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: The Child and Adult Care Food Program (CACFP) relies on the Lead Agency’s Child Care Licensing program to ensure a program is in good standing and eligible to participate. CACFP provides data on programs issued an IPV to the Lead Agency QRS program. Providers with CACFP violations are ineligible to participate in the QRS program. Montana’s SNAP, TANF, and Medicaid data is maintained in the Lead Agency database. This system functions to conduct client analysis and issue benefits. The Lead Agency’s subsidy and licensing database interfaces with family portal to determine express client eligibility, i.e. a TANF approved family is eligible for the child care subsidy program. Clients determined ineligible due to fraud are made ineligible for child care subsidy funds. Between 2020-2022, CACFP cited eight child care providers for being seriously deficient, and one child care provider was terminated and disqualified from participation in CACFP. None of them were disqualified from participating in the QRS program. Between 2020-2022, there are no instance where a client was found ineligible for the child care subsidy program. 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:: 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: A daily report of payment issues is automatically created and recorded in an error log. A designated program specialist reviews the daily report and works with child care providers and individuals to resolve payment issues. The Lead Agency’s database invoicing process automatically flags invoices that exceed 10% of the authorized amount requiring a review by a scholarship contractor’s eligibility supervisor. Invoices justified in the over authorized amount can be fully paid, otherwise they are reduced to the authorized amount. The database generates a daily error log. This report logs payments that the payment system was unable to processes in the previous day. A program specialist reviews this log to determine the reason for the error. Once the cause is determined, they use that information to address the failed payment, including reissuing the payment if necessary and reporting the issue to FOB for technical assistance. The result of these activities are a quick remediation of payment errors and a reduction of payment errors due to technological errors. Montana’s Department of Administration reissued eight checks for payment in 2021 and lowered the number to one reissued check in 2022. The Lead Agency saw a rise in documentation issues resulting in a delayed payment from 19 in 2021 to 47 in 2022. An example of a documentation issue is a missing W-9. When a child care provider uses online invoicing, the invoice and payment are processed quicker. Additionally, online invoices are processed by the database through auto-releasing. As of May 2023, 84% of Montana’s child care providers participate in online invoicing, 52% of which are auto-released by the database. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: A daily report of payment issues is automatically created and recorded in an error log. A designated program specialist reviews the daily report and works with child care providers and individuals to resolve payment issues. Montana’s Department of Administration reissued eight checks for payment in 2021 and lowered the number to one reissued check in 2022. The Lead Agency saw a rise in documentation issues from 19 in 2021 to 47 in 2022 that delayed a payment. An example of a documentation issue is a missing W-9. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: A daily report of payment issues is automatically created and recorded in an error log. A designated program specialist reviews the daily report and works with child care providers and individuals to resolve payment issues. Review of this report identifies agency errors in the automated payment process. Errors are referred to ECFSD’s FOB team for correction. Most payment issues are resolved by a program specialist. Some payment issues are system wide and require the FOB team’s support. One issue in 2021 and two issues in 2022 were referred to the fiscal team. 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: A monthly invoice for a selected child, submitted by a child care provider, is reviewed as part of the error-rate review process. Reviewing monthly invoices aids in the identification and prevention of fraud and intentional program violations because it requires a review of actual attendance against the authorized hours of care for a child. Child care providers are required to retain attendance records for six years after date of attendance. The results of this practice are an identification of providers who need technical assistance to detect of improper invoicing, recover improper payments, and reduce improper payments made. A review of sign-in/sign-out records was added to case file reviews in 2023. During 2020-2022, monitoring of child care provider’s sign-in/sign-out records was completed routinely. In three months of case file reviews, technical assistance has been given to 25% of the child care providers. Additionally, the Lead Agency has worked to standardize technical assistance efforts with scholarship contractor agencies. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Scholarship contractor agency staff conduct investigations into invoices. Invoices subject to inquiry are those that appear to practice block billing, are over authorized hours, or that claim a child in more than one program during the same period. During the investigative process, scholarship contractor agency staff request provider attendance records to review. The Lead Agency aids in these reviews as needed. Records reviewed include sign-in/sign-out sheets, invoices, and authorization plans. If staff are unable to reconcile attendance records with the invoice, the case is referred to the Lead Agency. A Lead Agency specialist reviews the case and determines the overpayment to be assessed. Providers are required to retain attendance records for six years after the attendance date. Providers determined to have an overpayment as the result of an unintentional program violation are issued a technical assistance letter in addition to the notification of overpayment. In 2020, there were 23 investigations, with technical assistance given to 17 child care providers. In 2021, there were 18 investigations technical assistance given to 13 child care providers. In 2022, there were 7 investigations, technical assistance given to 3 child care providers. iii. [ ] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: 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: Monthly eligibility cases are selected by the Lead Agency for a second level review by the scholarship contractor agency eligibility supervisors. These supervisor reviews mirror the error-rate review process at the state level. Monthly supervisor reviews aid in the identification and prevention of fraud and intentional program violations because they allow for a review of eligibility cases where potential fraud can be identified. Results of the supervisor reviews are shared with the Lead Agency and include the actions the scholarship contractor agency has taken to resolve the errors, and processes established to prevent the recurrence of similar errors. This process allows the Lead Agency to provide targeted technical assistance and training to specific scholarship contractor agency staff based on their need. This results in better trained eligibility staff who can more readily identify errors to reduce instances of intentional program violations and fraud. In 2023, the Lead Agency and scholarship contractor agencies meet monthly to discuss monthly case reviews and identify errors and trends. In three months of scholarship contractor case file reviews, technical assistance has been given to 25% of the child care providers. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Each month, the Lead Agency randomly selects case files from each scholarship contractor region. These cases are reviewed at the scholarship contractor level by each agency’s eligibility supervisor to determine if eligibility determinations and child care payments are accurate and in accordance with Best Beginnings Child Care Scholarship policy. The supervisor shares the result with the Lead Agency along with mitigation strategies and processes they have employed to prevent reoccurrence of an identified error. The Lead Agency conducts monthly reviews of eligibility supervisor case files. Results of the supervisor reviews are shared with the state and include the actions the scholarship contractor agency has taken to resolve the errors, and any processes established to prevent the recurrence of similar errors. This allows the state to provide targeted technical assistance and training to specific scholarship contractor agency staff based on need. Better trained eligibility staff can more readily identify errors that lead to unintentional program violations and prevent them from occurring. Lead Agency and scholarship contractor agencies meet monthly to discuss monthly case reviews, errors, and trends. In three months of scholarship contractor case file reviews, technical assistance has been given to 25% of the child care providers. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Each month, the Lead Agency conducts error rate reviews, even in non-reporting years. Eligibility supervisors provide the Lead Agency with an overview of the reviews including the nature of the errors discovered. Lead Agency staff review the summary and follow-up with reviews on individual cases to ensure accuracy. An agency with an error rate higher than 10% must submit a plan of correction to the Lead Agency detailing their plan to address errors and prevent similar errors from arising in the future. The Lead Agency must approve the plan. The plan is satisfied when the error rate returns below 10%. Any agency found with a repeated error rate higher than 10% must submit a plan for approval to the Lead Agency outlining plans to address their errors. In the event of repeated 10% or higher error rates, the agency is placed into a corrective action plan. The results of these activities are a reduction in agency errors. One scholarship contractor agency was on a corrective action plan in 2021. There was no corrective action plans in 2022. 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 scholarship contractor agency staff conduct investigations into invoices. Invoices subject to inquiry are those that appear to practice block billing, e.g. same time in and time out for a child during an invoice period, are over authorized hours, or that claim a child in more than one program during the same period. During the investigative process of a program, scholarship contractor agency staff request provider attendance records to review. The Lead Agency aids in these reviews as needed. Records reviewed include sign-in/sign-out sheets, invoices, and authorization plans. If a scholarship contractor agency staff member is unable to reconcile attendance records with the invoice, the case is referred to the Lead Agency. A Lead Agency specialist reviews the case and determines the overpayment to be assessed and, if applicable, an intentional program violation. Record reviews aid in the identification of provider technical assistance needs and in the reduction of instances of fraud and intentional program violations. In 2020, there were 23 investigations, with four resulting intentional program violations issued and technical assistance given to 17 child care providers. In 2021, there were 18 investigations, with six resulting intentional program violations and technical assistance given to 13 child care providers. In 2022, there were 7 investigations, with one resulting intentional program violation and technical assistance given to 3 child care providers. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The scholarship contractor agency staff conduct investigations into invoices. Invoices subject to inquiry are those that appear to practice block billing, e.g. same time in and time out for a child during an invoice period, are over authorized hours, or that claim a child in more than one program during the same period. During the investigative process of a program, scholarship contractor agency staff request provider attendance records to review. The Lead Agency aids in these reviews as needed. Records reviewed include sign-in/sign-out sheets, invoices, and authorization plans. If a scholarship contractor agency staff member is unable to reconcile attendance records with the invoice, the case is referred to the Lead Agency. A Lead Agency specialist reviews the case and determines the overpayment to be assessed and if the error is the result of an unintentional program violation. Providers found to have an unintentional program violation are provided a technical assistance letter. In 2020, there were 23 investigations, with technical assistance given to 17 child care providers. In 2021, there were 18 investigations technical assistance given to 13 child care providers. In 2022, there were 7 investigations, technical assistance given to 3 child care providers. iii. [ ] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: 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: All scholarship contractor agency eligibility staff are required to complete the state’s subsidy policy course, Eligibility Basics, at the onset of their onboarding with their agency. In addition, new eligibility staff are required to have a training plan prior to assuming a caseload. The Lead Agency provides ongoing training for this group. Trainings address policy and rule changes and updates. When either a payment or an administrative error is identified during the error-rate review process, the scholarship contractor agency eligibility supervisor is required to train all regional eligibility staff on the applicable policy and procedure. This aids in the identification and prevention of fraud and intentional program violations. Well trained staff are better able to identify fraud and intentional program violations. For the federal error-rate review years, 2018 and 2021, the Lead Agency has maintained a federal improper payment percentage under 3% and less than 10% of cases had errors. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: When either a payment or an administrative error is identified during the error-rate review process, the scholarship contractor agency eligibility supervisor is required to train all regional eligibility staff on the applicable policy and procedure. This aids in the identification and prevention of fraud and intentional program violations. Well- trained staff have reduced the number of unintentional program violations. For the federal error-rate review years, 2018 and 2021, the Lead Agency has maintained a federal improper payment percentage under 3% and less than 10% of cases had errors. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: When either a payment or an administrative error is identified during the error-rate review process, the scholarship contractor agency eligibility supervisor is required to train all scholarship contractor agency eligibility staff on the applicable policy and procedure. This aids in the identification and prevention of fraud and intentional program violations. The scholarship contractor agency informs the Lead Agency on internal procedures to address training needs. The Lead Agency is available to provide technical assistance and training input as needed. The results of these activities are a reduction of agency error. For the federal error-rate review years, 2018 and 2021, the Lead Agency has maintained a federal improper payment percentage under 3% and less than 10% of cases had 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): The State’s Business and Financial Services Division pursues the collection 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 Lead Agency’s policy does not pursue repayment under $100. If a household or provider receives any amount of subsidy funds to which they are not entitled, an overpayment may occur. Once an overpayment has been determined and assessed, the head of household or provider establishes a payment plan with BFSD. A household who is not current on their overpayment is not eligible for child care assistance, and a provider who is not current is not eligible for subsidy payments until payments are current. In 2021-2022, child care providers with overpayments may have still received subsidy payments. Now, child care providers with an overpayment must maintain compliance to receive subsidy payments. At initial and annual re- determination, a parent’s overpayment compliance is verified. If a parent is not in compliance, then the parent is not eligible for child care assistance. The Lead Agency plans to track this information to determine if there are denials of eligibility based on these criteria. 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: When an improper payment is determined, the Lead Agency works with BFSD to establish an accounts receivable for the improper payment. BFSD manages the recovery of improper payments. BFSD submits a monthly aging report to the subsidy program manager and the FOB. This report allows the Lead Agency to determine which overpayment cases are current and which are delinquent. Parties in overpayment who have not made a payment after 30 days receive a notification. A second notification is issued after 60 days of inactivity. Cases without payment activity for 90 days are referred to tax offset for collection of the remaining amount. In 2021 and 2022, one child care provider each year was issued an overpayment and were sent to tax offset for payment collection. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: BFSD can work with a household or a provider with an established improper payment to determine a repayment plan. Provider or family payment plans allow the Lead agency to recover improper payments. BFSD establishes a repayment plan with a client unless the client chooses to pay the improper payment in full. The Lead Agency works with BFSD on ensure overpayments have a current repayment agreement. In 2021-2022, child care providers may have had a current overpayment and still received subsidy payments. In 2023, Montana began to enforce a child care provider with an overpayment must be incompliance to receive subsidy payments. Four child care providers had current overpayments and are in compliance with paying their overpayments. At initial and annual re- determination, a parent’s overpayment compliance is verified. If a parent is not in compliance, then the parent is not eligible for child care assistance. The Lead Agency tracks this data to determine if there are denials of eligibility based on these criteria. 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: When a parent or child care provider is in default on an improper payment, BFSD will establish a tax intercept. An account is determined to be in default if there is no activity over the previous 90 days. This ensures an improper payment can be recovered if a parent or child care provider receives a state tax refund. In 2021 and 2022, one child care provider each year was issued an overpayment and not paying timely and sent to tax offset for payment collection. 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. [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 Lead Agency does not pursue repayment on amounts below $100. The Lead Agency tracks improper payments below $100. These are often a small error and do not require technical assistance. For example, a child care provider may enter incorrect hours for one day, causing an overpayment that is less than $100. 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: When an improper payment is determined, the Lead Agency works with BFSD to establish an accounts receivable for the improper payment. BFSD manages the payments and recovery of the improper payment. The provider or family is issued an overpayment notification letter, which includes the determination, amount of overpayment, and directions for appeal. Only one improper payment was appealed in 2020. 2021-2022 there were no appealed improper payments. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: BFSD can work with a household or provider with an established improper payment to determine a repayment plan. Provider or family payment plans allow the Lead Agency to recover improper payment. BFSD establishes a repayment plan with a client unless the client chooses to pay the improper payment in full. The Lead Agency will work with BFSD on tracking that overpayments have a current repayment agreement. In 2021-2022, child care providers may have had a current overpayment and still received subsidy payments. Now, child care providers with an overpayment must maintain compliance to receive subsidy payments. At initial and annual re-determination, a parent’s overpayment compliance is verified. If a parent is not in compliance, then they are not eligible for child care assistance The Lead Agency tracks this data to determine if there are denials of eligibility based on these criteria. 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: When a parent or child care provider is in default on an improper payment, BFSD will establish a tax intercept. This ensures an improper payment can be recovered if a child care provider receives a state tax refund. In 2021 and 2022, one child care provider each year was issued an overpayment and sent to tax offset for payment collection. 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? [ ] 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: If an investigation determines an improper payment is due to an error caused by the Lead Agency or a scholarship contractor agency, the Lead Agency does not pursue repayment. However, if a family receiving benefits is determined to be above 85% state median income, then recovery of the improper payment is sought. The family is issued an overpayment notification letter, which includes the facts of the determination of overpayment, amount of overpayment, direction to satisfy the overpayment, and direction for appeal of the overpayment assessment. During 2020-2023, no overpayment was pursued based off a family being over 85% SMI. 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 Business and Financial Services Division (BFSD) is the state agency tasked with the pursuit of overpayment collections. A family in overpayment status establishes a payment plan with BFSD. The plan is in effect until the overpayment is satisfied with no outstanding balance. BFSD furnishes the Lead Agency with a monthly status on all overpayments resulting in the collection of improperly issued funds. The Lead Agency meets regularly with BFSD to pursue overpayments based on fraud and to bring both child care providers and parents into compliance. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: BFSD establishes improper payment to determine a repayment plan. Provider or family p payment plan allow the Lead Agency to recover improper payments in full. The Lead Agency meets regularly with BFSD to pursue overpayments based on fraud and to bring both child care providers and parents into compliance. 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: When a family is in default on an improper payment, BFSD establishes a tax intercept ensuring the improper payment is recoverable if a family receives a state tax refund. The result of this activity is a higher recovery rate of improperly issued funds. In 2021 and 2022, one child care provider each year was issued an overpayment and sent to tax offset for payment collection. 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: In its Administrative Rule, the Lead Agency can issue an Intentional Program Violation (IPV) whether an overpayment is issued or not. Clients may be disqualified from participation after the second IPV is issued up to a period of seven years. Clients can appeal the IPV through the Fair Hearing Process. Directions for appealing are included with all IPV notifications. The process begins with an appeal for an administrative review by the Lead Agency of the case. The review is conducted by a member of the Lead Agency’s subsidy unit. If the review is found in the client’s favor, the client is reinstated in the program. If the administrative review upholds the previous disqualification, the client may seek redress through the Office of Administrative Hearing. The client submits a request for a hearing through the Office of Administrative Hearing. The office schedules a hearing with the client and the Lead Agency as well as any other parties relevant to the case. Hearings are presided over by an administrative law judge. The administrative law judge decides the outcome and instructs the Lead Agency in writing to either uphold the previous decision or to reinstate the client. Between 2020-2022 there were no appealed improper payments for clients. No parent was disqualified from receiving the child care subsidy. 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: In its Administrative Rule, the Lead Agency can issue an Intentional Program Violation (IPV) whether an overpayment is issued or not. Providers may be disqualified from participation after the second IPV is issued up to a period of seven years. Providers can appeal the IPV through the Fair Hearing Process. Directions for appealing are included with all IPV notifications. The process begins with an appeal for an administrative review by the Lead Agency of the case. The review is conducted by a member of the Lead Agency’s subsidy unit. If the review is found in the provider’s favor, the provider is reinstated in the program. If the administrative review upholds the previous disqualification, the provider may seek redress through the Office of Administrative Hearing. The provider submits a request for a hearing through the Office of Administrative Hearing. The office schedules a hearing with the provider and the Lead Agency as well as any other parties relevant to the case. Hearings are presided over by an administrative law judge. The administrative law judge decides the outcome and instructs the Lead Agency in writing to either uphold the previous decision or to reinstate the provider. Between 2020-2022 there were no appealed improper payments for providers. No child care provider was disqualified from receiving the child care subsidy. 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: