control (BPC) unit that an offset has occurred and must be manually applied.  Once notified of the existence of the payment, BPC then manually applies the offset to the overpayment(s) existing at the time.

Workforce West Virginia utilizes the Interstate Recovery Offset Recovery Arrangement (IRORA) IB8606 Intestate Overpayment Reports to crossmatch claimant’s Open/New claims in other states against open/new claims in West Virginia.  The crossmatch detects potential overpayments due to open claims in two states and detects potential Identity Theft claims in other states and in West Virginia.  Where potential identity theft claims are detected, WorkForce West Virginia notifies the integrity/fraud unit for follow-up.  The state also uses the IRORA IB8606 request database to recover West Virginia overpayments and recover overpayments for other states.  

WorkForce West Virginia’s legal counsel actively participates in bankruptcy proceedings and monitors bankruptcy filings.  WorkForce West Virginia files Proof of Claims in cases where there are assets to be distributed by a trustee, and if Adversary Proceedings are warranted, WorkForce West Virginia will pursue it. WorkForce West Virginia will comply with the order issued by the Bankruptcy Court. 

WorkForce West Virginia utilizes property liens against all claimant who have overpayments resulting from fraud and non-fraud causes.  Overpayments caused by administrative error are not included in the overpayments subject to property liens.  Where a claimant has an outstanding balance on an overpayment, the claimant will be notified that unless they contact BPC to either enter into an agreement of restitution, or pay their overpayment balance in full, a property lien will be presented to the appropriate court for issuance.  

The Agency does not currently have the capability to offset state income tax, lottery winnings, or homestead exemptions. WorkForce West Virginia does not report to credit bureaus or collection agencies and does not plan to do so in the future. Many employers conduct background and credit checks prior to hiring and WorkForce West Virginia does not want to create any additional barriers to employment for the citizens of West Virginia. 

WorkForce West Virginia’s Fraud Unit utilizes skip tracing, civil actions, and works proactively and collaboratively with banks and financial institutions. 

WorkForce West Virginia is currently working on establishing policies and procedures to begin filing civil suits with the Magistrate and Circuit Courts to obtain judgments against all claimants who have overpayments resulting from fraud and non-fraud causes.  Overpayments caused by administrative error will not be included in the overpayments subject to civil suit.  Upon being granted a judgment against these claimants, WorkForce West Virginia will begin the process of garnishing the claimant’s wages.

• State use and employer participation in State Information Data Exchange System (SIDES) (see TEN No. 12-16). 
• Provide details on the state’s current usage of SIDES. 
• If the state does not currently use all available SIDES exchanges, provide the state’s plan for how to connect to all SIDES exchanges and an anticipated timeline to implement each SIDES exchange.  Sides Exchanges include:
  • Separation Information
  • Monetary & Potential Charges 
  • Additional Fact-Finding
  • Determinations & Decisions
  • Earnings Verification
  • Benefit Charges

• Identify any barriers to SIDES exchange participation, either in state promotion or in employer adoption.  

Of the six available SIDES exchanges WorkForce West Virginia currently utilizes two: Separation Information and Earnings Verification. WorkForce West Virginia does not currently use all available SIDES exchanges, however WV plans on implementing additional exchanges over the course of the next year through the Tiger Team initiative. SIDES implementation is the state’s top priority Tiger Team recommendation. One challenge WorkForce West Virginia has encountered with employer adoption of the SIDES exchanges is the lack of reliable internet service within the rural areas of the state. 

• State strategies designed to facilitate claimants’ compliance with state work search requirements while also supporting their reemployment such as adoption of the work search requirements in the Model Work Search Legislation (see TEN No. 17-19).
• Outline the state’s work search requirement and explain state challenges with work search improper payments.
• Discuss the state’s plan to improve work search compliance by reducing work search errors and strengthening reemployment. 

Currently West Virginia law requires that unemployed individuals must be “doing that which a reasonably prudent person in his or her circumstances would do in seeking work.”  Without a law specifying work search requirements, WV requires a minimum of one work search activity per week and only requires individuals to provide the number of job contacts. If claimants are selected for RESEA or a Quality Control Audit, further information regarding work search activities is required. Legislation was introduced in the 2021, 2022, and 2023 Legislative sessions pertaining to requirements on work search, based on the model work search legislation found TEN 17-19, but the bills have not passed in both houses of the Legislature. WorkForce West Virigina plans to reintroduce legislation based on the model work search legislation in the 2024 session 

• (Topic #2) – State plans and actions to address the state's top three improper payment root causes in Payment Integrity Information Act (PIIA) 2022.
• Identify the state’s top three improper payment root causes.
• Explain the state’s challenges in reducing improper payments in the top three root cause categories.
• Discuss the state’s plan to reduce improper payments in each root cause category. 

West Virginia’s top three improper payment root causes for 2022 were Benefit Year Earnings, Able and Available, and Separation Issues. Training for inexperienced staff has continued to be  major hurdle due to backlog of claims, limitations on experienced merit staff to train, and funding to carry out the training. To address all causes of improper payments, the agency has developed online training courses addressing claims processing to better educate staff on proper procedures and how to recognize potential issues. With the creation of the Integrity Unit, a dedicated crossmatch section was also established which should improve the identification of unreported benefit year earnings.  WorkForce WV has also changed the language on the separation reasons on the on-line application, adding terms such as lay off and fired, to help improve claimant responses.  Additionally, through both the Equity grant and Tiger Team initiative, WorkForce WV has plain language projects to improve online applications and claimant notices and make these more understandable to claimants.

• (Topic #3) – State coordination and collaboration with the DOL-OIG and other state and Federal law enforcement agencies to investigate and prosecute UI fraud and recover overpayments.  This should also include state plans to continue providing all confidential UC information to DOL-OIG for purposes of both investigating fraud and performing audits.

The WorkForce WV Integrity unit works closely with DOL-OIG agents to pursue federal prosecution of unemployment fraud and identity theft, as well as working with other federal state and local law enforcement and prosecutorial agencies, such as United States Attorney’s offices in both districts of WV, Homeland Security, FBI and US Secret Service.

WorkForce WV will continue provided confidential UC information, per DOL-OIG’s requirements, using an automated, encrypted, SFTP process, to DOL-OIG’s specifications.  

• (Topic #4) – State plans to strengthen program integrity in UI tax operations, including current activities and plans to identify and prevent worker misclassification, State Unemployment Tax Act (SUTA) Dumping, and fictitious employer schemes, and development/use of effective employer audit strategies (i.e., use of remote audits).  
• Identify current activities and plans to address:
  • Worker Misclassification
  • SUTA Dumping
  • Fictitious employer schemes

• Development/use of effective employer audit strategies (including, but not limited to, use of remote audits).

Currently, WorkForce West Virginia performs random verification audits and investigate tips received from the public concerning worker misclassification. The agency works to educate employers on the guidelines found in state code, which were amended in 2021, concerning the classification of workers as independent contractors. WorkForce WV plans to use additional resources, through the GLDEP, to select at-risk employers, which could potentially be misclassifying workers.   

  WV currently utilizes the SUTA Dumping Detection System (SDDS) to identify potential SUTA dumping. Queries are run quarterly to flag any potential employers which may be involved in SUTA dumping, based on employee movement from one account to another. The Contributions Accounting section investigates the employers identified to determine if any employers have registered new accounts to reduce their unemployment tax rates. 

  In order to identify fictitious employer schemes, each new employer application is reviewed. During this review, staff look for common identifiers of fictitious employers and information is verified through contact with the employer representative(s).  Staff also review accounts which submit payments that are returned for non-sufficient funds and accounts which indicate potential fraud through wage and contribution reporting. The Contributions Accounting section works closely with the agency’s Integrity Unit for assistance with identifying potential fictitious employers.  The Integrity Unit also provides alerts for fictitious employer schemes from IDH to the Contributions Accounting section. The Integrity Unit has trained staff in methods to assist in identifying fictitious employers. WorkForce WV is also developing reports listing employers with backdated liability dates for additional review.

  To employ effective audit strategies, field auditors are working with employers to remotely perform audits and securely receive information utilizing secure shared drives. The agency is also exploring alternate methods to perform remote audits.

• (Topic #5) – State plans and actions to strengthen internal security and ensure that all appropriate internal controls and processes are in place and are adequate to assess internal risks and threats, ensure program integrity, and minimize program vulnerabilities (see UIPL No. 14-17).

Workforce West Virginia(WFWV) is the Agency that administers the Unemployment Insurance Program for the State of West Virginia. The Agency has always strived for Internal Security Controls that ensure all facets of vulnerability associated with Unemployment Insurance. In addition, various levels of staff are utilized to adequately access and mitigate these safety measures to ensure the integrity and security of the entire Unemployment operation. The Agency has continued to enhance various security policies related not only to its physical business locations and equipment but also the agency employees. In fact, all physical building locations have undergone intensive changes to upgrade building security and public access. One of these changes initiated a yearly review of all permitted building access for agency staff. This review not only ensures no entity has access to the facilities but also limits hours and days of the week that employees can access the premises based upon level of job responsibilities. Various premises also have official guards on duty as well as metal detectors. The administrative policy currently requires Agency employees to sign a new Privileged and/or Confidentially and Information Technology Usage Policy Acknowledgement agreement on an annual basis. Various other agreements are signed between employees and the Agency which relate to ethics, telephone usage, workplace security, acknowledge of policy to return an Information Security Incident, etc. To combat potential fraudulent employee activities the Agency has instituted various automated reports that list questionable system access, building access, or other factors are that considered to be abnormal behavior. The occurrence of this type of activity is investigated by the Agency’s Internal Security Division. The Internal Security Division is a separate impartial division within the Agency that has the authority to investigate any type of internal fraudulent activity, risk, or threat as well as perform reviews, assessment, or audits deemed necessary to ensure the integrity of the Unemployment Program operations or systems. To be diligent regarding separation of duties the Agency has always maintained separate divisions within the Unemployment Insurance Program. This security measurement not only provides the separation of duties required but also provides an additional measure of integrity against staff being able to manipulate various processes for personal gain. This type of separation also eliminates one staff member from having the ability to complete all transactions associated with either setting up an employer account or approving unemployment benefits for a claimant.

Currently, the Agency’s Unemployment Program is maintained and operated through a statewide Mainframe System. The Mainframe System is controlled overall by the State’s Office of Technology (OT) and potentially serves various other State Agencies such as the Department of Health and Human Resources. OT in conjunction with each Agency’s IT staff set user authentication, system access protocols, permissions, password criteria, event logs, fire walls, data encryption, data connections, data security, safeguards for the confidentially of the data, disaster recovery plans, antivirus software, security awareness policies & training and overall system security. WFWV’s Unemployment IT Staff are utilized by the Agency to monitor batch processes, system programming updates, issues within the Unemployment Programming files and data as well as monitor the mainframe for any system vulnerabilities that could prove to be a potential security risk. However, the Office of Technology has the overall management oversight of the Statewide Mainframe System. As the overall Mainframe management team, OT is responsible for maintaining the integrity, security, and data for the entire state’s mainframe computer system including libraries of backup files, disaster recovery, etc. WFWV has been involved in several attempts to acquire a more modernized system for the Unemployment Program, however, this has proven to be a difficult task based upon the Software Vendors that currently offer these types of modern systems. The vendors in the community of Unemployment Insurance System are either not diligent in the way the program is developed causing efficiency issues or long-term system vulnerabilities. In addition, the vendor’s prices for both the acquisition of the System and the maintenance are not affordable for a small state. WorkForce WV has developed an RFP for modernization of the UI system which is focused on a microservice architecture, allowing for modular upgrades and enhancements, while improving uptime, with APIs created to seamlessly integrate with other WorkForce systems and operations. WorkForce has submitted the initial application funding for modernization provided by UIPL 11-23 and has had discussions with the state legislature regarding funding for a modernized UI system.

• (Topic #6) – State plans and actions to evaluate the effectiveness and equity of fraud prevention and detection, ID verification, and improper payment reduction activities.  State should include strategies to ensure that processes used to detect and prevent fraud are effective and do not limit the ability for a legitimate claimant to apply for and become eligible for UC.  States implementing or using facial recognition technology in their ID proofing processes must also report findings from bias testing and provide updates on efforts to mitigate biases or barriers in this section of the IAP.  
• Identify potential barriers that are created by fraud prevention and detection functions for legitimate claimants.  Provide plans and actions designed to mitigate such risks.
• As required in UIPL No. 11-23, states must ensure there is at least one timely, effective, and accessible non-digital alternative to online ID verification, which should not be overly burdensome on applicants, limit access to public benefits programs or the timely receipt of benefits, or stigmatize members of the public in any way.  Provide details on the state’s non-digital ID verification option(s). 
• Include how the state flags cases for suspected fraudulent activity and how investigation resources are assigned, including:
  • What risk scoring elements and/or prioritization elements are used.
  • How the risk scoring elements and/or prioritization elements are weighted.
  • How the state evaluates the weights based on false positives and negatives.
  • How risk scoring elements and/or prioritization elements are updated.
  • How the state ensures the fraud risk scoring and/or prioritization of cases does not negatively affect legitimate claimants.

• Include details on how the state measures claimants’ usage of both digital and non-digital identity verification options, how the state reviews digital services for false positive and false negatives, and how the state ensures legitimate claimants have alternative paths to prove their identity and/or resolve issues, including providing a possible recourse.

Workforce West Virginia has designed our prevention measures specifically to avoid friction and barriers for legitimate claimants.   In West Virginia, state law requires a one week waiting period for all claims. This allows the Integrity team to review and evaluate all claims filed for suspicious activity without delaying payments in most cases.  All claims are entered manually.  The Agency has trained claims professionals who review each claim entered for eligibility issues, traditional fraud indicators and suspicious activity.  As previously stated, all claims also receive a similar review by an Integrity team member.  This occurs within the initial waiting period.  During the life of the claim, the Cross Match Unit monitors employer wage reports, with automated programs, to detect possible misuse or fraud.  Currently, West Virginia does not use a scoring element or prioritization in our fraud detection process.   The Integrity team maintains unique data identified in known identity theft claims that is used by the system to place review flags on initial claims with similar characteristics.  Additionally, each new claim filed is reviewed by staff to identify red flags and suspicious behavior or to remove unwarranted stops within three days of the claim being received. All claimants are required to provide a government issued photo identification during the initial claims process, and anytime they change their direct deposit.  These documents are reviewed in the previously mentioned two-phased staff review.  Workforce West Virginia utilizes the full spectrum of NASWA’s IDH review in each claim.  However, we do not place automated stops on claims based on IDH results. Workforce West Virginia has dedicated staff in local offices statewide who are trained to assist legitimate claimants with any barrier they encounter in the claims process.  Any stops placed on claims can be removed by contacting one of our local offices or calling one of our customer service 1-800 numbers.  In addition to providing information on-line or by phone,  to resolve any potential issues due to suspected fraud, claimants may come in person to any WorkForce WV local claims office. All denied claims receive appealable decision letters that give them access to due process. 

• (Topic #7) – State plans and actions to mitigate negative consequences for victims of UI ID fraud, including ensuring simplified processes to remove the victim’s liability for overpayments resulting from ID fraud.
• Include details regarding how the state provides a reporting mechanism for UI ID fraud on their websites, communicates status updates for such investigations, and takes action to protect the victim when the state determines that UI ID fraud has occurred (seeUIPL No. 11-23 for more details on protecting victims of ID fraud).
• Include the state’s procedures for mitigating negative impacts on the UI ID fraud victim (e.g., establishing a pseudo claim record, temporarily marking the overpayment as “uncollectible”, etc.).

Unemployment fraud can be reported via a dedicated email address, by phone, or through the WorkForce WV website.  All emails, calls, and reports received via the website form are received by Integrity unit staff.  Any reports of fraud in person at local offices are also referred to Integrity unit staff. Victims of ID theft unemployment claims who contact the agency receive information regarding recommended steps to take in the event of ID theft, such as credit reporting information and contact information for the three major credit reporting agencies, the FTC, IRS, and Social Security Administration.

Claims which have been identified as ID fraud are flagged as such on the benefits payment system.  This prevents improper payment collections notices from being generated and sent to the victim of ID fraud and any overpayments on the claim are not offset from future benefits. 

• (Topic #8) – If the state has not provided complete and accurate overpayment reporting on the ETA 227 reports (Overpayment Detection and Recovery Activities), and the ETA 902P report (Pandemic Unemployment Assistance Activities), the state must provide information on plans for improvement, including timeframes and milestones, for addressing the issue and ensuring complete, accurate, and timely reporting in FY 2024.
• If the state has submitted all data for the ETA 227 or 902P reports, this section is not applicable, and the state can input “N/A”.

WorkForce West Virginia has corrected the FPUC, PEUC, and EUC issues on the previously submitted ETA 227 reports. WorkForce West Virginia is reviewing and verifying the remaining information on those 227 reports are accurate. WorkForce West Virginia has trained new staff on how to properly complete the ETA 227 report and are working with the technical team to streamline the reporting process to maintain the integrity of the ETA 227 report. 

 WorkForce West Virginia has regained full access to the PUA system as of August 2023 and plans to review the PUA system to ensure the information provided on the 902P report is accurate.