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Child Care Assistance Program Policy Manual Issued 05/2022 Fraud referrals 13.3 Fraud exists when: • A family has willfully or intentionally withheld, concealed, or misrepresented information to receive or to attempt to receive more benefits than they are eligible to receive or to help another person to receive or to attempt to receive more benefits than the person is entitled to receive. • A provider has willfully or intentionally withheld, concealed, or misrepresented information to be authorized by CCAP; to receive or to attempt to receive payments to which the provider was not entitled; or to help another person to receive child care assistance to which that person is not entitled. For administrative disqualifications against a provider, intent may be proven by showing a pattern of conduct that violates CCAP policies. Family fraud referrals Refer families you suspect of fraud for investigation. For CCAP agencies participating in the Fraud Prevention Investigation (FPI) program, use the Fraud Prevention Investigation Referral form DHS-3335A (PDF) to make a referral for an FPI. For CCAP agencies not participating in the FPI program, follow your agency’s process to make a referral for possible family fraud investigation and use the Fraud Prevention Investigation Referral DHS-3335A (PDF) form to notify the DHS Office of Inspector General (OIG) of the investigation. Agency processes for making referrals may include contacting your agency’s fraud investigator or investigative unit, your county or tribal attorney, and/or your local sheriff’s department. Family fraud referrals should be made whenever case file information exhibits characteristics of possible misinterpretation or omission of relevant facts or when there is inconsistent information that impacts eligibility, to determine if fraud may have occurred. These situations may occur at the time of application, redetermination, a change report, when case file information is updated or reviewed for accuracy, or when your agency receives a report of potential fraud. Provider fraud referrals Refer or notify the DHS Office of Inspector General (OIG) Child Care Provider Fraud Investigations Unit of providers you have program integrity concerns about, such as concerns about record keeping practices and/or providers you suspect of fraud. Some CCAP agencies may have the resources to investigate provider fraud locally. However, CCAP agencies are encouraged to use the Child Care Provider Investigations Communications DHS-6811 (PDF) form to inform the OIG of all child care provider investigations. Send referrals or notifications whenever it appears a provider is withholding, concealing, or misrepresenting information in order to: • Become a registered provider; • Receive payments for which the provider is not entitled; and/or • Resolve current registration or payment issues, including possible fraud.