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: During the eligibility process and case review process the Lead Agency compares data provided in the Equifax Work Number database (which is a digital verification service) and the Louisiana Immunization Network for Kids Statewide (LINKS) central registry with information provided in family Child Care Assistance Program applications. Using the Equifax system, analysts are able to verify letters of separation from previous jobs, identify when jobs may be intentionally or unintentionally omitted on an application, and assist families in reporting all income when a transition from one program to another occurs. Utilization of Work Number and LINKS allows CCAP staff to expedite processing times, validate documentation, and eliminate the need of requesting additional documentation from participants' applications. In addition, data regarding provider compliance is provided by the Louisiana Division of Nutrition Support to the Fraud Management Unit. In addition to working to identify and prevent fraud and misrepresentation by providers, the Fraud Management Unit (FMU) also works directly with the Department of Children and Family Services (DCFS)’ Strategies To Empower People (STEP) Program regarding fraud and intentional program violations by families and/or providers. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Equifax Work Number database (which is a digital verification service) data is collected and is used by the Lead Agency as a tool to address unintentional program violations. Child Care Assistance Program (CCAP) analysts have the ability to see employment information that is reported to the state using this system. Access to this system helps to prevent fraud in the transition of cases, when the time is appropriate, from the TANF-funded Strategies to Empower People (STEP) Program to a regular low-income CCAP case. Using the Equifax system, analysts are able to verify separation from previous jobs, identify when jobs may be intentionally or unintentionally omitted on an application, and assist families in reporting all income when a transition from one program to another occurs. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice:: Ongoing case sampling reviews help program administrators identify processing errors using the internal errors process and provide both individual and programmatic intervention through training opportunities. 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 Lead Agency utilizes a web- based reporting application that interfaces with eligibility payment processing systems to generate reports of possible discrepancies in payments and eligibility determination. Types of reports include the following: cases closed for sufficient income, previous check-in / previous check-out, location identifier, underutilized authorizations, and care provided outside of hours. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: As the Fraud Management Unit team reviews reports, trends are identified and brought to the attention of management during bi-weekly high-priority case reviews. During these reviews, provider and participant case information is discussed, along with needed changes to policy and/or procedure, when trends indicate continuous concerns in specific areas. Once these internal meetings (which include representatives from Legal, Administration, CCCBC, Licensing, and EC Strategy) occur, changes to procedure and policy and additional training results if necessary. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: ￿Red flag￿ reports include information about excessive back scans, scans outside of hours, scans outside of location, and provider-participant address matches. These reports help to identify not only intentional and unintentional program violations but also can indicate errors made by the Lead Agency’s provider certification, participant eligibility certification, or payments teams. When these errors are found, program management reviews collected data during high-priority meetings. This trend data drives changes to internal controls. 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: Through monitoring of provider records and ￿red flag￿ reports such as excessive back scan reports or outside of hours reports, the Lead Agency may request a provider's manual attendance records for internal review, to compare to the site’s billing request and/or billing records. Excessive back scans by full-time enrolled families, outside of hours attendance scans, and participant and provider address matches can all be an indicator of intentional or unintentional fraud as well as administrative error. This data is examined during bi-weekly meetings, and when trends are observed, changes to procedure and or policy may occur to mitigate risk. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Through monitoring of provider records and ￿red flag￿ reports such as excessive back scan reports or outside of hours reports, the Lead Agency may request a provider's manual attendance records for internal review, to compare to the site’s billing request and/or billing records. Excessive back scans by full-time enrolled families, outside of hours attendance scans, and participant and provider address matches can all be an indicator of intentional or unintentional fraud as well as administrative error. This data is examined during bi-weekly meetings, and when trends are observed, changes to procedure and or policy may occur to mitigate risk. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Inadvertent errors are identified and found through case reviews and internal audit findings. Violations may also be submitted to fraud from other areas. Excessive back scans by full-time enrolled families, outside of hours attendance scans, and participant and provider address matches can all be an indicator of intentional or unintentional fraud as well as administrative error. This data is examined during bi-weekly meetings, and when trends are observed, changes to procedure and or policy may occur to mitigate risk. 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: Case readings are completed by supervisory staff. Eligibility supervisors conduct formal case readings each month per analyst. Social service analyst supervisors conduct monthly random case readings per analyst and program specialists. These random case readings can take place when a case is questioned by an external source, such as cases that receive a complaint, and as a part of the ACF 403 monitoring process. Random samples are extracted to analyze payment and administrative errors and to ensure program integrity during the enrollment and eligibility process. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: During supervisor review, data is collected on specific cases that allow management to look for trends that indicate intentional and unintentional program violations and also administrative error. As a result of this review of data, changes can occur to policy and procedures and additional training both for internal staff and external stakeholders can occur. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: During supervisor review, data is collected on specific cases that allows management to look for trends that indicate intentional and unintentional program violations and also administrative error. As a result of this review of data, changes can occur to policy and procedures and additional training both for internal staff and external stakeholders can occur. e. [x] Audit provider records. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Retrospective and prospective audits are completed on provider billing records, on compliance guidance, and through internal and external referrals. Based on the information provided during the referral, complaint, and the preliminary investigation, audits of providers are prioritized based on the seriousness of the allegation and based on the recovery amounts. Louisiana follows an approved written audit procedure which guides the audit of provider records, monitoring, and training in each allegation. Whether resulting from an external complaint or an internal Lead Agency discovery, as a result of intentional program violations or unintentional program violations, a provider or participant may receive a written notice of violation and the Lead Agency may conduct a technical assistance visit with the provider. For more egregious offenses where intentional program violations are indicated, suspension of eligibility for a period, or in extreme cases of non-compliance, termination of certification and a period of ineligibility, is imposed, if deemed necessary. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Retrospective and prospective audits are completed on provider billing records, on compliance guidance, and through internal and external referrals. Based on the information provided during the referral, complaint, and the preliminary investigation, audits of providers are prioritized based on the seriousness of the allegation and based on the recovery amounts. Louisiana follows an approved written audit procedure which guides the audit of provider records, monitoring, and training in each allegation. Whether resulting from an external complaint or an internal Lead Agency discovery, as a result of intentional program violations or unintentional program violations, a provider or participant may receive a written notice of violation and the Lead Agency may conduct a technical assistance visit with the provider. For more egregious offenses where intentional program violations are indicated, suspension of eligibility for a period, or in extreme cases of non-compliance, termination of certification and a period of ineligibility, is imposed, if deemed necessary. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: When agency error is noted during audit, program management uses this information to inform procedure and policy changes and for individual and programmatic training. 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: Staff receive annual training on all program policies and procedures. In addition, staff receive ongoing individual and/or team training based on trending occurrences. Louisiana follows an approved system of tracking individual staff errors and incoming complaints. This helps program administration tailor training to individual staff needs and plan both large and small group training on all topics and areas of need. Furthermore, staff are trained to review all documentation for accuracy, report all instances of misleading statements or misrepresentation of relevant facts, and report suspected evidence to supervisors for review. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Staff receive annual training on all program policies and procedures. In addition, staff receive ongoing individual and/or team training based on trending occurrences. Louisiana follows an approved system of tracking individual staff errors and incoming complaints. This helps program administration tailor training to individual staff needs and plan both large and small group training on all topics and areas of need. Furthermore, staff are trained to review all documentation for accuracy, report all instances of misleading statements or misrepresentation of relevant facts, and report suspected evidence to supervisors for review. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Louisiana follows an approved system of tracking individual staff errors and incoming complaints. This helps program administration tailor training to individual staff needs and plan both large and small group training on all topics and areas of need. Each analyst has an individual error rate based on the sampling of cases. This data is used to determine agency error trends and plan ongoing training during monthly meetings and the annual CCAP staff training. Staff receive annual training on all program policies and procedures. In addition, staff receive ongoing individual and/or team training based on trending, common, recurring case errors and methods to prevent administrative errors. 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): If the participant and/or provider has been determined to have committed fraud or intentional program violation, the participant and/or provider will be required to repay all improperly paid benefits and is ineligible to receive child care assistance program funding during the disqualification period. The Lead Agency collaborates with the Office of Debt Recovery, within the Louisiana Department of Revenue and the Louisiana Attorney General's Office, to collect any debt owed to the state as a result of fraud. 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: There is no minimum recovery threshold, and action will be taken to recover all payments made for 1) ineligible households that are currently participating in the program; 2) any ineligible household resulting from the household's act of fraud, such as the submission of false or altered documents or information, intentionally making a false or misleading statement, or misrepresenting, concealing, or withholding relevant fact; 3) any ineligible household resulting from errors that are discovered in a quality control review; 4) an ineligible provider resulting from any act of fraud, such as the submission of false or altered documents or information, noncompliance with all state and federal grant guidance for compliance, intentionally making a false or misleading statement, or misrepresenting, concealing, or withholding relevant fact; and 4) any ineligible service that results in an improper overpayment. 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: The Lead Agency collaborates with the Office of Debt Recovery (ODR), within the Louisiana Department of Revenue and the Louisiana Attorney General's Office, to recover improper payments. When the Lead Agency issues an initial notification for payment due, if no payment is received by 30 days from that initial payment due date, the Lead Agency sends a courtesy reminder notification. If no payment is received by 60 days from that initial payment due date, the debt is considered delinquent, and the Lead Agency sends that notification. If no payment is received by 30 days from that delinquent payment notice, a final notice is sent, with the date that the case will be referred to the ODR. If payment is still not received by that referral date, the case is transferred to the ODR. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: The Fraud Management Unit (FMU) is responsible for notifying the household(s) and/or provider(s) of the improper payment and identifies the responsible party for the overpayment. A Repayment Agreement is sent out to the responsible party with repayment options, either for the provider to choose that the Lead Agency deduct and withhold funds from any CCAP reimbursement payment or for the provider to elect to return funds within 10 calendar days. The agreement is due back within 10 calendar days from the date on the agreement. All monthly payments begin on the 1st of the month following the month in which the repayment agreement is signed by the debtor. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: Providers who are identified as the responsible party for the improper payment are allowed to have the money to be recouped ￿deducted￿ from future deposits of CCAP electronic payments by selecting that option on their Repayment Agreement. When this option is selected, the Lead Agency will set up automatic payments to be withheld from the provider’s future electronic payment on specific dates. When payments are successfully withheld, the provider debt to the Lead Agency is reduced by the confirmed payment amount. A manual payment option is also available to reduce debt amount to the Lead Agency, in which providers can elect to return the funds via check back to the Lead Agency. v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: When the debtor fails to make payment to the Office of Debt Recovery (ODR) to clear debt with the Lead Agency, the Office of Debt Recovery or affiliates will intercept, seize, or garnish any state tax refund in the name of any debtor who is listed in the ODR's electronic debt registry as owing a delinquent final debt. vi. [x] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: The Office of Debt Recovery (ODR) may establish and use an electronic Financial Institution Data Match System, as authorized in La. R.S. 47:1677, for comparison of certain account information held by financial institutions. When the debtor fails to make payments, the ODR can intercept, seize, or garnish any monies identified in an account that is in the name of any debtor who is listed in the ODR's electronic debt registry as owing a delinquent final debt. The Office of Debt Recovery will give the Lead Agency notice thirty days prior to the utilization of any collection tool not specified by La. R.S. 47:1676, such as offset from income taxes or other accounts payable. 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: The Lead Agency has a program integrity and accountability unit within the Office of Early Childhood Care and Education that investigates internal and external referrals, ensures effective controls, and identifies areas of risk. This unit, called the Fraud Management Unit, performs audits on provider billing records and grants compliance and recovers improper payments according to established policies and procedures in addition to federal and state laws. The Lead Agency Bureau of Internal Audit may be asked to audit as well. The team is comprised of the FMU Program Consultant, Investigator, Auditor, Recovery Specialist, and administrative support staff. viii. [x] Other. Describe the activities and the results of these activities: If the participant and/or provider has been determined to have committed fraud or intentional program violation, the participant and/or provider will be required to repay all improperly paid benefits. Furthermore, ineligible providers are not eligible for grants, other certification or license approval, or other Lead Agency funding approval. Providers’ and/or participants’ certification period of time following the termination or closure of CCAP during the disqualification period may result in a sanction: 12 months funding disqualification for the first violation, 24 months funding disqualification for the second violation, and permanent funding disqualification for the third violation. 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: Inadvertent household errors require a minimum $125 recovery threshold to be met, and the household must be an inactive participant of the program. Action will be taken to recover all other inadvertent household and/or provider errors that result in improper payments made on behalf of ineligible households and any ineligible service that results in an improper overpayment. 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: The Lead Agency collaborates with the Office of Debt Recovery (ODR), within the Louisiana Department of Revenue and the Louisiana Attorney General's Office, to recover improper payments. When the Lead Agency issues an initial notification for payment due, if no payment is received by 30 days from that initial payment due date, the Lead Agency sends a courtesy reminder notification. If no payment is received by 60 days from that initial payment due date, the debt is considered delinquent, and the Lead Agency sends that notification. If no payment is received by 30 days from that delinquent payment notice, a final notice is sent, with the date that the case will be referred to the ODR. If payment is still not received by that referral date, the case is transferred to the ODR. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: The Fraud Management Unit (FMU) is responsible for notifying household(s) and/or provider(s) of improper payment and identifies the responsible party for the overpayment. A Repayment Agreement is sent out to the responsible party for repayment and is due back within 10 calendar days from the date on the agreement. All monthly payments begin on the 1st of the month following the month in which the repayment agreement is signed by the debtor. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: Providers are allowed to have the money to be recouped via deduction from future deposits of CCAP electronic payments by selecting that option on their Repayment Agreement. When this option is selected, the Lead Agency will set up automatic payments to be withheld from the provider’s future electronic payment on specific dates. When payments are successfully withheld, the provider debt to the Lead Agency is reduced by the confirmed payment amount. v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: When the debtor fails to make payment to the Office of Debt Recovery (ODR) to clear debt with the Lead Agency, the Office of Debt Recovery or affiliates will intercept, seize, or garnish any state tax refund in the name of any debtor who is listed in the ODR's electronic debt registry as owing a delinquent final debt. vi. [x] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: The Office of Debt Recovery (ODR) may establish and use an electronic Financial Institution Data Match System, as authorized in La. R.S. 47:1677, for comparison of certain account information held by financial institutions. When the debtor fails to make payments, the ODR can intercept, seize, or garnish any monies identified in an account that is in the name of any debtor who is listed in the ODR's electronic debt registry as owing a delinquent final debt. The Office of Debt Recovery will give the Lead Agency notice thirty days prior to the utilization of any collection tool not specified by La. R.S. 47:1676, such as offset from income taxes or other accounts payable. 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: The Lead Agency has a program integrity and accountability unit within the Office of Early Childhood Care and Education that investigates internal and external referrals, ensures effective controls, and identifies areas of risk. This unit, called the Fraud Management Unit, performs audits on provider billing records and compliance and recovers improper payments according to established policies and procedures in addition to federal and state laws. The Lead Agency Bureau of Internal Audit may be asked to audit as well. viii. [x] Other. Describe the activities and the results of these activities: If the participant and/or provider has been determined to have committed fraud or intentional program violation, the participant and/or provider will be required to repay all improperly paid benefits. Furthermore, ineligible providers are not eligible for grants, other certification or license approval, or other Lead Agency funding approval. Providers’ and/or participants’ certification period of time following the termination or closure of CCAP during the disqualification period may result in a sanction: 12 months funding disqualification for the first violation, 24 months funding disqualification for the second violation, and permanent funding disqualification for the third violation. 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: All CCAP payments made on behalf of ineligible households are subject to action to recover the payments, with the exception of inadvertent household and administrative error claims in the amount of $125 or less for households who are not currently participating in CCAP. 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: The Lead Agency collaborates with the Office of Debt Recovery (ODR), within the Louisiana Department of Revenue and the Louisiana Attorney General's Office, to recover improper payments. When the Lead Agency issues an initial notification for payment due, if no payment is received by 30 days from that initial payment due date, the Lead Agency sends a courtesy reminder notification. If no payment is received by 60 days from that initial payment due date, the debt is considered delinquent, and the Lead Agency sends that notification. If no payment is received by 30 days from that delinquent payment notice, a final notice is sent, with the date that the case will be referred to the ODR. If payment is still not received by that referral date, the case is transferred to the ODR. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: The Fraud Management Unit (FMU) is responsible for notifying household(s) and/or provider(s) of improper payment and identifies the responsible party for the overpayment. A Repayment Agreement is sent out to the responsible party for repayment and is due back within 10 calendar days from the date on the agreement. All monthly payments begin on the 1st of the month following the month in which the repayment agreement is signed by the debtor. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: Providers are allowed to have the money to be recouped via ￿deduction￿ from future deposits of CCAP electronic payments by selecting that option on their Repayment Agreement. When this option is selected, the Lead Agency will set up automatic payments to be withheld from the provider’s future electronic payment on specific dates. When payments are successfully withheld, the provider debt to the Lead Agency is reduced by the confirmed payment amount. v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: When the debtor fails to make payment to the Office of Debt Recovery (ODR) to clear debt with the Lead Agency, the Office of Debt Recovery or affiliates will intercept, seize, or garnish any state tax refund in the name of any debtor who is listed in the ODR's electronic debt registry as owing a delinquent final debt. vi. [x]Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: The Office of Debt Recovery (ODR) may establish and use an electronic Financial Institution Data Match System, as authorized in La. R.S. 47:1677, for comparison of certain account information held by financial institutions. When the debtor fails to make payments, the ODR can intercept, seize, or garnish any monies identified in an account that is in the name of any debtor who is listed in the ODR's electronic debt registry as owing a delinquent final debt. The Office of Debt Recovery will give the Lead Agency notice thirty days prior to the utilization of any collection tool not specified by La. R.S. 47:1676, such as offset from income taxes or other accounts payable. 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: The Lead Agency has a program integrity and accountability unit within the Office of Early Childhood Care and Education that investigates internal and external referrals, ensures effective controls, and identifies areas of risk. This unit, called the Fraud Management Unit (FMU), performs audits on provider billing records and compliance and recovers improper payments according to established policies and procedures in addition to federal and state laws. The Lead Agency Bureau of Internal Audit may be asked to audit as well. 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: When an intentional program violation or fraud is established, the Lead Agency will send notice of disqualification or termination to the household. The Fraud Management Unit (FMU) will take action with the appropriate approved penalty. A household may be disqualified for 12 months for the first violation, 24 months for the 2nd violation, and permanently for the 3rd violation. When an applicant/co-applicant does not agree with the action that has been taken by the Fraud Management Unit (FMU) staff, the FMU Supervisor will first address the issue informally, by contacting the client, explaining the reason for the disqualification, and answering any questions the client may have in reference to the sanction. If the discrepancy cannot be resolved informally, the following dispute process must be followed: 1. Within 30 calendar days of receipt of the decision notice, the applicant or co- applicant must send a written request of dispute to the CCAP Eligibility Program Manager. The Program Manager and the Executive Director of Early Childhood Operations review the request, and then a written correspondence is sent within ten calendar days of receipt of the request. 2. Written notice is considered given (a) when it is sent by email or fax to the last email address or fax number furnished to the Lead Agency, (b) when it is hand- delivered, or (3) on the fifth calendar day after it was mailed to the last mailing address furnished to the Lead Agency. 3. If the applicant or co-applicant is not satisfied with the decision of the CCAP Eligibility Program Manager and the Executive Director of Early Childhood Operations, the applicant or co-applicant must send a written request for a final dispute to the Assistant Superintendent of Early Childhood Care and Education within 15 calendar days of receipt of the decision notice sent from the CCAP Eligibility Program Manager. The Assistant Superintendent of Early Childhood Care and Education has 15 calendar days to review the request and respond in writing. The decision of the Assistant Superintendent of Early Childhood Care and Education is final. All requests for appeal and responses must be in writing. If the applicant or co-applicant misses the timeline, the right to dispute is forfeited. All disputes sent by applicant or co-applicant will be counted as sent on the date as postmarked. 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: When intentional program violation or fraud is established, the Lead Agency will send notice to the provider to be disqualified. For the first violation, the Lead Agency will issue a written notice of violation that informs the provider that continued or additional violations may result in revocation or refusal to renew certification and a period of ineligibility. For the second violation, the Lead Agency will issue a second written notice of violation that includes a Corrective Action Plan that must be implemented immediately. For the third violation, the Department will terminate certification and impose a period of ineligibility of 12 months, 24 months, or permanently. When a provider does not agree with the action that has been taken by the Fraud Management Unit (FMU) staff, the FMU Supervisor will first address the issue informally. If the discrepancy cannot be resolved informally, the following dispute process must be followed: 1. Within 30 calendar days of receipt of the decision notice, the applicant or co- applicant must send a written request of dispute to the CCAP Eligibility Program Manager. The Program Manager and the Executive Director of Early Childhood Operations review the request, and then a written correspondence is sent within ten calendar days of receipt of the request. 2. Written notice is considered given (a) when it is sent by email or fax to the last email address or fax number furnished to the Lead Agency, (b) when it is hand- delivered, or (3) on the fifth calendar day after it was mailed to the last mailing address furnished to the Lead Agency. 3. If the applicant or co-applicant is not satisfied with the decision of the CCAP Eligibility Program Manager and the Executive Director of Early Childhood Operations, the applicant or co-applicant must send a written request for a final dispute to the Assistant Superintendent of Early Childhood Care and Education within 15 calendar days of receipt of the decision notice sent from the CCAP Eligibility Program Manager. The Assistant Superintendent of Early Childhood Care and Education has 15 calendar days to review the request and respond in writing. The decision of the Assistant Superintendent of Early Childhood Care and Education is final. All requests for appeal and responses must be in writing. If the applicant or co-applicant misses the timeline, the right to dispute is forfeited. All disputes sent by applicant or co-applicant will be counted as sent on the date as postmarked. iii. [ ] Prosecute criminally. Describe the activities and the results of these activities based on the most recent analysis: 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: