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: An Intentional Program Violation is established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. If the Intentional Program Violation is established in a contested case, the Department initiates the Intentional Program Violation hearing. There is no administrative appeal after a person waives the right to an Intentional Program Violation hearing, and the penalty may not be changed by subsequent administrative action except as follows: A person who waives the right to an Intentional Program Violation hearing may seek relief in court or request a contested case hearing on the sole issue of whether the waiver was signed under duress (see OAR 461-025-0310). If there was a determination that the waiver was signed under duress, the initial Intentional Program Violation penalty is voided, and: if a court determines that a waiver was signed under duress, the court may determine whether an Intentional Program Violation occurred and the amount of penalty; or if an administrative law judge determines that a waiver was signed under duress, the Department may initiate an Intentional Program Violation hearing to determine whether an Intentional Program Violation occurred and the amount of the penalty. Child care providers who have incurred an overpayment established as an Intentional Program Violation claim are ineligible for payment as follows: for six months and until the full amount of the overpayment is paid; or permanently, if the Oregon Department of Human Services Child Care Program Manager finds that such ineligibility is in the public interest. Intentional Program Violations are assessed rarely and only in situations where there is repeat fraudulent activity. Providers with an Intentional Program Violation are prohibited from participating in the subsidy program in the future, thereby resulting in no further potentially fraudulent activity and billing. In more egregious situations the agency could choose to prosecute the case criminally. In this case it would be staffed with appropriate Leadership and local district attorneys for appropriateness. Because the ONE system includes data from various programs, share/match data from other programs is utilized in establishing and preventing intentional program violations. Results: Between July 2022 and June 2024, two provider caused IPV’s were written. We do not currently have the data to disaggregate where the initial referral originated. Between July 2022 and June 2024, 17 cases of suspected provider fraud were referred to the Fraud Investigation Unit, with two Intentional Program violations written. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: A monthly audit of child care for School-Age children is conducted for months when school is in full-time session. The audit reviews child care hours billed for School-Age children to identify improper payments resulting from providers billing for care during the school day. This work results in the opportunity to discover errors earlier in the process, to enhance program integrity and stewardship, and to verify the accuracy of eligibility. Referrals are also received from other parts of the agency including the Direct Pay Unit, Fraud Investigation Unit, and branch offices. These are followed up on via the Overpayment Writing Unit. Data Match Unit (DMU) also works on a variety of federally mandated reports in conjunction with other states to achieve their goal of ensuring program integrity. DMU will notify workers if potential action is needed. Because the ONE system includes data from various programs, share/match data from other programs is utilized in establishing and preventing unintentional program violations. Results: Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals from reports worked, the Direct Pay Unit, and ODHS Branches and wrote 589 overpayments for a total of $881,712.24. As of June 2024, ODHS has collected $ 444,371.97 of the total. 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: Data Match Unit works a variety of federally mandated reports in conjunction with other states to achieve their goal of ensuring program integrity. DMU will notify workers if potential action is needed. A monthly audit of child care for School-Age children is conducted for months when school is in full-time session. The audit reviews child care hours billed for School-Age children to identify improper payments resulting from providers billing for care during the school day. Other areas of potential program violation are identified outside of system reports. Results: Between July 2022 and June 2024, two provider caused IPV’s were written. We do not currently have the data to disaggregate where the initial referral originated. Between July 2022 and June 2024, 17 cases of suspected provider fraud were referred to the Fraud Investigation Unit, with two Intentional Program violations written. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Data Match Unit works a variety of federally mandated reports in conjunction with other states to achieve their goal of ensuring program integrity. DMU will notify workers if potential action is needed. A monthly audit of child care for School-Age children is conducted for months when school is in full-time session. The audit reviews child care hours billed for School-Age children to identify improper payments resulting from providers billing for care during the school day. Other areas of potential program violation are identified outside of system reports. Results: Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals from reports worked, the Direct Pay Unit, and ODHS Branches and wrote 589 overpayments for a total of $881,712.24. As of June 2024, ODHS has collected $ 444,371.97 of the total. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The Data Match Unit also works a variety of federally mandated reports in conjunction with other states to achieve their goal of ensuring program integrity. DMU will notify workers if potential action is needed. A monthly audit of child care for School-Age children is conducted for months when school is in full-time session. The audit reviews child care hours billed for School-Age children to identify improper payments resulting from providers billing for care during the school day. Other areas of agency error are identified outside of system reports. 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: An Intentional Program Violation is established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. If the Intentional Program Violation is established in a contested case, the Department initiates the Intentional Program Violation hearing. There is no administrative appeal after a person waives the right to an Intentional Program Violation hearing, and the penalty may not be changed by subsequent administrative action except as follows: A person who waives the right to an Intentional Program Violation hearing may seek relief in court or request a contested case hearing on the sole issue of whether the waiver was signed under duress (see OAR 461-025-0310). If there was a determination that the waiver was signed under duress, the initial Intentional Program Violation penalty is voided, and: if a court determines that a waiver was signed under duress, the court may determine whether an Intentional Program Violation occurred and the amount of penalty; or if an administrative law judge determines that a waiver was signed under duress, the Department may initiate an Intentional Program Violation hearing to determine whether an Intentional Program Violation occurred and the amount of the penalty. Child care providers who have incurred an overpayment established as an Intentional Program Violation claim are ineligible for payment as follows: for six months and until the full amount of the overpayment is paid; or permanently, if the Oregon Department of Human Services Child Care Program Manager finds that such ineligibility is in the public interest. Intentional Program Violations are assessed rarely and only in situations where there is repeat fraudulent activity. Providers with an Intentional Program Violation are prohibited from participating in the subsidy program in the future, thereby resulting in no further potential fraudulent activity and billing. In more egregious situations the agency could choose to prosecute the case criminally. In this case it would be staffed with appropriate Leadership and local district attorneys for appropriateness. Intentional program violations are initiated via referrals to the Office of Payment Accuracy and Recovery, which houses (in addition to other areas) the Overpayment Writing Unit, Quality Control, Quality Assurance, and Fraud Investigations. Intentional program violations are only established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. However, review does occur preliminarily through enrollment documents and attendance through a variety of strategies: monthly randomized audits of child care billing forms through OPAR, monthly reports which demonstrate instances in which providers are billing full-time hours when a school age child is typically in school, and through case level reviews by both Quality Control and Quality Assurance. In addition to these initiatives, the Direct Pay Unit may receive referrals of potential fraud or program misuse and refer outward to OPAR for further investigation. All of these initiatives inform better practice to adequately identify and prevent instances of intentional program violations. Results: Between July 2022 and June 2024, two provider caused IPV’s were written. We do not currently have the data to disaggregate where the initial referral originated. Between July 2022 and June 2024, 17 cases of suspected provider fraud were referred to the Fraud Investigation Unit, with two Intentional Program violations written. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: An Intentional Program Violation is established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. If the Intentional Program Violation is established in a contested case, the Department initiates the Intentional Program Violation hearing. There is no administrative appeal after a person waives the right to an Intentional Program Violation hearing, and the penalty may not be changed by subsequent administrative action except as follows: A person who waives the right to an Intentional Program Violation hearing may seek relief in court or request a contested case hearing on the sole issue of whether the waiver was signed under duress (see OAR 461-025-0310). If there was a determination that the waiver was signed under duress, the initial Intentional Program Violation penalty is voided, and: if a court determines that a waiver was signed under duress, the court may determine whether an Intentional Program Violation occurred and the amount of penalty; or if an administrative law judge determines that a waiver was signed under duress, the Department may initiate an Intentional Program Violation hearing to determine whether an Intentional Program Violation occurred and the amount of the penalty. Child care providers who have incurred an overpayment established as an Intentional Program Violation claim are ineligible for payment as follows: for six months and until the full amount of the overpayment is paid; or permanently, if the Oregon Department of Human Services Child Care Program Manager finds that such ineligibility is in the public interest. Intentional Program Violations are assessed rarely and only in situations where there is repeat fraudulent activity. Providers with an Intentional Program Violation are prohibited from participating in the subsidy program in the future, thereby resulting in no further potential fraudulent activity and billing. In more egregious situations the agency could choose to prosecute the case criminally. In this case it would be staffed with appropriate Leadership and local district attorneys for appropriateness. Intentional program violations are initiated via referrals to the Office of Payment Accuracy and Recovery, which houses (in addition to other areas) the Overpayment Writing Unit, Quality Control, Quality Assurance, and Fraud Investigations. Intentional program violations are only established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. However, review does occur preliminarily through enrollment documents and attendance through a variety of strategies: monthly randomized audits of child care billing forms through OPAR, monthly reports which demonstrate instances in which providers are billing full-time hours when a school age child is typically in school, and through case level reviews by both Quality Control and Quality Assurance. In addition to these initiatives, the Direct Pay Unit may receive referrals of potential fraud or program misuse and refer outward to OPAR for further investigation. The Direct Pay Unit also houses a Provider Specialist who reviews random billing forms on a monthly basis and conducts one-on-one technical assistance with providers to ensure billing is completed according to CCDF rules. All of these initiatives inform better practice to adequately identify and prevent instances of unintentional program violations. Results: Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals from reports worked, the Direct Pay Unit, and ODHS Branches and wrote 589 overpayments for a total of $881,712.24. As of June 2024, ODHS has collected $ 444,371.97 of the total. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: An Intentional Program Violation is established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. If the Intentional Program Violation is established in a contested case, the Department initiates the Intentional Program Violation hearing. There is no administrative appeal after a person waives the right to an Intentional Program Violation hearing, and the penalty may not be changed by subsequent administrative action except as follows: A person who waives the right to an Intentional Program Violation hearing may seek relief in court or request a contested case hearing on the sole issue of whether the waiver was signed under duress (see OAR 461-025-0310). If there was a determination that the waiver was signed under duress, the initial Intentional Program Violation penalty is voided, and: if a court determines that a waiver was signed under duress, the court may determine whether an Intentional Program Violation occurred and the amount of penalty; or if an administrative law judge determines that a waiver was signed under duress, the Department may initiate an Intentional Program Violation hearing to determine whether an Intentional Program Violation occurred and the amount of the penalty. Child care providers who have incurred an overpayment established as an Intentional Program Violation claim are ineligible for payment as follows: for six months and until the full amount of the overpayment is paid; or permanently, if the Oregon Department of Human Services Child Care Program Manager finds that such ineligibility is in the public interest. Intentional Program Violations are assessed rarely and only in situations where there is repeat fraudulent activity. Providers with an Intentional Program Violation are prohibited from participating in the subsidy program in the future, thereby resulting in no further potential fraudulent activity and billing. In more egregious situations the agency could choose to prosecute the case criminally. In this case it would be staffed with appropriate Leadership and local district attorneys for appropriateness. Intentional program violations are initiated via referrals to the Office of Payment Accuracy and Recovery, which houses (in addition to other areas) the Overpayment Writing Unit, Quality Control, Quality Assurance, and Fraud Investigations. Intentional program violations are only established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. However, review does occur preliminarily through enrollment documents through case level reviews by both Quality Control and Quality Assurance. In addition to these initiatives, the Direct Pay Unit may receive referrals of potential fraud or program misuse and refer outward to OPAR for further investigation, or the Child Care Assistance Program may receive an inquiry from eligibility staff pertaining to incorrect billing or payment completed which might suggest agency error. All of these initiatives inform better practice to adequately identify and prevent instances of agency error. 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: All completed cases in the fraud unit are reviewed by lead staff and approved through an internal quality control process. Random reviews of cases are completed by team lead workers, Quality Assurance staff, or management. Data Match Unit also works a variety of federally mandated reports in conjunction with other states to achieve their goal of ensuring program integrity. The results of this are that DMU will notify workers if potential action is needed, and corrective action can be taken to prevent intentional program violations. Between July 2022 and June 2024, 17 cases of suspected provider fraud were referred to the Fraud Investigation Unit, with two Intentional Program violations written. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: A monthly audit of 160 child care providers for School-Age children is conducted for months when school is in full- time session. The audit reviews child care hours billed for School-Age children to identify improper payments resulting from providers billing for care during the school day. Random reviews of any CCDF-funded case is completed by team lead workers, Quality Assurance staff, or management. Enrollment documents, attendance and billing records are gathered, reviewed and either cleared or established as an overpayment. Data Match Unit also works a variety of federally mandated reports in conjunction with other states to achieve their goal of ensuring program integrity. The results of this are that DMU will notify workers if potential action is needed, and corrective action can be taken to prevent unintentional program violations. Results: Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals from reports worked, the Direct Pay Unit, and ODHS Branches and wrote 589 overpayments for a total of $881,712.24. As of June 2024, ODHS has collected $ 444,371.97 of the total. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: A monthly audit of 160 child care providers for School-Age children is conducted for months when school is in full-time session. The audit reviews child care hours billed for School-Age children to identify improper payments resulting from providers billing for care during the school day. Random reviews of any CCDF-funded case can be completed by team lead workers, Quality Assurance staff, or management. Enrollment documents, attendance and billing records are gathered, reviewed and either cleared or established as an overpayment. Data Match Unit also works a variety of federally mandated reports in conjunction with other states to achieve their goal of ensuring program integrity. The results of this are that DMU will notify workers if potential action is needed, and corrective action can be taken to prevent unintentional program violations. e. [x] Audit provider records. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: An Intentional Program Violation is established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. If the Intentional Program Violation is established in a contested case, the Department initiates the Intentional Program Violation hearing. There is no administrative appeal after a person waives the right to an Intentional Program Violation hearing, and the penalty may not be changed by subsequent administrative action except as follows: A person who waives the right to an Intentional Program Violation hearing may seek relief in court or request a contested case hearing on the sole issue of whether the waiver was signed under duress (see OAR 461-025-0310). If there was a determination that the waiver was signed under duress, the initial Intentional Program Violation penalty is voided, and: if a court determines that a waiver was signed under duress, the court may determine whether an Intentional Program Violation occurred and the amount of penalty; or if an administrative law judge determines that a waiver was signed under duress, the Department may initiate an Intentional Program Violation hearing to determine whether an Intentional Program Violation occurred and the amount of the penalty. Child care providers who have incurred an overpayment established as an Intentional Program Violation claim are ineligible for payment as follows: for six months and until the full amount of the overpayment is paid; or permanently, if the Oregon Department of Human Services Child Care Program Manager finds that such ineligibility is in the public interest. Intentional Program Violations are assessed rarely and only in situations where there is repeat fraudulent activity. Providers with an Intentional Program Violation are prohibited from participating in the subsidy program in the future, thereby resulting in no further potential fraudulent activity and billing. In more egregious situations the agency could choose to prosecute the case criminally. In this case it would be staffed with appropriate Leadership and local district attorneys for appropriateness. Intentional program violations are initiated via referrals to the Office of Payment Accuracy and Recovery, which houses (in addition to other areas) the Overpayment Writing Unit, Quality Control, Quality Assurance, and Fraud Investigations. Intentional program violations are only established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. However, review does occur preliminarily through the auditing and review of enrollment documents and attendance through a variety of strategies: monthly randomized audits of child care billing forms through OPAR, monthly reports which demonstrate instances in which providers are billing full-time hours when a school age child is typically in school, and through case level reviews by both Quality Control and Quality Assurance. In addition to these initiatives, the Direct Pay Unit may receive referrals of potential fraud or program misuse and refer outward to OPAR for further investigation. All of these initiatives inform better practice to adequately identify and prevent instances of intentional program violations. Results: Between July 2022 and June 2024, two provider caused IPV’s were written. We do not currently have the data to disaggregate where the initial referral originated. Between July 2022 and June 2024, 17 cases of suspected provider fraud were referred to the Fraud Investigation Unit, with two Intentional Program violations written. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: An Intentional Program Violation is established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. If the Intentional Program Violation is established in a contested case, the Department initiates the Intentional Program Violation hearing. There is no administrative appeal after a person waives the right to an Intentional Program Violation hearing, and the penalty may not be changed by subsequent administrative action except as follows: A person who waives the right to an Intentional Program Violation hearing may seek relief in court or request a contested case hearing on the sole issue of whether the waiver was signed under duress (see OAR 461-025-0310). If there was a determination that the waiver was signed under duress, the initial Intentional Program Violation penalty is voided, and: if a court determines that a waiver was signed under duress, the court may determine whether an Intentional Program Violation occurred and the amount of penalty; or if an administrative law judge determines that a waiver was signed under duress, the Department may initiate an Intentional Program Violation hearing to determine whether an Intentional Program Violation occurred and the amount of the penalty. Child care providers who have incurred an overpayment established as an Intentional Program Violation claim are ineligible for payment as follows: for six months and until the full amount of the overpayment is paid; or permanently, if the Oregon Department of Human Services Child Care Program Manager finds that such ineligibility is in the public interest. Intentional Program Violations are assessed rarely and only in situations where there is repeat fraudulent activity. Providers with an Intentional Program Violation are prohibited from participating in the subsidy program in the future, thereby resulting in no further potential fraudulent activity and billing. In more egregious situations the agency could choose to prosecute the case criminally. In this case it would be staffed with appropriate Leadership and local district attorneys for appropriateness. Intentional program violations are initiated via referrals to the Office of Payment Accuracy and Recovery, which houses (in addition to other areas) the Overpayment Writing Unit, Quality Control, Quality Assurance, and Fraud Investigations. Intentional program violations are only established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. However, review does occur preliminarily through enrollment documents and attendance through a variety of strategies: monthly randomized audits of child care billing forms through OPAR, monthly reports which demonstrate instances in which providers are billing full-time hours when a school age child is typically in school, and through case level reviews by both Quality Control and Quality Assurance. In addition to these initiatives, the Direct Pay Unit may receive referrals of potential fraud or program misuse and refer outward to OPAR for further investigation. The Direct Pay Unit also houses a Provider Specialist who reviews random billing forms on a monthly basis and conducts one-on-one technical assistance with providers to ensure billing is completed according to CCDF rules. All of these initiatives inform better practice to adequately identify and prevent instances of unintentional program violations. Results: Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals from reports worked, the Direct Pay Unit, and ODHS Branches and wrote 589 overpayments for a total of $881,712.24. As of June 2024, ODHS has collected $ 444,371.97 of the total. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: An Intentional Program Violation is established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. If the Intentional Program Violation is established in a contested case, the Department initiates the Intentional Program Violation hearing. There is no administrative appeal after a person waives the right to an Intentional Program Violation hearing, and the penalty may not be changed by subsequent administrative action except as follows: A person who waives the right to an Intentional Program Violation hearing may seek relief in court or request a contested case hearing on the sole issue of whether the waiver was signed under duress (see OAR 461-025-0310). If there was a determination that the waiver was signed under duress, the initial Intentional Program Violation penalty is voided, and: if a court determines that a waiver was signed under duress, the court may determine whether an Intentional Program Violation occurred and the amount of penalty; or if an administrative law judge determines that a waiver was signed under duress, the Department may initiate an Intentional Program Violation hearing to determine whether an Intentional Program Violation occurred and the amount of the penalty. Child care providers who have incurred an overpayment established as an Intentional Program Violation claim are ineligible for payment as follows: for six months and until the full amount of the overpayment is paid; or permanently, if the Oregon Department of Human Services Child Care Program Manager finds that such ineligibility is in the public interest. Intentional Program Violations are assessed rarely and only in situations where there is repeat fraudulent activity. Providers with an Intentional Program Violation are prohibited from participating in the subsidy program in the future, thereby resulting in no further potential fraudulent activity and billing. In more egregious situations the agency could choose to prosecute the case criminally. In this case it would be staffed with appropriate Leadership and local district attorneys for appropriateness. Intentional program violations are initiated via referrals to the Office of Payment Accuracy and Recovery, which houses (in addition to other areas) the Overpayment Writing Unit, Quality Control, Quality Assurance, and Fraud Investigations. Intentional program violations are only established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. However, review does occur preliminarily through enrollment documents through case level reviews by both Quality Control and Quality Assurance. In addition to these initiatives, the Direct Pay Unit may receive referrals of potential fraud or program misuse and refer outward to OPAR for further investigation, or the Child Care Assistance Program may receive an inquiry from eligibility staff pertaining to incorrect billing or payment completed which might suggest agency error. All of these initiatives inform better practice to adequately identify and prevent instances of agency error. 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: Staffing with the Child Care Assistance Program team and online trainings are held with fraud investigators. There is a provider team which is a small group of investigators who are solely responsible for ERDC provider cases. The results of this staffing mean that investigators are knowledgeable and up to date with current policy and guidelines. Additionally, the Child Care Assistance Program team works with the Direct Pay Unit and with eligibility staff statewide to communicate any relevant policy changes to the Employment Related Day Care program which might impact what may be considered an overpayment or liable for potential program violation. The results of this work are that staff are more knowledgeable and know when and when not to write referrals to the Office of Payment Accuracy and Recovery. The CCDF administrative team has a close relationship with the Child Care Assistance Program team, the Budget team, the Accounting team, the Grants team, the Licensing team, and other program teams across the agency and provides updates on a weekly basis with any changes or clarifications in policy at the federal level. The result of this communication and collaboration is that staff across the entirety of the Lead Agency are well-informed as they conduct their own areas of the work which may pertain to or utilize CCDF funding. Results: Between July 2022 and June 2024, two provider caused IPV’s were written. We do not currently have the data to disaggregate where the initial referral originated. Between July 2022 and June 2024, 17 cases of suspected provider fraud were referred to the Fraud Investigation Unit, with two Intentional Program violations written. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Staffing with the Child Care Assistance Program team and online trainings are held with fraud investigators. There is a provider team which is a small group of investigators who are solely responsible for ERDC provider cases. The results of this staffing mean that investigators are knowledgeable and up to date with current policy and guidelines. Additionally, the Child Care Assistance Program team works with the Direct Pay Unit and with eligibility staff statewide to communicate any relevant policy changes to the Employment Related Day Care program which might impact what may be considered an overpayment or liable for potential program violation. The results of this work are that staff are more knowledgeable and know when and when not to write referrals to the Office of Payment Accuracy and Recovery. The CCDF administrative team has a close relationship with the Child Care Assistance Program team, the Budget team, the Accounting team, the Grants team, the Licensing team, and other program teams across the agency and provides updates on a weekly basis with any changes or clarifications in policy at the federal level. The result of this communication and collaboration is that staff across the entirety of the Lead Agency are well-informed as they conduct their own areas of the work which may pertain to or utilize CCDF funding. Results: Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals from reports worked, the Direct Pay Unit, and ODHS Branches and wrote 589 overpayments for a total of $881,712.24. As of June 2024, ODHS has collected $ 444,371.97 of the total. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Staffing with the Child Care Assistance Program team and online trainings are held with fraud investigators. There is a provider team which is a small group of investigators who are solely responsible for ERDC provider cases. The results of this staffing mean that investigators are knowledgeable and up to date with current policy and guidelines. Additionally, the Child Care Assistance Program team works with the Direct Pay Unit and with eligibility staff statewide to communicate any relevant policy changes to the Employment Related Day Care program which might impact what may be considered an overpayment or liable for potential program violation. The results of this work are that staff are more knowledgeable and know when and when not to write referrals to the Office of Payment Accuracy and Recovery. The CCDF administrative team has a close relationship with the Child Care Assistance Program team, the Budget team, the Accounting team, the Grants team, the Licensing team, and other program teams across the agency and provides updates on a weekly basis with any changes or clarifications in policy at the federal level. The result of this communication and collaboration is that staff across the entirety of the Lead Agency are well-informed as they conduct their own areas of the work which may pertain to or utilize CCDF funding. 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): Oregon Department of Human Services via an interagency agreement with the Lead Agency. 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: A $200 minimum overpayment threshold is required for both Oregon Department of Human Services and the Lead Agency to pursue an overpayment back to the agency. After review of referral and case information a potential overpayment is below the threshold, the referral is cleared as non-actionable. If the overpayment meets or exceeds the threshold, an overpayment is established for collection. Setting a minimum overpayment threshold helps to ensure that the agency is not spending more money on administration costs to collect an overpayment than what the overpayment collection would yield. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals, only 589 of which met the threshold and resulted in overpayments written. ii. [ ] Coordinate with and refer to the other State/Territory agencies (e.g., State/Territory collection agency, law enforcement agency). Describe the activities and the results of these activities based on the most recent analysis: iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: Repayment plans are offered upon request. Providers must have been actively providing care for subsidy families for at least 12 months to be eligible for a repayment plan. The nature of the overpayment cannot be due to provider fraud. Minimum payments of $50 are required. The balance of the overpayment must be paid off within 10 months. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. In the 2023 calendar year, there were 271 provider overpayments written, out of which 231 repaid the amount owed with payment plan, and 23 were paid in full by the provider sending in a check. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: Overpayments incurred due to fraud are not eligible for the repayment plan criteria. If the provider is still active with the Department of Early Learning and Care and receiving payments the overpayment is recovered out of subsequent payments at100%, until the overpayment is satisfied. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: Tax intercepts are utilized when a provider is not in an active status with the Department of Early Learning and Care, and they have not submitted a payment. Accounts Receivable mails two separate notices to the provider. If the provider does not respond or fails to continue making payments a garnishment request is sent to the Oregon Department of Revenue. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. vi. [x] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: Wage garnishments are utilized when a provider is not in an active status with the Department of Early Learning and Care, and they have not submitted a payment. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. In the 2023 calendar year, 271 overpayments were written. Out of these, 17 were sent to collections to attempt to recoup the funds. 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 Oregon Department of Human Services Office of Payment Accuracy and Recovery has four units that work together to identify and collect improper payments: Data Match, Fraud Investigations, Overpayment Writing, and Overpayment Recovery. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. viii. [x] Other. Describe the activities and the results of these activities: A monthly audit of child care for School-Age children is conducted during school months to identify improper payments resulting from providers billing for care during the school day (during months in which school is in full-time session), eligibility workers refer potential client and provider payments and fraud to the Office of Payment Accuracy and Recovery. The Data Match Unit also works on a variety of federally mandated reports in conjunction with other states to achieve their goal of ensuring program integrity, while reducing erroneous benefits and identifying fraud. The Oregon Department of Human Services has a statewide toll-free number for reporting fraud. This number is publicized in notices sent to child care providers and clients. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. 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: A $200 minimum threshold is required for both Oregon Department of Human Services and the Early Learning Division to pursue collection of an overpayment. Overpayments are investigated through the Office of Payment Accuracy and Recovery and are conducted due to provider/parent referrals, random program integrity audits, and through review of reports. Setting a minimum overpayment threshold helps to ensure that the agency is not spending more money on administration costs to collect an overpayment than what the overpayment collection would yield. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals, only 589 of which met the threshold and resulted in overpayments written. 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 Data Match Unit also works a variety of federally mandated reports in conjunction with other states to achieve their goal of ensuring program integrity, while reducing erroneous benefits and identifying fraud. The Oregon Department of Human Services sends monthly reports to the Department of Revenue to help identify subsidy payments so they cannot also be claimed as out of pocket child care expenses for parents claiming child care tax credits. Sending the data match to the Department of Revenue helps to prohibit subsidy recipients from claiming subsidy paid child care expenses as their own out of pocket child care costs for tax purposes. These activities resulted in Oregon being able to utilize other state data sources to ensure that CCDF funds are spent appropriately. Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals, only 589 of which met the threshold and resulted in overpayments written. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: Repayment plans are offered upon request. Providers must have been actively providing care for subsidy families for at least 12 months to be eligible for a repayment plan. The nature of the overpayment cannot be due to provider fraud. Minimum payments of $50 are required. The balance of the overpayment must be paid off within 10 months. If a provider is inactive then the Office of Financial Services (OFS) sends an invoice to the provider to make a payment or negotiate a payment plan usually for 12 months or less. If the provider does not pay or communicate to create a repayment agreement after a second invoice is sent or the provider fails to meet the repayment agreement, they have signed then OFS refers the account to the Department of Revenue (DOR). The DOR has a variety of options available to recover the funds including Oregon tax offset, payroll or bank account garnishments, repayment plan or asset liens on large overpayments. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. In the 2023 calendar year, there were 271 provider overpayments written, out of which 231 repaid the amount owed with payment plan, and 23 were paid in full by the provider sending in a check. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: Providers who meet the repayment plan criteria listed above can have subsequent payments reduced in order to cover the overpayment amount. The same limitations apply where the payment is a minimum of $50 and the overpayment balance must be satisfied within 10 months. If providers do not meet the repayment plan criteria the overpayment is recovered out of subsequent payments at 100%, until the overpayment is satisfied. If an improper payment due to an unintentional program violation is found during the course of subrecipient fiscal monitoring or regular, ongoing monitoring of the Lead Agency’s contracts and grants, the contractor or grantee has the option to have subsequent payments reduced until the amount is paid back in full. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: Tax intercepts are utilized when a provider is not in an active status with the Lead Agency, and they have not submitted a payment. Accounts Receivable mails two separate notices to the provider. If the provider does not respond or fails to continue making payments a garnishment request is sent to the Oregon Department of Revenue. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. vi. [x] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: Wage garnishments are utilized when a provider is not in an active status with the Lead Agency, and they have not submitted a payment. Accounts Receivable mails two separate notices to the provider. If the provider does not respond or fails to continue making payments a garnishment request is sent to the Oregon Department of Revenue. If an improper payment due to an unintentional program violation is found during the course of subrecipient fiscal monitoring or regular, ongoing monitoring of the Lead Agency’s contracts and grants, the contractor or grantee has the option to issue a check for the overpayment amount back to the Lead Agency to satisfy the overpayment. Accounts Receivable may create an invoice for tracking purposes and if a need for collections through Oregon Department of Revenue is needed in the event the contractor or grantee does not repay the requested funds. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. In the 2023 calendar year, 271 overpayments were written. Out of these, 17 were sent to collections to attempt to recoup the funds. 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: Wage garnishments are utilized when a provider is not in an active status with the Lead Agency, and they have not submitted a payment. Accounts Receivable mails two separate notices to the provider. If the provider does not respond or fails to continue making payments a garnishment request is sent to the Oregon Department of Revenue. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. viii. [x] Other. Describe the activities and the results of these activities: A monthly audit of child care for School-Age children is conducted during school months to identify improper payments resulting from providers billing for care during the school day, providers attendance logs are checked against the amount billed and client case record information. Eligibility workers refer potential clients and provider overpayments and fraud to the Office of Payment Accuracy and Recovery. The Oregon Department of Human Services has a statewide toll-free number for reporting fraud. This number is publicized in notices sent to child care providers and clients. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. 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: A $200 minimum threshold is required for both Oregon Department of Human Services and the Lead Agency to pursue an overpayment. Overpayments are investigated through the Office of Payment Accuracy and Recovery and are conducted due to provider/parent referrals, random program integrity audits, and through review of reports. Setting a minimum overpayment threshold helps to ensure that the agency is not spending more money on administration costs to collect an overpayment than what the overpayment collection would yield. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals, only 589 of which met the threshold and resulted in overpayments written. 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: ODHS Office of Financial Services Accounts Receivable Unit will refer provider overpayments to Oregon Department of Revenue if the provider fails to meet a repayment agreement. The Department of Revenue may set repayment agreements, Oregon tax offset or payroll and bank account garnishment. The Department of Revenue may also to asset lines, or they may send the case to an outside collection agency. These activities resulted in Oregon being able to utilize other state data sources to ensure that CCDF funds are spent appropriately. Between July 2022 and June 2024, the Overpayment Writing Unit received 3,999 referrals, only 589 of which met the threshold and resulted in overpayments written. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: Repayment plans are offered upon request. Providers must have been actively providing care for subsidy families for at least 12 months to be eligible for a repayment plan. The nature of the overpayment cannot be due to provider fraud. Minimum payments of $50 are required. The balance of the overpayment must be paid off within 10 months. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. In the 2023 calendar year, there were 271 provider overpayments written, out of which 231 repaid the amount owed with payment plan, and 23 were paid in full by the provider sending in a check. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: Providers who meet the repayment plan criteria listed above can have subsequent payments reduced in order to cover the overpayment amount. The same limitations apply where the payment is a minimum of $50 and the overpayment balance must be satisfied within 12 months. If providers do not meet the repayment plan criteria the overpayment is recovered out of subsequent payments at 100%, until the overpayment is satisfied. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: Tax intercepts are utilized when a provider is not in an active status with the Lead Agency, and they have not submitted a payment. Accounts Receivable mails two separate notices to the provider. If the provider does not respond or fails to continue making payments a garnishment request is sent to the Oregon Department of Revenue. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. vi. [x]Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: Wage garnishments are utilized when a provider is not in an active status with the Lead Agency, and they have not submitted a payment. Accounts Receivable mails two separate notices to the provider. If the provider does not respond or fails to continue making payments a garnishment request is sent to the Oregon Department of Revenue. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. In the 2023 calendar year, 271 overpayments were written. Out of these, 17 were sent to collections to attempt to recoup the funds. 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: Wage garnishments are utilized when a provider is not in an active status with the Lead Agency, and they have not submitted a payment. Accounts Receivable mails two separate notices to the provider. If the provider does not respond or fails to continue making payments a garnishment request is sent to the Oregon Department of Revenue. These activities resulted in Oregon being able to have clear policies and procedures around overpayment collection in the instances of fraud or misuse of CCDF funds. 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. [ ] 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: 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: An Intentional Program Violation is established when a provider commits fraud as determined by a state or federal court, by an administrative agency in a contested case, or by a person signing the designated form acknowledging the Intentional Program Violation and waiving the right to an administrative hearing. If the Intentional Program Violation is established in a contested case, the Department initiates the Intentional Program Violation hearing. There is no administrative appeal after a person waives the right to an Intentional Program Violation hearing, and the penalty may not be changed by subsequent administrative action except as follows: A person who waives the right to an Intentional Program Violation hearing may seek relief in court or request a contested case hearing on the sole issue of whether the waiver was signed under duress (see OAR 461-025-0310). If there was a determination that the waiver was signed under duress, the initial Intentional Program Violation penalty is voided, and: if a court determines that a waiver was signed under duress, the court may determine whether an Intentional Program Violation occurred and the amount of penalty; or if an administrative law judge determines that a waiver was signed under duress, the Department may initiate an Intentional Program Violation hearing to determine whether an Intentional Program Violation occurred and the amount of the penalty. Child care providers who have incurred an overpayment established as an Intentional Program Violation claim are ineligible for payment as follows: for six months and until the full amount of the overpayment is paid; or permanently, if the Department of Early Learning and Care Child Care Assistance Program Manager finds that such ineligibility is in the public interest. Intentional Program Violations are assessed rarely and only in situations where there is repeat fraudulent activity. Providers with an Intentional Program Violation are prohibited from participating in the subsidy program in the future, thereby resulting in no further potentially fraudulent activity and billing. These activities resulted in Oregon being able to have clear policies and procedures around establishing intentional program violations in the instances of fraud or misuse of CCDF funds. iii. [x] Prosecute criminally. Describe the activities and the results of these activities based on the most recent analysis: A small portion of the cases are prosecuted criminally. The case is staffed with leadership and approved to present to the local district attorney. These activities resulted in Oregon having clear policies and procedures around criminal prosecutions where needed pertaining to sanctions and improper payments. iv. [x] Other. Describe the activities and the results of these activities based on the most recent analysis: Methods for recovering overpayments in the Oregon Department of Human Services self-sufficiency programs (including child care) are established in OAR 461-195-0551. These activities resulted in Oregon being able to have clear policies and procedures around establishing collecting overpayments in the instances of fraud or misuse of CCDF funds. 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: