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Fun with Program Integrity

Fun with Program Integrity. Division of Child Development and Early Education. Subsidized Child Care Program. Program Integrity Currently no State initiative County level Referral to Program Integrity Investigation by the Child Care Unit. Focus of Program Integrity .

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Fun with Program Integrity

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  1. Fun with Program Integrity Division of Child Development and Early Education Work Support Strategies 2014 Leadership Summit

  2. Subsidized Child Care Program Program Integrity • Currently no State initiative • County level • Referral to Program Integrity • Investigation by the Child Care Unit Work Support Strategies 2014 Leadership Summit

  3. Focus of Program Integrity Emphasis is on prevention and deterrents in the processes by which initial and continuing eligibility is determined: • Efficiency • Thoroughness • Integrity Work Support Strategies 2014 Leadership Summit

  4. Wilson County • Model Program • Piloted December 2000 - March 2001 • Assigned Program Integrity Staff to review Child Care cases • Results • 62 of 692 cases investigated • 18 cases (29%) had evidence of suspected fraud Work Support Strategies 2014 Leadership Summit

  5. Wilson County Discrepancies found • Failure to report father of child(ren) was in the home • Underreported income • Failure to report new employment • Failure to report job loss • Failure to report monetary contributions from sources outside of the home • Failure to report marriage to the father of the child(ren) • Forged employers signature on wage verification forms • Altered check stubs Work Support Strategies 2014 Leadership Summit

  6. Wilson County • Made assignment of Program Integrity Staff to child care a permanent activity • Staff of investigators who divert their time to child care as needed to complete activities • Investigations are completed upfront before applicants are made eligible Work Support Strategies 2014 Leadership Summit

  7. Wilson County Process: • Review all agency records in other programs • Ask who the father of each of each child is and where the father lives and document this information • Complete system inquiry checks • Compare bills to income Work Support Strategies 2014 Leadership Summit

  8. Wilson County Savings calculated as the amount of child care subsidy funds that would have been paid for the family over the certification period Work Support Strategies 2014 Leadership Summit

  9. Wilson County • Critical partnerships between Child Care Team and Special Investigations Team seeks to: • Maximize funding for eligible families • Encourage child support compliance • Promote personal and family responsibility • Ensure program integrity Work Support Strategies 2014 Leadership Summit

  10. Child Care Fraud • DCDEE often hears there is no fraud in child care • Corrections are required at the point of discovery • County reimbursement negatively affected • No recovery incentive • Consider upfront investigations model • Utilize savings from prevention of improper payments as justification for staff time. Work Support Strategies 2014 Leadership Summit

  11. Subsidized Child Care Services Manual DCDEE website: http://ncchildcare.nc.gov • Select “County Staff” • Select “Manuals” • Select “Access the latest version of the Subsidized Child Care Services Manual” Work Support Strategies 2014 Leadership Summit

  12. Chapter 23 Fraudulent Misrepresentation and Overpayments • Two main areas • Fraud • Inadvertent errors • Details responsibilities of the LPA Work Support Strategies 2014 Leadership Summit

  13. Convictions Possible for Fraud • $1000 or less • Class I misdemeanor • Greater than $1000 • Class I felony Work Support Strategies 2014 Leadership Summit

  14. Sanctions Imposed for Fraud Types • Recipient • Provider Work Support Strategies 2014 Leadership Summit

  15. Recipient Sanctions Sanctions less than $10,000 • First Sanction • repay or repayment agreement • Second Sanction • Ineligible for 3 months AND • Repay or repayment agreement • Third Sanction • Permanent ineligibility • Second Sanction Work Support Strategies 2014 Leadership Summit

  16. Recipient Sanctions • Fraud determined for more than $10,000 or • Conviction of Fraud • Results in permanent ineligibility even on the first occurrence Work Support Strategies 2014 Leadership Summit

  17. Provider Sanctions • First sanction • No new children for 12 months • Repay or enter into repayment agreement • Secondsanction • Permanent ineligibly • Repay or enter into repayment agreement • Removal of children receiving subsidy Work Support Strategies 2014 Leadership Summit

  18. Provider Sanctions • Fraud determined for more than $10,000 or • Conviction of Fraud • Results in permanent ineligibility even on the first occurrence Work Support Strategies 2014 Leadership Summit

  19. Sanctions • The LPA imposes sanctions • 10A NCAC 10. 0308 • Must provide appeal rights Work Support Strategies 2014 Leadership Summit

  20. Chapter 24 • Appeals and Hearings • Details the process for appeals and hearings • Types • Parents • Providers Work Support Strategies 2014 Leadership Summit

  21. Parent Appeals • Information contained on • Application of Child Care Services • Child Care Voucher • Child Care Action Notice Work Support Strategies 2014 Leadership Summit

  22. Process for Parent Appeals • Contact Child Care Worker to request a local hearing • 60 days after the effective date of the action • Local Appeal Hearing Officer’s Handbook • Next steps • State level hearing • Petition for judicial review in Superior Court Work Support Strategies 2014 Leadership Summit

  23. Authority for Provider Appeals • 10A NCAC 10 .0311 • PROVIDER APPEAL TO LOCAL PURCHASING AGENCY • 10A NCAC 10. 0312 • APPEAL TO DIVISION OF CHILD DEVELOPMENT AND EARLY EDUCATION SUBSIDY SERVICES REVIEW Work Support Strategies 2014 Leadership Summit

  24. Provider Appeals • Child Care Provider Agreement • Sanction letters • Appeal decision notifications Work Support Strategies 2014 Leadership Summit

  25. Process for Provider Appeals • Request local review Request local hearing by contacting LPA • 30 days form the effective date of the determination of the initial review • Local hearing • Next steps • DCDEE Subsidy Services Appeals Panel • Office of Administrative Hearings Work Support Strategies 2014 Leadership Summit

  26. Contact Information Kim Miller • Program Manager (Acting Section Chief) Subsidy Services Section • Kim.Miller@dhhs.nc.gov • 919-527-6594 • Division of Child Development and Early Education • http://ncchildcare.nc.gov Work Support Strategies 2014 Leadership Summit

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