c. Errors Caused by Parents and Providers

Overpayments that are not due to administrative error shall be classified as parent or provider caused.

Overpayments caused by the parent shall include, but not be limited to errors caused by reporting false or inaccurate information, delays in reporting changes in household circumstances or provider arrangements, or excess payments made as the result of a request to continue benefits pending an administrative hearing.

Overpayments caused by the provider shall include, but not be limited to the following types of errors: inaccurate reporting of information concerning licensing status, age or other provider eligibility requirements; inaccurate reporting of the provider’s relationship to the child or the location at which care is given; inaccurate reporting of household circumstances; committing an illegal act, such as cashing a replacement check after falsely claiming that the original check was lost, stolen or destroyed; inaccurate reporting of actual charges, attendance or dates of service; and any other false claim for goods or services provided as enumerated in section 53a-290 of the Connecticut General Statutes.

The error shall be classified as both parent and provider caused if the parent and the provider both had knowledge and actively participated in the action that caused the overpayment to occur.

The CCAP administrator shall make a preliminary determination of whether the overpayment was intentional or unintentional pursuant to guidelines established by the department. Overpayments shall be classified as intentional if the parent or provider knowingly withheld or provided false information on matters affecting eligibility, benefits or a claim for services. An overpayment shall be considered unintentional under the following circumstances: if there was clearly no intent to commit fraud or to obtain benefits or payments under false pretenses; if the parent or provider did not purposefully withhold or provide erroneous information; if illness, a family emergency or other good cause reasons exist for not reporting information timely or accurately; or if the error was due to a delay in taking action as the result of an administrative hearing request.

Where the CCAP administrator makes a preliminary determination that a parent or provider may have committed fraud, the case may be referred as appropriate to the Office of the Attorney General, the Office of the Chief State’s Attorney or for an administrative disqualification hearing. Administrative disqualification hearings shall be conducted in accordance with the requirements of section 17b-749-22 of the Regulations of Connecticut State Agencies.

A final determination that an error was intentional shall be made only as the result of a decision by a court or administrative hearing official, or if the parent waives his or her right to an administrative hearing. If the error was intentional, the CCAP administrator shall disqualify the family or the provider from participating in CCAP for the period specified in subsection (h) of this section.