1 / 29

Connecticut DSS Staff

Connecticut Department of Social Services Care 4 Kids Child Care Subsidy Program Program Integrity Methods October 27, 2010. Connecticut DSS Staff. Michael P. Starkowski, Commissioner Peter Palermino, State Administrator Theresa Emery, Public Assistance Consultant

britain
Download Presentation

Connecticut DSS Staff

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Connecticut Department of Social Services Care 4 Kids Child Care Subsidy ProgramProgram Integrity Methods October 27, 2010

  2. Connecticut DSS Staff Michael P. Starkowski, Commissioner Peter Palermino, State Administrator Theresa Emery, Public Assistance Consultant Don Beltrame, Public Assistance Consultant Brian McGuiness, Investigation Supervisor

  3. Agenda • Overview of Care 4 Kids Subsidy Program • History of Program Integrity Methods - Questions and Answers • Current Administrative Controls - Questions and Answers • Fraud Preventive Measures/Results - Questions and Answers

  4. Connecticut Child Care Subsidy Program • Outsourced to Statewide R&R Agency, which determines eligibility, processes invoices, etc. • $100 Million Annual State/Federal Benefits • 22,000 Kids/15,000 Families Monthly • Applications - 1,800/month • Redeterminations – 1,250/month • 1,400 licensed / 3,500 unlicensed providers

  5. Connecticut Child Care Subsidy Program Organizational Chart

  6. DSS Quality Control Reviews • Started QC reviews when subsidy program was outsourced in 1997 • Reviews parallel federal SNAP review process • Statistically valid sample of 100 cases per quarter • Measured contractor and client error

  7. QC Error Findings(1997-2003) • Contractor error averaged 5% - 6% • Client error averaged 15% - 18% • Client error ranged as high as 23%

  8. Contractor Error Categories/Incidence(1997 – 2003) • Income computed incorrectly or verified (38%) • Family co-pay not deducted (13%) • Reported or known changes not pursued (9%) • Approved care hours not verified (8%) • Ineligible provider arrangement approved (7%) • School schedule overlapped care hours (5%) • Incorrect household composition (5%)

  9. Client Error Categories/Incidence(1997-2003) • Unreported job loss/did not attend training (24%) • Misrepresentation of: • Work hours or shift (22%) • Income (4%) • Provider not available during care hours (15%) • Unreported: • Income (10%) • Spouse in household (6%) • Change in employment (5%)

  10. Questions and Answers

  11. Corrective Actions • Change regulations & procedures • Enhance staff training and development • Increase monitoring (DSS and Contractor) • Mine data and expand access to other state databases • Develop fraud detection/prevention strategies

  12. Regulation and Procedure Changes • Payment for care based on: • A range of hours vs. strict per hour rates (e.g. half and full-time) • Enrollment vs. actual attendance • No change in co-payment between redeterminations • Go paperless (document imaging) • Increase utilization of third party verifications • Amend vendor fraud statute to include child care providers and lifetime disqualification penalty • Mandate compliance with QA and Investigations

  13. Staff Training and Development • Fund 2 full-time contractor training positions • Establish 3 month training program for newly hired staff • Increase use of policy transmittals, reminder bulletins and desk aids • Targeted training and refresher training of error prone categories

  14. MONITORING • Greater coordination between DSS and contractor • Maintain an on-site presence • Corrective action planning meetings • Monthly desk reviews by contractor • Additional system edits • Annual audits by DSS Child Care Team and state auditor

  15. Data Mining • Unlicensed providers with: • Out-of-state residence • PO Boxes • Excessive care hours authorized • Number of children in care exceeds provider limit • Multiple providers reside at same address • System screen data not populated

  16. Database Interfaces • Depts. of Labor, Motor Vehicle, Corrections dbases • DSS Public Assistance mainframe (EMS) • TANF E&T dbase • Child Support dbase and Paternity Registry • Child abuse/neglect data match • IRS/TIN data match • NAEYC data match • Licensed provider data match • Medicaid provider disability data match

  17. Questions and Answers

  18. Fraud Prevention Measures and Results • FRaud Early Detection (FRED) unit created2005: • Home visits and verification of information • Follow-up home-visits for error prone providers • Active Case Assessment Program (ACAP) unit created 2007

  19. DSS Quality AssuranceOrganization Chart

  20. Fraud Early Detection (FRED) Purpose – identify, investigate and determine errors before paying benefits. Staff – 4 full-time non-law enforcement investigators and 1 unit supervisor Complete 120 referrals/mo: 1,421 in SFY 10 Cost Avoidance –$4.4 million SFY 10 –$15.8 million SFY 08-10

  21. FRED REFERRAL SOURCES • 1-800 Fraud hotline • C4K contractor via automated system • DSS eligibility staff • Database matches • Other, i.e. special projects, provider referrals, law enforcement agencies

  22. FRED PROCESSReferrals Top 5 Targeted Error Prone Categories Self-employment Cash employment Questionable household composition 2nd & 3rd shift work hours Young Male Providers

  23. FRED PROCESS investigation Investigation Steps: Case reviews and contractor interviews Database and Internet searches Third party verification - landlords, employers, property records, banks, court records, etc., Field visit to home, work or child care site Subpoena authority

  24. Active Case Assessment Program (ACAP) Parallel to FRED but with active cases Staff – 4 full-time non-law enforcement investigators and 1 supervisor Investigate historical and current eligibility Prepare Arrest Warrant Affidavit Testify in court proceedings

  25. ACAP Activity(2007 – 2009) • Completed 1,220 investigations • 142 arrest warrant affidavits - 50 criminal convictions - 92 accelerated rehabilitation (AR) granted • 121 program disqualifications • $500,000 cost avoidance in SFY 10 • $700,000 recovered in SFY 10

  26. ACAP Activity (cont.) • #1 Priority is prosecution • $8,450 - Avg. claim value • $136,000 highest value case • Most adjudicated with full restitution • Lifetime disqualification if provider convicted or given A&R

  27. FRED/ACAP Partnerships

  28. Questions and ANsWERS

  29. For More Information Contact: CT Child Care Subsidy Program – Child Care Team: Peter Palermino – (860) 424-5006 Peter.Palermino@ct.gov Don Beltrame (860) 424-5363 Don.Beltrame@ct.gov Office of Quality Assurance - Fraud & Recoveries Division: Stephen J. Markowski (860) 424-5954 Stephen.Markowski@ct.gov Brian McGuiness (860) 424-5955 Brian.McGuiness@ct.gov

More Related