10.2 Fraud Investigation, Payment Recovery, and Sanctions

Lead Agencies must have the necessary controls to identify fraud and other program violations to ensure program integrity. Program violations can include both intentional and unintentional client and/or provider violations, as defined by the Lead Agency. These violations and errors, identified through the error-rate review process and other review processes, may result in payment or nonpayment (administrative) errors and may or may not be the result of fraud, based on the Lead Agency definition. 10.2.1 Strategies used to identify and prevent program violations Check the activities the Lead Agency employs to ensure program integrity, and for each checked activity, identify what type of program violations the activity addresses, describe the activity and the results of these activities based on the most recent analysis. a. [x] Share/match data from other programs (e.g., TANF program, Child and Adult Care Food Program, Food and Nutrition Service (FNS), Medicaid) or other databases (e.g., State Directory of New Hires, Social Security Administration, Public Assistance Reporting Information System (PARIS)). i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Lead Agency’s Audits and Compliance team developed a risk assessment tool that incorporates data from other programs, including the Child and Adult Care Food Program, Georgia’s Pre-K Program, the state Child Care Licensing program, and the Department of Labor wage file. These data-matching activities have resulted in the Lead Agency being able to better identify providers who are at higher risk for committing intentional program violations and discovering violations such as billing for children who are not in attendance. This practice improves our audit selection because we are better able to target our audit resources to these providers. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency’s Audits and Compliance team developed a risk assessment tool that incorporates data from other programs, including the Child and Adult Care Food Program, Georgia’s Pre-K Program, the state Child Care Licensing program, and the Department of Labor wage file. These data-matching activities have resulted in the Lead Agency being able to better identify providers who are at higher risk for committing unintentional program violations and discovering violations such as improper record practices. In November 2023, the Lead Agency created a new functional area, Child Care and Parent Services (CAPS) Provider Relations, composed of four teams, one of them the Quality Assurance and Payments (QA&P) team. This team is responsible for proactive reviews of provider payments to detect and correct errors in billing before payment. This review reduces overpayments to providers and later recoupment of funds. Errors in provider billing are shared with the CAPS Provider Relations Education and Outreach team to perform the following: 1) Target areas of training on provider billing practices; and 2) Recommend specific providers for technical assistance visits. Multiple analytics that flag potential payment errors are built into the payment system. These flags are reviewed by the QA&P consultants and released if there is no payment error. If a payment error is detected, the payment is corrected and issued to the provider. Analytics that indicate possible errors made by eligibility staff when issuing certificates are shared with the applicable teams to complete the following: 1) Training with eligibility staff on policy compliance; and 2) System requirements needed to prevent unintentional errors in issuing benefits. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice:: The Lead Agency's Child Care and Parent Services (CAPS) program conducts data analysis that results in the identification of agency errors and training opportunities. For example, data analysis is regularly conducted to ensure that staff enter accurate information on cases and scholarships. When errors are identified, a communication and training plan is implemented for staff to correct the errors and to follow updated processes to prevent errors going forward. Additionally, Provider data such as number of enrolled children with active scholarships is monitored and analyzed to prevent potential overcrowding and ensure that Providers maintain correct ratios from a CAPS program perspective. The Lead Agency also performs payment data analysis to identify system errors and corrections needed for data reconciliation and accuracy. b. [x] Run system reports that flag errors (include types). i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Audits and Compliance Division runs reports showing the billing history for a specific provider and child over time. The Audits and Compliance Team compares the billing reports to actual attendance documentation from the provider to ensure accuracy and to identify intentional program violations. The process results in the identification of potential intentional program violations, however, additional procedures are necessary to confirm that violations are intentional. These processes are also used to improve our practices. For instance, the Audits and Compliance Division has learned that providers that mark attendance for all children every day are at higher risk for committing an intentional program violation. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Audits and Compliance Division runs reports showing the billing history for a specific provider and child over time. The Audits and Compliance Team compares the billing reports to actual attendance documentation from the provider to ensure accuracy and to identify unintentional program violations. These practices have led to the issuance of an overpayment claim whenever a provider bills on a scholarship that isn’t supported by attendance documentation. Over time, the Audits and Compliance Division has learned that many of the unintentional program violations are due to lax procedures at the childcare center level, which includes failure to ensure that all children are signed in/out pursuant to Child Care and Parent Services (CAPS) policy. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The Audits and Compliance Division runs reports showing the billing history for a specific provider and child over time. The Audits and Compliance Team can compare the billing reports to actual attendance documentation from the provider to ensure accuracy. Depending on the findings identified, a determination can be made regarding if it is a result of an agency error. The process has resulted in the identification of improper billing resulting from agency error. Over time, the Audits and Compliance Division has learned that agency errors most commonly have included issuing a scholarship for a child who isn’t eligible, issuing the wrong type of scholarship to a child, or approving a childcare center as a Child Care and Parent Services (CAPS) provider that should not be eligible. c. [x] Review enrollment documents and attendance or billing records. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Audits and Compliance team reviews attendance documents and billing records by requesting attendance documents via a letter emailed to providers or requested while onsite. Once the records are received, staff compare the attendance documents to the billing records. Any discrepancies are identified, and a determination of the improper payment is made. The results of these activities include establishing an overpayment when warranted, and collection efforts are made pursuant to policy. Over time, we have learned that obtaining documents while onsite during an unannounced visit is effective at preventing the provider from altering records. This practice is done whenever there is cause, such as a significant concern regarding potential intentional program violations. If discrepancies that are the result of an intentional program violation are found or suspected, the cases will be forwarded to an investigative agency or to the State Attorney General’s Office for review. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Audits and Compliance team reviews attendance documents and billing records by requesting attendance documents via a letter emailed to providers or requested while onsite. Once the records are received, staff compare the attendance documents to the billing records. Any discrepancies are identified, and a determination of the improper payment is made. The results of these activities include establishing an overpayment when warranted, and if the discrepancies are due to an unintentional program violation, collection efforts are made pursuant to policy. In addition, in November 2023, the Lead Agency implemented a new payment system and built in analytics to flag potential payment errors. These flags are reviewed by staff from the Quality Assurance and Payments team, and the payment is authorized if there is no error. If a payment error is detected, the payment is corrected and issued to the provider. Errors detected are shared with the Provider Relations Education and Outreach team to target areas for potential training on billing practices or to conduct technical assistance with specific providers. Analytics that indicate possible errors made by eligibility staff when issuing certificates are shared with the applicable teams to complete the following: 1) Training with eligibility staff on policy compliance; and 2) System requirements needed to prevent unintentional errors in issuance of benefits. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency's Child Care and Parent Services (CAPS) program conducts data analysis that results in the identification of agency errors and training opportunities. For example, Provider enrollment records are monitored and analyzed to prevent potential overcrowding and ensure that Providers maintain correct ratios from a CAPS program perspective. The Lead Agency also performs analysis on billing records to identify errors and corrections needed for accurate payments. d. [x] Conduct supervisory staff reviews or quality assurance reviews. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency's Child Care and Parent Services (CAPS) program has a stand-alone Quality Assurance & Training (QA&T) unit that performs quality assurance reviews of eligibility determinations made by staff. These quality assurance reviews are used to monitor and assess policy implementation on an ongoing basis, ensure program integrity, and determine effectiveness of training. The QA&T unit does not determine eligibility but does administer the quality assurance process by reviewing the work of others and providing training for staff in areas that need improvement. Cases are selected from a random sample of initial eligibility, changes during the eligibility period, and redeterminations completed each month. Cases processed by newer staff are monitored more frequently than staff who have more experience processing eligibility. To further ensure program integrity, the QA&T unit also supports staff by conducting ongoing focused training in areas with the highest error rate in determining eligibility. In addition, the Lead Agency CCDF program supervisors conduct quality assurance reviews of cases processed by their staff and provide coaching on areas that need improvement. The Lead Agency’s Audits and Compliance unit separate from the CCDF program also conducts error-rate reviews on cases during the triennial Error Rate Review process. In addition to this being a federal requirement, it is also used to ensure training effectiveness, provide feedback to staff, and improve reliability in determining eligibility according to policy. These reviews have resulted in Audits and Compliance staff providing training to CAPS managers on the identification of falsified documents. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency's Child Care and Parent Services (CAPS) program has a stand-alone Quality Assurance & Training (QA&T) unit that performs quality assurance reviews of eligibility determinations made by staff. These quality assurance reviews are used to monitor and assess policy implementation on an ongoing basis, ensure program integrity, and determine effectiveness of training. The QA&T unit does not determine eligibility but does administer the quality assurance process by reviewing the work of others and providing training for staff in areas that need improvement. Cases are selected from a random sample of initial eligibility, changes during the eligibility period, and redeterminations completed each month. Cases processed by newer staff are monitored more frequently than staff who have more experience processing eligibility. To further ensure program integrity, the QA&T unit also supports staff by conducting ongoing focused training in areas with the highest error rate in determining eligibility. In addition, the Lead Agency CCDF program supervisors conduct quality assurance reviews of cases processed by their staff and provide coaching on areas that need improvement. The Lead Agency’s Audits and Compliance unit separate from the CCDF program also conducts the triennial error-rate review on cases to ensure training effectiveness, provide feedback to staff, and improve reliability in determining eligibility according to policy. The knowledge that the Audits and Compliance team gained from conducting these reviews resulted in training content designed to educate front-line managers on the types of errors identified during the error rate review so that corrective measures could be implemented. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency's Child Care and Parent Services (CAPS) program has a stand-alone Quality Assurance & Training (QA&T) unit that performs quality assurance reviews of eligibility determinations made by staff. These quality assurance reviews are used to monitor and assess policy implementation on an ongoing basis, ensure program integrity, and determine effectiveness of training. The QA&T unit does not determine eligibility but does administer the quality assurance process by reviewing the work of others and providing training for staff in areas that need improvement. Cases are selected from a random sample of initial eligibility, changes during the eligibility period, and redeterminations completed each month. Cases processed by newer staff are monitored more frequently than staff who have more experience processing eligibility. To further ensure program integrity, the QA&T unit also supports staff by conducting ongoing focused training in areas with the highest error rate in determining eligibility. In addition, the Lead Agency CCDF program supervisors conduct quality assurance reviews of cases processed by their staff and provide coaching on areas that need improvement. The Lead Agency’s Audits and Compliance unit separate from the CCDF program also conducts the triennial error-rate review on cases to ensure training effectiveness, provide feedback to staff, and improve reliability in determining eligibility according to policy. The errors identified during the review process are generally agency errors. The knowledge that the Audits and Compliance team gained from conducting these reviews resulted in training content designed to educate front-line managers on the types of errors identified during the error rate review so that corrective measures could be implemented. e. [x] Audit provider records. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Audits and Compliance unit reviews provider attendance documents and billing records by requesting attendance documents via a letter emailed to providers or requested while onsite. Once the records are received, staff then compare the attendance documents to the billing records. Any discrepancies are identified, and a determination of the improper payment is made. The results of these activities include establishing overpayments when warranted, and collection efforts are made pursuant to policy. Over the years, our experience with auditing provider records has informed the policy writing process whereby policy is now clear in how all provider records should be created and stored. Because of these enhancements, it is more difficult for providers to commit intentional program violations. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Audits and Compliance Division unit reviews attendance documents and billing records by requesting attendance documents via a letter emailed to providers or requested while onsite. Once the records are received, staff then compare the attendance documents to the billing records. Any discrepancies are identified, and a determination of the improper payment is made. The results of these activities include establishing an overpayment when warranted, and collection efforts are made pursuant to policy. Over the years, our experience with auditing provider records has informed the policy writing process whereby policy is now clear in how all provider records should be created and stored. Because of these enhancements, it is more difficult for providers to commit unintentional program violations. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency's Child Care and Parent Services (CAPS) program reviews provider records given by the Audits and Compliance Division to identify agency errors and training opportunities. For example, provider data such as attendance and enrollment records are monitored and analyzed to prevent potential overcrowding and ensure that providers maintain correct ratios from a CAPS program perspective. The Lead Agency also reviews Provider billing records to identify errors and corrections needed for accurate payment. f. [x] Train staff on policy and/or audits. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency's Child Care and Parent Services (CAPS) program contains a stand-alone Quality Assurance and Training (QA&T) unit to conduct training on policy and implementation. The scope and type of policy and/or audits training is based on the needs of the staff members and is categorized into three main areas: 1) new hires, 2) existing staff, and 3) other divisions within the Lead Agency and other agencies. New hires to the CCDF program are trained in full policy and how to use the various systems needed to operate the program. Existing staff are given policy and systems training based on the needs of those staff and through ongoing monitoring of areas that need improvement. Other divisions within the Lead Agency and other agencies are given policy and systems training based on their needs and roles. The QA&T unit also conducts weekly updates to clarify policy and best practices to ensure that staff training needs are met in a timely manner. This training results in staff identifying signs of intentional or unintentional program violations and agency errors. Additionally, training on Policy assisted with determining improved processes, which enhanced staff knowledge and skills and increased efficiency. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency's Child Care and Parent Services (CAPS) program contains a stand-alone Quality Assurance and Training (QA&T) unit to conduct training on policy and implementation. The scope and type of policy and/or audits training is based on the needs of the staff members and is categorized into three main areas: 1) new hires, 2) existing staff, and 3) other divisions within the Lead Agency and other agencies. New hires to the CCDF program are trained in full policy and how to use the various systems needed to operate the program. Existing staff are given policy and systems training based on the needs of those staff and through ongoing monitoring of areas that need improvement. Other divisions within the Lead Agency and other agencies are given policy and systems training based on their needs and roles. The QA&T unit also conducts weekly updates to clarify policy and best practices to ensure that staff training needs are met in a timely manner. This training results in staff identifying signs of intentional or unintentional program violations and agency errors. Additionally, training on Policy assisted with determining improved processes, which enhanced staff knowledge and skills and increased efficiency. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency's Child Care and Parent Services (CAPS) program contains a stand-alone Quality Assurance and Training (QA&T) unit to conduct training on policy and implementation. The scope and type of policy and/or audits training is based on the needs of the staff members and is categorized into three main areas: 1) new hires, 2) existing staff, and 3) other divisions within the Lead Agency and other agencies. New hires to the CCDF program are trained in full policy and how to use the various systems needed to operate the program. Existing staff are given policy and systems training based on the needs of those staff and through ongoing monitoring of areas that need improvement. Other divisions within the Lead Agency and other agencies are given policy and systems training based on their needs and roles. The QA&T unit also conducts weekly updates to clarify policy and best practices to ensure that staff training needs are met in a timely manner. This training results in staff identifying signs of intentional or unintentional program violations and agency errors. Additionally, training on Policy assisted with determining improved processes, which enhanced staff knowledge and skills and increased efficiency. g. [x] Other. Describe the activity(ies): See descriptions for selected items. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: In addition to the activities noted above, the Audits and Compliance unit maintains a dedicated phone line and an email inbox where complaints can be submitted. The phone number and email address are published in the Lead Agency CCDF program policy manual. Upon receiving a complaint, the Audits and Compliance unit investigates to determine if a program violation occurred (intentional or unintentional) and if any funds are due back to DECAL. This process has resulted in the identification of numerous cases where a violation had occurred, and funds were due back to DECAL. With the success of the reporting lines, the Lead Agency recently chose to expand this process to include a web-based reporting tool which will be promoted in Lead Agency written materials. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: In addition to the activities noted above, the Audits and Compliance unit maintains a dedicated phone line and an email inbox where complaints can be submitted. The phone number and email address are published in the Lead Agency Child Care and Parent Services (CAPS) program policy manual. This process has resulted in the identification of numerous cases where a violation had occurred, and funds were due back to the Department of Early Care and Learning (DECAL). With the success of the reporting lines, DECAL recently chose to expand this process to include a web-based reporting tool which will be promoted in DECAL written materials. Further, in November 2023, the Lead Agency created a new functional area, CAPS Provider Relations, composed of four teams, including a Quality Assurance and Payments (QA&P) team. This team is responsible for proactive reviews of provider payments to detect and correct errors in billing before payment. This review reduces overpayments to providers and later recoupment of funds. Errors in provider billing are shared with the CAPS Provider Relations Education and Outreach team to: 1) Target areas of training on provider billing practices; and 2) Recommend specific providers for technical assistance visits. Multiple analytics that flag potential payment errors are built into the payment system. These flags are reviewed by the QA&P consultants and released if there is no payment error. If a payment error is detected, the payment is corrected and issued to the provider. Analytics that indicate possible errors made by eligibility staff are shared with the applicable teams to complete the following: 1) Training with eligibility staff on policy compliance; and 2) System requirements needed to prevent unintentional errors in issuance of benefits. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency's Child Care and Parent Services (CAPS) program reviews Provider records given by the Audits and Compliance Division to identify agency errors and training opportunities. For example, Provider data such as attendance and enrollment records are monitored and analyzed to prevent potential overcrowding and ensure that Providers maintain correct ratios from a CAPS program perspective. The Lead Agency also reviews Provider billing records to identify errors and corrections needed for accurate payment. 10.2.2 Identification and recovery of misspent funds Lead Agencies must identify and recover misspent funds that are a result of fraud, and they have the option to recover any misspent funds that are a result of unintentional program violations or agency errors. a. Identify which agency is responsible for pursuing fraud and overpayments (e.g., State Office of the Inspector General, State Attorney): The Lead Agency is responsible for recognizing the indicators of fraud within the CCDF program. This might include submitting falsified documents to the Lead Agency for the purpose of getting approved to participate as a Child Care and Parent Services (CAPS) client, knowingly billing the Lead Agency for children who were not in attendance or offering payment to Lead Agency staff for preferential treatment during the CAPS application process. When these indicators are identified by Lead Agency staff, the Lead Agency will work with other agencies that do criminal investigations, or with agencies that prosecute cases criminally. These agencies include the Georgia Office of Inspector General, the Georgia Office of the Attorney General, the U.S. Department of Health and Human Services Office of Inspector General, and the U.S. Attorney’s Office. If any monies are owed back to the program because of fraud, the Lead Agency will seek repayment of such funds through a court order as part of a criminal matter. If the state decided not to move forward with a criminal action, the Lead Agency seeks a civil repayment through the Office of State Administrative Hearings or through the Attorney General’s Office. b. Check and describe all activities, including the results of such activity, that the Lead Agency uses to investigate and recover improper payments due to fraud. Consider in your response potential fraud committed by providers, clients, staff, vendors, and contractors. Include in the description how each activity assists in the investigation and recovery of improper payment due to fraud or intentional program violations. Activities can include, but are not limited to, the following: i. [ ] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: ii. [x] Coordinate with and refer to the other State/Territory agencies (e.g., State/Territory collection agency, law enforcement agency). Describe the activities and the results of these activities based on the most recent analysis: Over the years, the Lead Agency has referred multiple cases to other state/federal agencies who are involved in the investigation and prosecution of cases. The frequency of our referrals has resulted in a close working relationship between the agencies, especially with client cases. For instance, the Office of the Attorney General has provided the Lead Agency with guidance for the types of cases that they want the Lead Agency to submit, including financial guideposts for losses incurred. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: In some cases, a court of competent jurisdiction may order a repayment. In these cases, the Lead Agency follows these orders. Per Child Care and Parent Services (CAPS) Policy, claims may be repaid through offsetting reimbursements, a lump sum, or, in limited situations, monthly installments. The Lead Agency has the right to enter into repayment agreements with parents or child care providers to ensure that all claims are collected in full and within 24 months. Providers may complete the Child Care Provider Repayment Statement and parents may complete the Parent Repayment Statement to determine the amount and frequency of claim payments. The provider or parent must adhere to all terms of the repayment statement. iv. [ ] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [ ] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: vii. [ ] Establish a unit to investigate and collect improper payments and describe the composition of the unit. Describe the activities and the results of these activities based on the most recent analysis: viii. [ ] Other. Describe the activities and the results of these activities: c. Does the Lead Agency investigate and recover improper payments due to unintentional program violations? [ ] No. [x] Yes. If yes, check and describe below any activities that the Lead Agency will use to investigate and recover improper payments due to unintentional program violations. Include in the description how each activity assists in the investigation and recovery of improper payments due to unintentional program violations. Include a description of the results of such activity. i. [ ] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: ii. [ ] Coordinate with and refer to the other State/Territory agencies (e.g., State/Territory collection agency, law enforcement agency). Describe the activities and the results of these activities based on the most recent analysis: iii. [ ] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: Improper payments that are the result of unintentional program violations are generally recouped by the program until the debt is paid. The program will recoup 50% of future payments until the improper payment amount has been fully recouped unless other arrangements are made. For instance, providers can pay the amount all at once or can submit a hardship request to extend the payment period. v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [ ] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: vii. [ ] Establish a unit to investigate and collect improper payments and describe the composition of the unit. Describe the activities and the results of these activities based on the most recent analysis: viii. [ ] Other. Describe the activities and the results of these activities: d. Does the Lead Agency investigate and recover improper payments due to agency errors? [x] No. [ ] Yes. If yes, check and describe all activities that the Lead Agency will use to investigate and recover improper payments due to agency errors. Include in the description how each activity assists in the investigation and recovery of improper payments due to administrative errors. Include a description of the results of such activity. i. [ ] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: ii. [ ] Coordinate with and refer to the other State/Territory agencies (e.g., State/Territory collection agency, law enforcement agency). Describe the activities and the results of these activities based on the most recent analysis: iii. [ ] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: iv. [ ] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [ ]Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: vii. [ ] Establish a unit to investigate and collect improper payments and describe the composition of the unit. Describe the activities and the results of these activities based on the most recent analysis: viii. [ ] Other. Describe the activities and the results of these activities: e. What type of sanction will the Lead Agency place on clients and providers to help reduce improper payments due to intentional program violations or fraud? Check and describe all that apply: i. [x] Disqualify the client. Describe this process, including a description of the appeal process for clients who are disqualified. Describe the activities and the results of these activities based on the most recent analysis: A parent will be disqualified from Child Care and Parent Services (CAPS) for the following: • If a child care case is closed for failure to cooperate with an investigation, the parent will be disqualified from CAPS for three months, after which they may reapply. Limited exceptions to this disqualification may be granted through a waiver request for families participating in or transitioning from Temporary Assistance for Needy Families (TANF) and families with an active Child Protective Services (CPS) case. • Failure to respond to or honor the child care claim and repayment statement may result in closure of the child care case. If a child care case is closed for failure to respond to or honor a repayment statement, the parent will be disqualified from CAPS until the claim is paid in full, after which they may reapply. Limited exceptions to this disqualification may be requested through a waiver for families participating in or transitioning from TANF and families with an active CPS case. • If falsified documents or information resulted in the authorization of benefits for which the family was not eligible, the child care case may be closed (if the family would not have been eligible), benefits will be appropriately adjusted for the remainder of the eligibility period (if applicable), and a claim will be established for the difference between benefits received and benefits for which they were eligible. Additional sanctions may be imposed, up to and including case closure or disqualification from CAPS, as determined by CAPS administration. Parents receiving subsidized child care have a right to appeal and receive a hearing regarding any actions instituted by the Department of Early Care and Learning (DECAL) that impact a parent’s eligibility and/or any action that would require a reclaim of funds. Lack of funding availability is not appealable. It is also important to note the following situations are not appealable: applications disposed as unable to process or withdrawn, selection of a child care provider that has been previously terminated by the CAPS program, dissatisfaction with care or services provided by the child care provider, statewide or local limitations on CAPS funding that results in a denial of CAPS services, the natural expiration of a family’s eligibility period, any changes in federal or state law, regulations, or policies that affect entire populations. If a parent appeals an adverse action that was imposed during the eligibility period, the parent may elect to continue receiving benefits at the current level until the appeal is resolved or until the end of the current eligibility period, whichever comes first. Funds paid when this option is exercised may be subject to reclaim. If a parent appeals an adverse action imposed at annual redetermination, they may not elect to continue receiving benefits beyond the eligibility period preceding the annual redetermination. The parent must request an administrative hearing, as appropriate, in writing within 14 calendar days from the date on the notice of adverse action. Failure to request an administrative hearing by the deadline listed on the notice or within 14 calendar days from the date of the notice shall automatically affirm DECAL’s decision. If the individual making a hearing request does not speak English and a bilingual staff person or interpreter is requested, DECAL must ensure that the appellant is afforded a translator at the hearing. ii. [x]Disqualify the provider. Describe this process, including a description of the appeal process for providers who are disqualified. Describe the activities and the results of these activities based on the most recent analysis: Disqualification of a child care provider refers to a time-limited or permanent status that disallows child care providers from participating in the Child Care and Parent Services (CAPS) program for failure to comply with Department of Early Care and Learning (DECAL) policies or federal or state laws and regulations. Providers may be disqualified due to the following: debarment or removal from any other federal or state program (disqualification will span a period of seven years plus any period thereafter that funds are still outstanding), failure to repay funds (disqualification will be lifted once the overpayment is paid in full), violation of CAPS policy; the period for disqualification will be based on the severity of the violation of policy, after a DECAL review has been conducted, fraud conviction by state court, federal court, and/or Attorney General’s Office (disqualification will be permanent), serious injury as defined in CAPS Policy Definitions and Acronyms. At the discretion of DECAL administration, providers may be suspended, dismissed, or disqualified for health and safety violations that are not explicitly defined in CAPS policy and are not subject to appeal. It is important to note that the following matters are not appealable: future payments, lack of funding availability, denial of participation in CAPS, dismissal from participation in CAPS, disqualification from participation in CAPS. Providers who participate in the subsidy program and are issued a notice of revocation of their license or a notice of emergency closure are afforded appeal procedures by the Lead Agency's Child Care Licensing division. Staff from the subsidy program follow the lead of the Child Care Licensing division who establish and monitor health and safety standards in Georgia, and providers must have a license or exemption to participate in the subsidy program. The Child Care Licensing division allows providers 10 days to appeal the revocation or 48 hours to appeal the emergency closure. Providers are advised of this right in the revocation or emergency closure paperwork. All revocation or emergency closure appeal requests are forwarded to the Lead Agency's Legal Division who then forwards all hearing requests to the Office of State Administrative Hearings (OSAH). OSAH sets the date and time for the administrative hearing and notifies all parties of that date and time. After the hearing, OSAH issues an Initial Decision affirming or denying the action of the Lead Agency. The decision contains the reason for the judgment, the supporting evidence and policy used to reach the judgment, findings of fact, and conclusions of law. Either party may file a motion to vacate a default, a motion for reconsideration, or a motion for rehearing within 10 days of the service of the Initial Decision. A party who seeks review by the Lead Agency must file an application for agency review within 30 days after service of the Initial Decision. In nearly all cases, agency review is a prerequisite for judicial review. If a timely application for agency review is not filed and the Lead Agency does not review the Initial Decision on its own motion, the Initial Decision will become the Final Decision of the Lead Agency by operation of law. Providers who participate in the subsidy program and are disqualified due to administrative reasons (such as not submitting required paperwork or not cooperating with an investigation) are not afforded appeal rights. iii. [x] Prosecute criminally. Describe the activities and the results of these activities based on the most recent analysis: Program violations that are believed to be intentional will be referred for criminal prosecution. There has been no criminal prosecution concluded in the recent past to report on or to inform Lead Agency activities. iv. [x] Other. Describe the activities and the results of these activities based on the most recent analysis: In addition to disqualifying a provider or parent, other methods used by the Lead Agency to sanction a provider or parent may include requiring the provider or parent to repay funds received because of improper payments or requiring a provider to attend mandatory training to continue participation in the subsidy program. Appendix 1: Lead Agency Implementation Plan The Appendix will be available for Lead Agencies to use in CARS after the Plan approval letter is issued. For each non-compliance, Lead Agencies must describe the following: • Action Steps: List the action steps needed to correct the finding (e.g., update policy manual, legislative approval, IT system changes, etc.). For each action step list the: o Responsible Entity: Indicate the entity (e.g., agency, team, etc.) responsible for completing the action step. o Expected Completion Date: List the expected completion date for the action step. • Overall Target Date for Compliance: List date Lead Agency anticipates completing implementation, achieving full compliance with all aspects of the findings. (Note: Compliance will not be determined until the FFY 2025-2027 CCDF Plan is amended and approved). Appendix 1: Form [Plan question with non-compliance and associated provision will pre-populate based on preliminary notice of non-compliance] A. Action Steps for Implementation B. Responsible Entity(ies) C. Expected Completion Date Step 1: Step 2 (as necessary): [Additional steps added as necessary] Overall Target Date for Compliance: