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. [ ] 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. [ ] 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:: b. [ ] 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. [ ] 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: 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 consistent case reviews done by Quality Assurance, Quality Control, the CCR&Rs, and annual monitoring, enrollment documents, attendance and billing records are reviewed for accuracy and compliance with the approved child care scholarship certificate. Intentional program violations are identified through these efforts, and appropriate referrals are made to the Investigations & Recovery unit to recoup funds, establish repayment plans, help avoid future errors, and improve program practices. For the state fiscal year 2024, there have been zero intentional program violations through these activities and practices. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Through consistent case reviews done by Quality Assurance, Quality Control, the CCR&Rs, and annual monitoring, enrollment documents, attendance and billing records are reviewed for accuracy and compliance with the approved child care scholarship certificate. Unintentional program violations are identified through these efforts, and corrective action plans that include additional training are developed to avoid future errors and facilitate better administration practices. For the state fiscal year 2024, there have been zero unintentional program violations through these activities and practices. 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: DWSS/CCDP uses Quality Control (QC) reviews, requires internal audit by subrecipient supervisory personnel, and monthly and quarterly reporting to assess programmatic activities and outcomes. QC reviews program records for accurate eligibility determinations for families receiving a child care scholarship, proper payment to providers, and ensures program expenditures comply with agency, state and federal requirements. These activities ensure that program regulations are followed and that eligibility is determined in accordance with State and Federal regulations. For the state fiscal year 2024, there have been zero intentional program violations identified through these activities and practices. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Through consistent case reviews done by Quality Assurance, Quality Control, the CCR&Rs, and annual monitoring, provider records are reviewed for completeness and accuracy. Unintentional program violations are identified through these efforts, and corrective action plans that include additional training are developed to avoid future errors facilitate better administration practices. For the state fiscal year 2024, there have been zero unintentional program violations identified through these activities and practices. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Through consistent case reviews done by Quality Assurance, Quality Control, the CCR&Rs, and annual monitoring, agency errors and training needs are identified and evaluated to facilitate better administration practices. The CCDP had 1 agency error identified for the state fiscal year 2024 as a result of these activities and practices. These activities inform better practices by identifying errors and facilitating improper payment recoupment efforts. 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 auditing of provider records is done by the State Child Care Licensing for licensed providers, and by the CCR&R agencies for license-exempt providers annually. These monitors are also used to identify intentional program violations and verify discrepancies. For the state fiscal year 2024, there have been zero intentional program violations through these activities. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Through consistent case reviews done by Quality Assurance, Quality Control, the CCR&Rs, and annual monitoring, provider records are reviewed for completeness and accuracy. Unintentional program violations are identified through these efforts, and corrective action plans that include additional training are developed to avoid future errors facilitate better administration practices. For the state fiscal year 2024, there have been zero unintentional program violations through these activities. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Through consistent case reviews done by Quality Assurance, Quality Control, the CCR&Rs, and annual monitoring, agency errors and training needs are identified and evaluated to facilitate better administration practices. The CCDP had 1 agency error identified for the state fiscal year 2024 as a result of these activities and practices. These activities inform better practices by identifying errors and facilitating improper payment recoupment efforts. 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: DWSS/CCDP uses Quality Control (QC) reviews, internal audits by subrecipient supervisory personnel, and monthly and quarterly reporting to assess programmatic activities and outcomes. QC reviews program records for accurate eligibility determinations for families receiving a child care scholarship, proper payment to providers, and ensures program expenditures comply with agency, state and federal requirements. These activities ensure that program regulations are followed by staff, and that eligibility is determined in accordance with State and Federal regulations. Training gaps are identified as a result of these reviews and are facilitated by the CCDP with the CCR&R agencies. This ensures staff are knowledgeable of the policies, can distinguish discrepancies that qualify as an intentional program violation (IPV), and know the appropriate actions to take when an IPV is identified. During initial training, subsidy eligibility staff are introduced to the Quality Control team and are provided a detailed overview of their role. During this training, subsidy eligibility staff are trained to identify questionable information while processing applications, and when and how to send cases to QC for review. Internal audits are also conducted to prevent fraud and intentional program violations. For the state fiscal year 2024, there have been zero intentional program violations through these activities and practices. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: DWSS/CCDP uses Quality Control (QC) reviews, internal audits by subrecipient supervisory personnel, and monthly and quarterly reporting to assess programmatic activities and outcomes. QC reviews program records for accurate eligibility determinations for families receiving a child care scholarship, proper payment to providers, and ensure program expenditures comply with agency, state and federal requirements. These activities ensure that program regulations are followed by staff, and that eligibility is determined in accordance with State and Federal regulations. Training gaps are identified as a result of these reviews and are facilitated by the CCDP with the CCR&R agencies. This ensures staff are knowledgeable and applying policy appropriately, educating families and providers accordingly, which reduces unintentional program violations. During initial training, subsidy eligibility staff are introduced to the Quality Control team and are provided a detailed overview of their role. During this training, subsidy eligibility staff are trained to identify questionable information while processing applications, and when and how to send cases to QC for review. Internal audits are also conducted to prevent unintentional program violations. For the state fiscal year 2024, there have been zero unintentional program violations through these activities and practices. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: DWSS/CCDP uses Quality Control (QC) reviews, internal audits by subrecipient supervisory personnel, and monthly and quarterly reporting to assess programmatic activities and outcomes. QC reviews program records for accurate eligibility determinations for families receiving a child care scholarship, proper payment to providers, and ensure program expenditures comply with agency, state and federal requirements. These activities assist in ensuring that program regulations are followed by staff, and that eligibility is determined in accordance with State and Federal regulations. Training gaps are identified as a result of these reviews and are facilitated by the CCDP with the CCR&R agencies. This ensures staff are knowledgeable of the policies, prevents agency errors resulting from overpayment, underpayment, and incorrect eligibility determinations as a result of agency error. During initial training, subsidy eligibility staff are introduced to the Quality Control team and are provided a detailed overview of their role. During this training, subsidy eligibility staff are trained to identify questionable information while processing applications, and when and how to send cases to QC for review. Internal audits are also conducted to prevent agency errors. The CCDP had 1 agency error identified for the state fiscal year 2024 as a result of these activities and practices. These activities inform better practices by identifying errors and facilitating improper payment recoupment efforts. 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): Division of Welfare and Supportive Services, Investigations and Recovery unit. b. Check and describe all activities, including the results of such activity, that the Lead Agency uses to investigate and recover improper payments due to fraud. Consider in your response potential fraud committed by providers, clients, staff, vendors, and contractors. Include in the description how each activity assists in the investigation and recovery of improper payment due to fraud or intentional program violations. Activities can include, but are not limited to, the following: i. [ ] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: ii. [x] Coordinate with and refer to the other State/Territory agencies (e.g., State/Territory collection agency, law enforcement agency). Describe the activities and the results of these activities based on the most recent analysis: CCDP identifies cases of improper payment through quality assurance and quality control case reviews, monitors, and record audit activities. Cases are referred to the DWSS I&R unit for payment recovery. The I&R unit establishes a repayment plan and collects debts until the debt becomes delinquent. Once the debt becomes delinquent, the debt is sent to the State Controller’s Office for collection to ensure payment recoupment in full. The CCDP identified 5 cases that required referral to the State Controller's Office for payment recoupment due to delinquency for state fiscal year 2024 as a result of these activities and practices. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: CCDP identifies cases of improper payment through quality assurance and quality control case reviews, monitors, and record audit activities. Cases are referred to the DWSS I&R unit to establish a repayment plan. Customers are provided an option to repay the debt in one lump sum or monthly payments over a three (3) year period. The DWSS I&R unit works with a customer if more time is needed to repay a debt. If the customer becomes delinquent on paying the repayment plan, DWSS I&R pursues debt collection through small claims court to ensure payment recoupment in full. The CCDP identified 1 case that resulted in repayment plan establishment for state fiscal year 2024 as a result of these activities and practices. iv. [ ] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [x] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: CCDP identifies cases of improper payment through quality assurance and quality control case reviews, monitors, and record audit activities. Cases are referred to the DWSS I&R unit for payment recovery. The I&R unit makes every attempt to collect the debt from the customer. The DWSS I&R unit pursues debt collection through small claims court for CCDP cases that are established on a repayment plan, but become delinquent. This ensures that improper payments are recouped in full. The CCDP had no cases referred to small claims court for state fiscal year 2024 as a result of these activities and practices. 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: DWSS I&R has an investigations unit comprised of a Chief Investigator, a manager overseeing investigations, four (4) Supervisory Compliance Investigators and twenty-three (23) Compliance Investigators who investigate cases of improperly issued benefits. DWSS I&R has a debt section comprised of one (1) debt supervisor and eight (8) Administrative Assistant III’s who collect debts. The I&R unit coordinates with the State Controller's Office, establishes repayment plans, and pursues debt collection through small claims court when necessary to ensure recoupment of improper payments including fraud, agency errors, unintentional program violations, and intentional program violations. The I&R unit makes every attempt to collect the debt from the customer, and coordinates with other agencies such as the State Controller's Office and small claims court when needed to ensure the payment is recouped in full. The CCDP established a repayment plan for 1 case due to agency error, and referred 5 cases to the State Controller's Office due to delinquency for state fiscal year 2024 as a result of these activities and practices. viii. [ ] Other. Describe the activities and the results of these activities: c. Does the Lead Agency investigate and recover improper payments due to unintentional program violations? [ ] No. [x] Yes. If yes, check and describe below any activities that the Lead Agency will use to investigate and recover improper payments due to unintentional program violations. Include in the description how each activity assists in the investigation and recovery of improper payments due to unintentional program violations. Include a description of the results of such activity. i. [ ] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: ii. [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: DWSS I&R collects debts for unintentional program violations until the debt becomes delinquent. Cases that have improper payments due to unintentional program violations, intentional program violations, agency error and fraud that become delinquent are sent to the State Controller’s Office for collection. The CCDP had 5 total cases identified in state fiscal year 2024 that required referral to the State Controller's Office for delinquent payment as a result of these activities and practices. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: Customers are provided an option to repay a debt in one lump sum or monthly payments over a three (3) year period. Individually, DWSS I&R will work with a customer if more time is needed to repay a debt. The CCDP had 0 cases that required the establishment of a repayment plan due to unintentional program violation for state fiscal year 2024, as a result of these activities and repayment plan practices. iv. [ ] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [x] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: DWSS I&R may pursue debt collection through small claims court. The CCDP had zero cases that required debt collection through small claims court as a result of an unintentional program violation for state fiscal year 2024 as a result of these other debt recovery efforts and activities. 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: DWSS I&R has an investigations unit comprised of a Chief Investigator, a manager overseeing investigations, four (4) Supervisory Compliance Investigators and twenty-three (23) Compliance Investigators who investigate cases of improperly issued benefits. DWSS I&R has a debt section comprised of one (1) debt supervisor and eight (8) Administrative Assistant III’s who collect debts. The I&R unit investigates cases referred due to intentional program violation, unintentional program violation, agency error, and fraud. The CCDP identified 1 case for the state fiscal year 2024 that required an improper payment to be investigated and a debt repayment agreement to be established through the I&R unit due to agency error. 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. [ ] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: ii. [x] Coordinate with and refer to the other State/Territory agencies (e.g., State/Territory collection agency, law enforcement agency). Describe the activities and the results of these activities based on the most recent analysis: DWSS I&R collects debts until the debt becomes delinquent. Cases that have improper payments due to unintentional program violations, intentional program violations, and agency error cases that become delinquent are sent to the State Controller’s Office for collection. The CCDP did not refer any cases to the State Controller's Office for delinquency due to agency errors for the state fiscal year 2024 as a result of the activities and practices in place to recover improper payments. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: Customers are provided an option to repay a debt in one lump sum or monthly payments over a three (3) year period. Individually, DWSS I&R will work with a customer if more time is needed to repay a debt. The CCDP identified 1 agency error for the state fiscal year 2024 through case reviews, monitors, and record audits that resulted in the establishment of a repayment plan as a result of these activities. iv. [ ] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [x]Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: DWSS I&R may pursue debt collection through small claims court. The CCDP had no agency errors or other improper payment cases for the state fiscal year 2024 that required the pursuit of debt collection through small claims court as a result of case reviews, monitors, and record audit activities. 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: DWSS I&R has an investigations unit comprised of a Chief Investigator, a manager overseeing investigations, four (4) Supervisory Compliance Investigators and twenty-three (23) Compliance Investigators who investigate cases of improperly issued benefits. DWSS I&R has a debt unit comprised of one (1) debt supervisor and eight (8) Administrative Assistant III’s who collect debts. The CCDP identified 1 agency error for the state fiscal year 2024 that required investigation and resulted in a repayment agreement for improper payment to be established through the I&R unit. 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 DWSS/CCDP seeks disqualification, a notice is mailed to the customer. The customer has 30 days to respond to the notice with either a request for a hearing or accepting the disqualification and waiving their right to a hearing. If no response is received from the customer, a hearing is scheduled. When there is a hearing, the hearings officer will render a decision. After the decision is rendered, the customer or the agency has 90 days to appeal to a district court in Nevada. The CCDP identified zero customer cases for the state fiscal year 2024 that required a disqualification or sanction from the program as a result of these processes. 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 DWSS/CCDP intends to seek disqualification, a notice is mailed to the child care provider. The child care provider has 30 days to respond to the notice with either a request for a hearing or accepting the disqualification and waiving their right to a hearing. If no response is received from the child care provider, a hearing will be scheduled. When there is a hearing, the hearings officer will render a decision. After the decision is rendered, the child care provider or the agency has 90 days to appeal to a district court in Nevada. The CCDP identified zero provider cases for the state fiscal year 2024 that required a disqualification or sanction from the program as a result of these processes. iii. [x] Prosecute criminally. Describe the activities and the results of these activities based on the most recent analysis: DWSS I&R may submit a criminal prosecution packet to the Nevada Attorney General’s Office to prosecute individuals depending on the nature of the investigation and loss to the agency. The CCDP had zero cases for the state fiscal year 2024 that required criminal prosecution due to agency loss as a result of these activities. 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: