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: Idaho currently shares data with the between the following programs: Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Aid to the Aged, Blind, and Disabled (AABD), and Medicaid as all of these programs share the same eligibility system. The sharing and matching of data with other programs helps prevent intentional program violations because it can show information that is required to be reported for the Child Care program but may have not been reported, although ICCP only acts on information from these other programs if the recipient is required to report it or if it will benefit the household. The results of this activity also reduce the risk of incorrect eligibility determinations. The Idaho Department of Health and Welfare (DHW) has an integrity unit who monitors PARIS matches monthly. The report is SNAP related and used across all programs. The report reflects households who may be receiving benefits in more than one state. This information is reviewed and if an IPV has been committed, a waiver of disqualification hearing is sent to the customer. If not signed, an administrative hearing is requested. If an Intentional Program Violation (IPV) was acknowledged, the party who committed the IPV loses eligibility for ICCP and an overpayment may be processed. If fraud is detected, it is routed to a Fraud Investigator to review and determine the proper course of action. Program staff meet with staff from the Self Reliance Resolutions Unit and Self Reliance Integrity Unit to review the outcomes of data sharing and reports and routinely monitors for patterns and errors to learn about opportunities to improve processes and policies to prevent negative client or provider outcomes such as IPV’s, unintentional program violations, and agency errors. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Idaho currently shares data with the between the following programs: Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Aid to the Aged, Blind, and Disabled (AABD), and Medicaid as all of these programs share the same eligibility system. The sharing and matching of data with other programs helps prevent unintentional program violations because it can show information that is required to be reported for the Child Care program but may have not been reported, although ICCP only acts on information from these other programs if the recipient is required to report it or if it will benefit the household. The results of this activity also reduce the risk of incorrect eligibility determinations. The Idaho Department of Health and Welfare (DHW) has an integrity unit who monitors PARIS matches monthly. The report is SNAP related and used across all programs. The report reflects households who may be receiving benefits in more than one state. If an unintentional program violation is determined, an overpayment is processed. Program staff meet with staff from the Self Reliance Resolutions Unit and Self Reliance Integrity Unit to review the outcomes of data sharing and reports and routinely monitors for patterns and errors to learn about opportunities to improve processes and policies to prevent negative client or provider outcomes such as IPV’s, unintentional program violations, and agency errors. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice:: Idaho currently shares data with the between the following programs: Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Aid to the Aged, Blind, and Disabled (AABD), and Medicaid as all of these programs share the same eligibility system. The sharing and matching of data with other programs helps prevent agency errors because it can show information that is required to be reported for the Child Care program but may have not been reported, although ICCP only acts on information from these other programs if the recipient is required to report it or if it will benefit the household. The results of this activity also reduce the risk of incorrect eligibility determinations. The Idaho Department of Health and Welfare (DHW) has an integrity unit who monitors PARIS matches monthly. The report is SNAP related and used across all programs. The report reflects households who may be receiving benefits in more than one state. If an agency error is determined, an overpayment or supplement is processed. Program staff meet with staff from the Self Reliance Resolutions Unit and Self Reliance Integrity Unit to review the outcomes of data sharing and reports and routinely monitors for patterns and errors to learn about opportunities to improve processes and policies to prevent negative client or provider outcomes such as IPV’s, unintentional program violations, and agency errors. b. [x] Run system reports that flag errors (include types). i. [ ] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Our automated eligibility system flags missing or conflicting data that may contribute to unintentional program violations highlighting it to eligibility workers, and can prevent the processing of eligibility without required eligibility data. Additionally, the Bureau Chief over operations monitors various reports on a daily, weekly, and monthly basis. Information obtained is provided to program managers relating to their region. Additionally, the information identified assists in training opportunities and identifying gaps. These automated eligibility system components and report reviews, combined with trained, skilled eligibility staff prevents many unintentional program violations. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Our automated eligibility system flags missing or conflicting data that may contribute to unintentional program violations highlighting it to eligibility workers, and can prevent the processing of eligibility without required eligibility data. Additionally, the Bureau Chief over operations monitors various reports on a daily, weekly, and monthly basis. Information obtained is provided to program managers relating to their region. Additionally, the information identified assists in training opportunities and identifying gaps. These automated eligibility system components and report reviews, combined with trained, skilled eligibility staff prevents many agency errors. 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: IDHW Integrity Unit and Child Care staff may request enrollment documents, attendance records, and billing records at any time, and often do to review and identify potentially inaccurate provider billing practices. Any resulting overpayment is established using these records, and they are used to identify potential fraud. The review of attendance and billing records is an ongoing practice allowing IDHW to measure discrepancies and validate billing. Audits and investigations are conducted in response to provider concerns, when possible issues are identified by IDHW staff, and based on complaints reported related to cases of suspected fraud or billing inaccuracies. As a result of reviewing enrollment documents and attendance and billing records staff are able to accurately attribute overpayments, IPVs, UPVs, and agency errors. Additionally, staff review of these documents and information has lead to document improvements, and improvement in provider trainings and technical assistance to prevent additional negative client or provider outcomes such as IPV’s, unintentional program violations, and agency errors. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: IDHW Integrity Unit and Child Care staff may request enrollment documents, attendance records, and billing records at any time, and often do to review and identify potentially inaccurate provider billing practices. Any resulting overpayment is established using these records, and they are used to identify potential fraud. The review of attendance and billing records is an ongoing practice allowing IDHW to measure discrepancies and validate billing. Audits and investigations are conducted in response to provider concerns, when possible issues are identified by IDHW staff, and based on complaints reported related to cases of suspected fraud or billing inaccuracies. As a result of reviewing enrollment documents and attendance and billing records staff are able to accurately attribute overpayments, IPVs, UPVs, and agency errors. Additionally, staff review of these documents and information has lead to document improvements, and improvement in provider trainings and technical assistance to prevent additional negative client or provider outcomes such as IPV’s, unintentional program violations, and agency errors. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: IDHW Integrity Unit and Child Care staff may request enrollment documents, attendance records, and billing records at any time, and often do to review and identify potentially inaccurate provider billing practices. Any resulting overpayment is established using these records, and they are used to identify potential fraud. The review of attendance and billing records is an ongoing practice allowing IDHW to measure discrepancies and validate billing. Audits and investigations are conducted in response to provider concerns, when possible issues are identified by IDHW staff, and based on complaints reported related to cases of suspected fraud or billing inaccuracies. As a result of reviewing enrollment documents and attendance and billing records staff are able to accurately attribute overpayments, IPVs, UPVs, and agency errors. Additionally, staff review of these documents and information has lead to document improvements, and improvement in provider trainings and technical assistance to prevent additional negative client or provider outcomes such as IPV’s, unintentional program violations, and agency errors. 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: Our review process is set up to find any areas in which our performance is at risk, pinpoint the area of concern (policy, process, or training) , and quickly respond to the field needs either at the local level or roll out statewide based on the findings. For each processing center/field office reviewed, the case reviews incorporate initial contact with the Idaho Department of Health and Welfare (DHW) through approval/denial as well as acting on changes. We review program access, integrity, system keying standards, and maintenance. Our reviews also include customer service standards and timeliness. Our review profile captures error causes and we have reports which help us to identify any error trends. Any errors discovered are sent for immediate correction. Errors are shared with the field program managers for individual performance management as well as used for identifying statewide trends. The bureau chiefs for Operations and Operations Design identify areas in which we can provide statewide training when necessary which supports our statewide business model. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Our review process is set up to find any areas in which our performance is at risk, pinpoint the area of concern (policy, process, or training) , and quickly respond to the field needs either at the local level or roll out statewide based on the findings. For each processing center/field office reviewed, the case reviews incorporate initial contact with the Idaho Department of Health and Welfare (DHW) through approval/denial as well as acting on changes. We review program access, integrity, system keying standards, and maintenance. Our reviews also include customer service standards and timeliness. Our review profile captures error causes and we have reports which help us to identify any error trends. Any errors discovered are sent for immediate correction. Errors are shared with the field program managers for individual performance management as well as used for identifying statewide trends. The bureau chiefs for Operations and Operations Design identify areas in which we can provide statewide training when necessary which supports our statewide business model. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Our review process is set up to find any areas in which our performance is at risk, pinpoint the area of concern (policy, process, or training) , and quickly respond to the field needs either at the local level or roll out statewide based on the findings. For each processing center/field office reviewed, the case reviews incorporate initial contact with the Idaho Department of Health and Welfare (DHW) through approval/denial as well as acting on changes. We review program access, integrity, system keying standards, and maintenance. Our reviews also include customer service standards and timeliness. Our review profile captures error causes and we have reports which help us to identify any error trends. Any errors discovered are sent for immediate correction. Errors are shared with the field program managers for individual performance management as well as used for identifying statewide trends. The bureau chiefs for Operations and Operations Design identify areas in which we can provide statewide training when necessary which supports our statewide business model. e. [x] Audit provider records. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: IDHW Integrity Unit and Child Care staff may request enrollment documents, attendance records, and billing records at any time, and often do to review and identify potentially inaccurate provider billing practices. Any resulting overpayment is established using these records, and they are used to identify potential fraud. The review of attendance and billing records is an ongoing practice allowing IDHW to measure discrepancies and validate billing. Audits and investigations are conducted in response to provider concerns, when possible issues are identified by IDHW staff, and based on complaints reported related to cases of suspected fraud or billing inaccuracies. Any audits resulting in findings are reviewed by the Program Manager, division leadership, and have been requested by legislative auditors. Patterns identified in audit findings have been the impetus for agency document and process improvements, and improvement in provider trainings and technical assistance to prevent ongoing audit findings. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: IDHW Integrity Unit and Child Care staff may request enrollment documents, attendance records, and billing records at any time, and often do to review and identify potentially inaccurate provider billing practices. Any resulting overpayment is established using these records, and they are used to identify potential fraud. The review of attendance and billing records is an ongoing practice allowing IDHW to measure discrepancies and validate billing. Audits and investigations are conducted in response to provider concerns, when possible issues are identified by IDHW staff, and based on complaints reported related to cases of suspected fraud or billing inaccuracies. Any audits resulting in findings are reviewed by the Program Manager, division leadership, and have been requested by legislative auditors. Patterns identified in audit findings have been the impetus for agency document and process improvements, and improvement in provider trainings and technical assistance to prevent ongoing audit findings. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: IDHW Integrity Unit and Child Care staff may request enrollment documents, attendance records, and billing records at any time, and often do to review and identify potentially inaccurate provider billing practices. Any resulting overpayment is established using these records, and they are used to identify potential fraud. The review of attendance and billing records is an ongoing practice allowing IDHW to measure discrepancies and validate billing. Audits and investigations are conducted in response to provider concerns, when possible issues are identified by IDHW staff, and based on complaints reported related to cases of suspected fraud or billing inaccuracies. Any audits resulting in findings are reviewed by the Program Manager, division leadership, and have been requested by legislative auditors. Patterns identified in audit findings have been the impetus for agency document and process improvements, and improvement in provider trainings and technical assistance to prevent ongoing audit findings. 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 Idaho Department of Health and Welfare’s Division of Self Reliance trains all self-reliance specialists on each program administered within the division. Training includes videos on program rules, policies, general program details, process documents, helpful tools, release notices, and monthly management reviews. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Idaho Department of Health and Welfare’s Division of Self Reliance trains all self-reliance specialists on each program administered within the division. Training includes videos on program rules, policies, general program details, process documents, helpful tools, release notices, and monthly management reviews. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The Idaho Department of Health and Welfare’s Division of Self Reliance trains all self-reliance specialists on each program administered within the division. Training includes videos on program rules, policies, general program details, process documents, helpful tools, release notices, and monthly management reviews. g. [ ] Other. Describe the activity(ies): i. [ ] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: ii. [ ] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: iii. [ ] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: 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 Idaho Department of Health and Welfare in partnership with the State Office of Inspector General are responsible for the pursuit of fraud and overpayments. 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. [x] 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: The Department is required to pursue all overpayments when they reach the threshold of $100 dollars. If a case has been determined fraud and an improper payment was made, the Department would apply the overpayment as well as possibly take action to disqualify the provider or family from the program, as referenced in IDAPA section 700 of 16.06.12. The result of setting a minimum overpayment threshold helps to ensure that the agency is not spending more money on administration costs to collect an overpayment than what the overpayment collection would yield, while still holding participants accountable for the responsible use of the funds. 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. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: Financial services works to establish repayment plans with identified families or providers. To assist in the recovery of improper payments due to fraud or intentional program violations, a process for payment is established and signed between both parties. The result of recovering funds through repayment plans helps to ensure that participants are accountable for full repayment and the responsible use of the funds while limiting the financial burden of repayment and potentially maintaining eligibility for needed programs or provider participation. iv. [ ] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: Financial Services works with the state controller’s office to comply when individuals or providers have overpayments that necessitate collection through intercepts after other means of collection have been unsuccessful. As a result of recovering funds through tax intercepts the child care program demonstrates ongoing fiscal accountability and maintains program sustainability. vi. [ ] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: vii. [x] 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: Allegations of fraud are forwarded to an Idaho Department of Health and Welfare (DHW)’s Integrity Unit that specializes in the review of child care payments, if fraud is discovered the case is forwarded to the Idaho Department of Health and Welfare (IDHW) maintained unit for welfare fraud investigations. Trained investigators actively pursue allegations of program abuse by clients and child care providers. Once their findings are complete, the Revenue Operations unit at DHW actively pursues the collection of various outstanding monies owed to DHW. They pursue the recovery of program benefit overpayments whether stemming from intentional program violations on the part of DHW clientele or from simple human error. To assist in the recovery of payments, the Revenue Operations pursue the capture of any monies receivable as negotiated through a repayment agreement or as awarded through fair hearing and legal proceedings, and then systematically process the receipt and distribution of those funds to ensure that they are deposited into the appropriate financial accounts. 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. [x] 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: The Department is required to pursue all overpayments when they reach the threshold of $100 dollars. If an Unintentional Program Violation occurs, the department would pursue to the overpayment but the family would not be disqualified from receiving services nor would it count toward the penalties associated to Intentional Program Violations. The result of setting a minimum overpayment threshold helps to ensure that the agency is not spending more money on administration costs to collect an overpayment than what the overpayment collection would yield, while still holding participants accountable for the responsible use of the funds. 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. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: Financial Services works to establish repayment plans with identified families or providers. A process for payment is established and signed between both parties. The result of recovering funds through repayment plans helps to ensure that participants are accountable for full repayment and the responsible use of the funds while limiting the financial burden of repayment and potentially maintaining eligibility for needed programs or provider participation. iv. [ ] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: Financial Services works with the state controller’s office to comply when individuals or providers have overpayments that necessitate collection through intercepts after other means of collection have been unsuccessful. As a result of recovering funds through tax intercepts the child care program demonstrates ongoing fiscal accountability and maintains program sustainability. vi. [ ] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: vii. [x] 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: Concerns about improper payments are forwarded to an Idaho Department of Health and Welfare (DHW)’s Integrity Unit that specializes in the review of child care payments, if an overpayment is discovered it must be repaid. The Revenue Operations unit at DHW actively pursues the collection of various outstanding monies owed to DHW. They pursue the recovery of program benefit overpayments whether stemming from intentional program violations on the part of DHW clientele or from simple human error. To assist in the recovery of payments, the Revenue Operations pursue the capture of any monies receivable as negotiated through a repayment agreement or as awarded through fair hearing and legal proceedings, and then systematically process the receipt and distribution of those funds to ensure that they are deposited into the appropriate financial accounts. 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? [ ] No. [x] 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. [x] 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: The Department is required to pursue all overpayments when they reach the threshold of $100 dollars. If an agency error occurs, the department would pursue the overpayment but the family would not be disqualified from receiving services nor would it count toward the penalties associated to Intentional Program Violations. The result of setting a minimum overpayment threshold helps to ensure that the agency is not spending more money on administration costs to collect an overpayment than what the overpayment collection would yield, while still holding participants accountable for the responsible use of the funds. 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. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: Financial Services works to establish repayment plans with identified families or providers. A process for payment is established and signed between both parties. The result of recovering funds through repayment plans helps to ensure that participants are accountable for full repayment and the responsible use of the funds while limiting the financial burden of repayment and potentially maintaining eligibility for needed programs or provider participation. iv. [ ] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: Financial Services works with the state controller’s office to comply when individuals or providers have overpayments that necessitate collection through intercepts after other means of collection have been unsuccessful. As a result of recovering funds through tax intercepts the child care program demonstrates ongoing fiscal accountability and maintains program sustainability. vi. [ ]Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: vii. [x] 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: Concerns about agency errors are forwarded to an Idaho Department of Health and Welfare (DHW)’s Integrity Unit that specializes in the review of child care subsidies, if an overpayment is discovered it must be repaid. The Revenue Operations unit at DHW actively pursues the collection of various outstanding monies owed to DHW. They pursue the recovery of program benefit overpayments whether stemming from intentional program violations on the part of DHW clientele or from simple human error. To assist in the recovery of payments, the Revenue Operations pursue the capture of any monies receivable as negotiated through a repayment agreement or as awarded through fair hearing and legal proceedings, and then systematically process the receipt and distribution of those funds to ensure that they are deposited into the appropriate financial accounts. 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: Intentional Program Violations (IPV) - (IDAPA: 16.06.12.702))- An IPV is an intentionally false or misleading action or statement as identified below in Subsections 702.01 through 702.08 of this rule. An IPV is established when a family member or the child care provider admits the IPV in writing and waives the right to an administrative hearing, or when determined by an administrative hearing, a court decision, or through deferred adjudication. Deferred adjudication exists when the court defers a determination of guilt because the accused family member or child care provider meets the terms of a court order or an agreement with the prosecutor. Penalties for an IPV - (IDAPA: 16.06.12.703) When the the Idaho Department of Health and Welfare (DHW) determines an IPV was committed, the party who committed the IPV loses eligibility for the Idaho Child Care Program (ICCP). If an individual has committed an IPV, the entire family is ineligible for child care benefits. If a child care provider has committed an IPV, the provider is ineligible to receive payments. The period of ineligibility for each offense, for both participants and providers, is as follows: First Offense. 12 months for the first IPV or fraud offense, or the length of time specified by the court Second Offense. 24 months for the second IPV or fraud offense, or the length of time specified by the court Third Offense. Permanent ineligibility for the third or subsequent IPV or fraud offense, or the length of time specified by the court Fair Hearing Process - (Benefits Process Manual: "Fair Hearing Process") Clients have 30 days from the date of the decision to request a fair hearing. Fair Hearing Officers review and respond to all requests within five calendar days of the "fair hearing requested" task being set. They communicate the status of reinstatement/continuance of benefits pending the hearing result to the customer within five calendar days of the "fair hearing requested" task being set. Then work with the client to coordinate and manage all aspects of a fair hearing to completion. The result of client disqualification temporary or permanently prevents ongoing misuse of program funds and maintains program sustainability. 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: Termination of Provider Status - (Idaho Code 56-209h) The Idaho Department of Health and Welfare (DHW) may terminate the provider agreement of, or otherwise deny provider status for a period of us to five years from the date DHW's action becomes final to any individual or entity providing the Idaho Child Care Program. Provider Notification - (IDAPA 16.06.17.750) When the Idaho Department of Health and Welfare (DHW) determines actions defined in Sections 701 through 705, 750, and 751 of these rules are appropriate, it will send written notice of the decision to the provider or person. The notice will state the basis for the action, the length of the action, the effect of the section on that person's ability to provide services under state and federal programs, and the person's appeal rights. Notice to State Licensing Authorities - (Benefits Process Manual: "Fair Hearing Process") DHW will promptly notify all appropriate licensing authorities having responsibility for licensing of a DHW action, and the facts and circumstances of that action. DHW may request certain actions be taken and that DHW be informed of actions taken. A certified letter serves as written notice of the decision. A decision issued by DHW in the Division of Welfare program will be final and effective unless an individual or representative files a written notice of appeal within 30 days from the date the decision was mailed. Appeals- Appeals can be sent to: Idaho Department of Health and Welfare Administrative Procedures Section (APS) P.O. Box 83720, Boise, Idaho 83720- 0036 or APS@dhw.idaho.gov (Letter of termination). Fair hearing officers review and respond to all requests within 14 calendar days of receipt of the appeal. They communicate the status of reinstatement of the provider agreement pending the hearing result to the provider, then work with the provider to coordinate and manage all aspects of a fair hearing to completion. The result of provider disqualification temporary or permanently prevents ongoing misuse of program funds and maintains program sustainability. iii. [x] Prosecute criminally. Describe the activities and the results of these activities based on the most recent analysis: Idaho would fully cooperate with law enforcement if an individual or provider was being prosecuted. iv. [ ] Other. Describe the activities and the results of these activities based on the most recent analysis: 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: