10.2 Fraud Investigation, Payment Recovery, and Sanctions

Lead Agencies must have the necessary controls to identify fraud and other program violations to ensure program integrity. Program violations can include both intentional and unintentional client and/or provider violations, as defined by the Lead Agency. These violations and errors, identified through the error-rate review process and other review processes, may result in payment or nonpayment (administrative) errors and may or may not be the result of fraud, based on the Lead Agency definition. 10.2.1 Strategies used to identify and prevent program violations Check the activities the Lead Agency employs to ensure program integrity, and for each checked activity, identify what type of program violations the activity addresses, describe the activity and the results of these activities based on the most recent analysis. a. [x] Share/match data from other programs (e.g., TANF program, Child and Adult Care Food Program, Food and Nutrition Service (FNS), Medicaid) or other databases (e.g., State Directory of New Hires, Social Security Administration, Public Assistance Reporting Information System (PARIS)). i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The ELRCs communicate on a regular basis with the County Assistance Offices (CAOs) who administer the TANF, SNAP and Medicaid programs. Information is shared on an as-needed basis. Information from (PARIS), when appropriate, is shared with the ELRCs. As needed, OCDEL communicates and obtains information from the Child and Adult Care Food Program. The information shared is used to review program eligibility and possible fraud situations. Involvement and communication with connecting agencies in these situations take place, as needed. During program year 2022-2023 the ELRCs with OSIG researched and/or acted on 476 parent cases. Resulting in 291 cases with a recoupment of $1,686,342 in cost avoidance. In program year 2022-2023 there are 173 cases still with the OSIG awaiting their final determination. There were 8 identified provider referrals. Provider billing errors are often found within the monthly billing statements and corrected during the invoicing process. This information is used to inform training needed for billing and opportunities for improved monitoring. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: OCDEL works collaboratively and closely with the ELRCs to identify and/or prevent agency errors. If errors are identified OCDEL works with the ELRCs to rectify any program violations, including identification and prevention of unintentional program violations. If a violation is identified, the ELRC communicates via email, phone, or a meeting with OCDEL to determine the best steps to rectify the specific violation. Additionally, the ELRCs or OCDEL will communicate with the County Assistance Offices (CAOs) who administer the TANF, SNAP and Medicaid programs or other Offices, if needed. Information is shared on an as-needed basis. Information from the PARIS, when appropriate, is shared with the ELRCs. As needed, OCDEL communicates and obtains information from the Child and Adult Care Food Program. The information shared is used to review program eligibility and identify program violations that may involve several programs. OCDEL has documented success in observed outcomes through these processes. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. This information also guides communication improvements for recipients of CCDF funding. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice:: The ELRCs communicate on a regular basis with the County Assistance Offices (CAOs) who administer the TANF, SNAP and Medicaid programs. Information is shared on an as-needed basis. Information from the PARIS, when appropriate, is shared with the ELRCs. As needed, OCDEL communicates and obtains information from the Child and Adult Care Food Program. The information shared is used to review program eligibility, prevent agency errors, and identify program violations that may involve several programs. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. 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: OCDEL runs a variety of reports on an as-needed basis to identify potential errors. There are several reports that identify one or more of the following: enrollments by funding programs, the type of enrollment and amount paid, timely processing related to applications, enrollment, eligibility, redetermination, reported changes and payment, sanction or disqualification statuses, budget opening or closures related to cases in which the parent or caretaker is a recipient of TANF benefits, and accurate co-payment assessment or waiver of co-payment. During program year 2022-2023 the ELRCs with OSIG researched and/or acted on 476 parent cases. This resulted in 291 cases with a recoupment of $1,686,342 in cost avoidance. In program year 2022-2023, there are 173 cases still with awaiting their final determination from OSIG. There were 8 identified provider referrals. Provider billing errors are often found within the monthly billing statements and corrected during the invoicing process. This information is used to inform training and opportunities for improved monitoring. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: OCDEL runs a variety of reports within the PELICAN system on a regular and sporadic basis to identify and/or prevent errors. There are several reports that identify one or more of the following: enrollments by funding programs; the type of enrollment and amount paid; timely processing related to application, enrollment, eligibility, redetermination, reported changes and payment; sanction or disqualification statuses; budget openings or closures related to cases in which the parent or caretaker is a recipient of TANF benefits; and accurate co-payment assessment or waiver of co-payment. The running of PELICAN reports has documented success in revealing situations requiring action and the needed steps for these situations take place. The ELRCs identify on their year-end fiscal recap to OCDEL any unintentional program violations which resulted in recoupment of funds. This information is used to inform training and opportunities for improved monitoring. This information also guides communication improvements for recipients of CCDF funding. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: OCDEL runs a variety of reports on a regular and sporadic basis to identify potential errors. There are several reports that identify one or more of the following: enrollments by funding programs; the type of enrollment and amount paid; timely processing related to application, enrollment, eligibility, redetermination, reported changes and payment; sanction or disqualification statuses; budget openings or closures related to cases in which the parent or caretaker is a recipient of TANF benefits; and accurate co-payment assessment or waiver of co-payment. The ELRCs will identify on their year-end fiscal recap to OCDEL agency errors which resulted in recoupment of funds. This information is used to inform training and opportunities for improved monitoring. 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: OCDEL program representatives run enrollment reports regularly. Annual OCDEL ELRC Operational monitoring requires reviewing enrollment documents along with provider payments for specific case records. OCDEL Program representatives and ELRCs review attendance and billing records on an as needed basis to determine potential fraud. Possible fraud cases are sent to the Office of State Inspector General for additional follow-up. The ELRCs and OCDEL have a working relationship with the Office of the State Inspector General (OSIG). When processing information including parent/caretaker applications/redeterminations and child care provider activity, the ELRC can submit information to OCDEL and/or OSIG on the front-end and back-end whenever they suspect that information submitted appears to be fraudulent. OSIG makes the final determination if a case is deemed fraudulent. Reportable details to OCDEL and/or OSIG may also include actions by a child care provider regarding quality grants or other grant opportunities where any fraudulent activity is suspected. The ELRCs may also receive phone calls informing them of potential provider and/or parent fraudulent actions. The ELRCs submit specific forms to OSIG to request review and follow-up. The following forms are used by the ELRC for specific purposes: OSIG-1009 Subsidized Child Care Application Investigation Referral, OSIG-735 Subsidized Child Care Suspected Provider Overpayment Referral, OSIG-761 Subsidized Child Care Parent/Caretaker Overpayment Referral, and follow-up reports from OSIG to the ELRC that submitted the forms: OSIG-762 Report on Subsidized Child Care Referral, and OSIG-767 Report on Subsidized Child Care Provider Referral. The ELRCs also maintain spreadsheets to document OSIG activity. During OCDEL ELRC program monitoring and case reviews OCDEL’s program representatives may also identify documents that appear to be fraudulent during a Compliance Review, the Program Representative will instruct the ELRC to submit information to OSIG for further investigation. During program year 2022-2023 the ELRCs with OSIG researched and/or acted 476 parent cases. Resulting in 291 cases with a recoupment of $1,686,342 in cost avoidance. In program year 2022-2023 there are 173 cases still with the OSIG awaiting their final determination. There were 8 identified provider referrals. Provider billing errors are often found within the monthly billing statements and corrected during the invoicing process. This information is used to inform training and opportunities for improved monitoring. This information also guides communication improvements for recipients of CCDF funding. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: OCDEL program representatives run enrollment reports as needed to review enrollment documents, attendance, or billing records to identify and/or prevent errors. OCDEL monitors operational ELRC payment child care provider payment processes throughout the year and conduct minimally an annual comprehensive review of operational activities. Monitoring compliance activities of ELRCs require reviewing enrollment documents along with provider payments for specific case records. Program representatives and ELRCs review attendance and billing records on an as-needed basis to determine potential program violations. Program violations are reviewed for potential fraud and overpayments. The review of enrollment documents and attendance or billing records has had documented success in revealing situations requiring action and the needed steps for these situations take place. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. This information also guides communication improvements for recipients of CCDF funding. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Reviews are ongoing throughout the year and encompass the use of various tools, reports, and meetings within OCDEL and the ELRCs to ensure accuracy of enrollment documents and attendance or billing records. OCDEL Bureau of Operations monitoring staff in conjunction with the ERLCs and the OCDEL Bureau of Certification review enrollment documents and attendance or billing records in accordance with inspections and monitoring activities. Program representatives review a random sample of cases which includes the review of enrollment documents and attendance or billing records. In addition, the ELRCs monitor enrollment documents and attendance or billing records for the child care providers for accuracy. The Bureau of Certification, in their reviews, may submit information to OCDEL and the ELRCs, for further review and investigation. Any suspicion of fraud is turned over to the Office of State Inspector General for investigation. The program monitors, referred to as the program representatives, run enrollment reports as needed. The yearly monitoring requires reviewing enrollment documents and attendance or billing records for specific case records. Program violations are reviewed for potential fraud and overpayments. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. 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: Quality assurance reviews are conducted annually, at a minimum, at the ELRCs by OCDEL staff through a review of a random selection of cases monitored by the program representatives. Discussions are held with OCDEL program representatives to review any issues or concerns with ELRCs or child care providers. During program year 2022-2023 the ELRCs with OSIG researched and/or took action on 476 parent cases. This resulted in 291 cases with a recoupment of $1,686,342 in cost avoidance. In program year 2022-2023 there are 173 cases still with the OSIG awaiting their final determination. There were 8 identified provider referrals. Provider billing errors are often found within the monthly billing statements and corrected during the invoicing process. This information is used to inform training and opportunities for improved monitoring. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Quality assurance reviews are ongoing throughout the year and encompass the use of various tools, reports, and meetings to identify and/or prevent errors. OCDEL Bureau of Operations monitoring staff conduct an annual review of a random selection of cases to monitor. Discussions take place internally with OCDEL supervisory staff to review any ongoing issues or concerns with the ELRCs or identified child care provider- specific needs. Conducting supervisory staff reviews and quality assurance reviews has assisted in revealing situations requiring action and the OCDEL monitoring team takes the needed steps for ensuring compliance and preventing errors. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Reviews are conducted annually by reviewing a random selection of cases monitored by the program representatives. Discussions are held with the program representatives to review ongoing issues/concerns. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. e. [x] Audit provider records. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Reviews are ongoing throughout the year and encompass the use of various tools, reports, and meetings within OCDEL and the ELRCs to ensure accuracy of provider records. OCDEL Bureau of Operations monitoring staff, in conjunction with the ELRCs, audit provider records in accordance with monitoring activities. Program representatives review a random sample of cases which includes the review of the provider information. In addition, the ELRCs monitor provider payment requests for accuracy. The Bureau of Certification, during their onsite inspections of provider records, may submit information to Program Representatives and the ELRCs for further review and monitoring. Any suspicion of fraud is turned over to the Office of State Inspector General for investigation. During program year 2022-2023 the ELRCs with OSIG researched and/or took action on 476 parent cases. This resulted in 291 cases with a recoupment of $1,686,342 in cost avoidance. In program year 2022-2023 there are 173 cases still with the OSIG awaiting their final determination. There were 8 identified provider referrals. Provider billing errors are often found within the monthly billing statements and corrected during the invoicing process. This information is used to inform training and opportunities for improved monitoring. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Reviews are ongoing throughout the year and encompass the use of various tools, reports, and meetings within OCDEL and the ELRCs to identify and/or prevent errors within provider records. OCDEL Bureau of Operations monitoring staff in conjunction with the ERLCs and the OCDEL, Bureau of Certification audit provider records in accordance with inspections and monitoring activities. Program representatives review a random sample of cases which includes the review of the provider information. In addition, the ELRCs monitor provider payment requests for accuracy. The Bureau of Certification, in their reviews, may submit information to OCDEL and the ELRCs, for further review and monitoring. Any suspicion of fraud is turned over to the Office of State Inspector General for investigation. The audit of provider records has assisted in revealing situations requiring action. The OCDEL monitoring team in collaboration with OSIG take the needed steps for ensuring compliance and preventing errors. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Provider records are reviewed as part of the annual compliance review for CCW. Families selected for review are matched with the provider where their children were enrolled during the review period. The review confirms the provider’s certification status and the ability to participate in the subsidized child care program. In addition, the ELRCs monitor provider payment requests for accuracy. The Bureau of Certification, in their reviews, may submit information to OCDEL and the ELRCs, for further review and monitoring. Any suspicion of fraud is turned over to the Office of State Inspector General for investigation. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. This information is used to inform training and opportunities for improved monitoring. 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: OCDEL and ELRC staff are trained on policy and/or audits. Trainings consist of written communications, webinars, or face-to-face meetings. Training materials are also posted to the ELRC portal, so they are accessible to all ELRC staff if training needs are identified at the child care provider level. During program year 2022-2023 the ELRCs with OSIG researched and/or took action on 476 parent cases. This resulted in 291 cases with a recoupment of $1,686,342 in cost avoidance. In program year 2022-2023 there are 173 cases still with the OSIG awaiting their final determination. There were 8 identified provider referrals. Provider billing errors are often found within the monthly billing statements and corrected during the invoicing process. This information is used to inform training and opportunities for improved monitoring. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Trainings can be through written communications, webinars or virtual or face-to-face meetings. Training materials are also posted to the ELRC portal, so it is accessible to all staff at any time. The ELRCs have clearly updated instructions, training and manuals on required audits. Through training of staff on policy and/or audits this assists OCDEL identify and/or prevent errors. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: OCDEL and ELRC staff are trained on policy and/or audits. Trainings can be through written communications, webinars or virtual or face-to-face meetings. Training materials are also posted to the ELRC portal, so it is accessible to all staff at any time. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. g. [x] Other. Describe the activity(ies): Use of systems. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: OCDEL reviews case and eligibility information from PELICAN-CCW system and the Electronic Client Information System (eCIS). eCIS contains case and eligibility related information for parents or caretakers that are receiving or have previously received TANF benefits. OCDEL also monitors contractor compliance and data integrity (via PELICAN Keys to Quality) as it relates to provider eligibility for quality grants and awards, accuracy of grant threshold amounts and STAR level designations. OCDEL and the Pennsylvania Department of Revenue coordinate the review of STARS providers against Revenue’s database for tax liens/liabilities. OCDEL contractors review the federal System for Award Management (SAM) website to ensure there are no federal issues prior to issuing quality grants and will review the Pennsylvania Department of General Services (DGS) Debarment list to ensure no providers are identified on the state’s contractor debarment list. The use of these resources ensures state and federal dollars are not issued when state/federal funds are owed or when problems exist. This process has netted recovery of substantial amounts of state/federal funds paid by providers. During program year 2022-2023 the ELRCs with OSIG researched and/or acted 476 parent cases. Resulting in 291 cases with a recoupment of $1,686,342 in cost avoidance. In program year 2022- 2023 there are 173 cases still with the OSIG awaiting their final determination. There were 8 identified provider referrals. Provider billing errors are often found within the monthly billing statements and corrected during the invoicing process. This information is used to inform training and opportunities for improved monitoring. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: OCDEL reviews case and eligibility information from PELICAN-CCW system and the Electronic Client Information System (eCIS) to identify and/or prevent errors. eCIS contains case and eligibility- related information for parents or caretakers that are receiving or have previously received TANF benefits. OCDEL also monitors contractor compliance and data integrity (via PELICAN Keys to Quality) as it relates to provider eligibility for quality grants and awards, accuracy of grant threshold amounts and STAR level designations to identify and/or prevent errors. OCDEL and the Pennsylvania Department of Revenue coordinate the review of STARS providers against Revenue’s database for tax liens/liabilities to identify and/or prevent errors. OCDEL contractors review the federal System for Award Management (SAM) website to ensure there are no federal issues prior to issuing quality grants and will review the Pennsylvania Department of General Services (DGS) Debarment list to ensure no providers are identified on the state’s contractor debarment list. The use of these resources ensures state and federal dollars are not issued when state/federal funds are owed or when problems exist. Through these processes the recovery of state/federal funds took place. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: OCDEL reviews case and eligibility information from PELICAN-CCW system and the Electronic Client Information System (eCIS). eCIS contains case and eligibility related information for parents or caretakers that are receiving or have previously received TANF benefits. OCDEL also monitors contractor compliance and data integrity (via PELICAN Keys to Quality) as it relates to provider eligibility for quality grants and awards, accuracy of grant threshold amounts and STAR level designations. OCDEL and the Pennsylvania Department of Revenue coordinate the review of STARS providers against Revenue’s database for tax liens/liabilities. OCDEL contractors review the federal System for Award Management (SAM) website to ensure there are no federal issues prior to issuing quality grants and will review the Pennsylvania Department of General Services (DGS) Debarment list to ensure no providers are identified on the state’s contractor debarment list. The use of these resources ensures state and federal dollars are not issued when state/federal funds are owed or when problems exist. This process has netted recovery of substantial amounts of state/federal funds paid by providers. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. This information is used to inform training and opportunities for improved monitoring. 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): Overpayments as a result of fraud are referred to the Office of State Inspector General for investigation (OSIG) and recovery of an overpayment. OSIG may then make a referral to the District Attorney’s Office or the Office of Attorney General, if warranted. b. Check and describe all activities, including the results of such activity, that the Lead Agency uses to investigate and recover improper payments due to fraud. Consider in your response potential fraud committed by providers, clients, staff, vendors, and contractors. Include in the description how each activity assists in the investigation and recovery of improper payment due to fraud or intentional program violations. Activities can include, but are not limited to, the following: i. [x] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: There is no minimum dollar amount for the recovery of an improper payment issued by an ELRC subgrantee. OCDEL works with the OSIG if needed to ensure recovery of the improper payment but in many instances the provider will work directly with the ELRC to rectify the improper payment and return the funds, as required. During program year 2022-2023 the ELRCs with OSIG researched and/or acted 476 parent cases. Resulting in 291 cases with a recoupment of $1,686,342 in cost avoidance. In program year 2022- 2023 there are 173 cases still with the OSIG awaiting their final determination. There were 8 identified provider referrals. Provider billing errors are often found within the monthly billing statements and corrected during the invoicing process. This information is used to inform training and opportunities for improved monitoring. 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: Overpayments because of fraud are referred to the OSIG for investigation and possible referral to the District Attorney’s Office or the Office of Attorney General, for the recovery of overpayments. These offices manage the collection process after referral. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: Providers receiving quality funds are suspended from STARS (stopping quality add on amounts and quality grants) until repayment is made to the ELRC or the Commonwealth via the ELRC. The repayment plans are developed based on the provider’s ability to pay. For CCW, the provider may be given the option of a lump sum repayment or establishment of a payment plan. This information is reported by the ELRCs. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: A recoupment letter is generated to the provider that details the amount of the recoupment and the percentage of recoupment from each payment. This process continues until the payment is made in full. v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [ ] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: vii. [ ] Establish a unit to investigate and collect improper payments and describe the composition of the unit. Describe the activities and the results of these activities based on the most recent analysis: viii. [x] Other. Describe the activities and the results of these activities: OCDEL program representatives, through their ongoing monitoring reviews, ELRC trainings and technical assistance activities, and program evaluation assist in the prevention and identification of misspent funds. The Bureau of ELRC Operations partners with Bureau of Policy and Professional Development, and Bureau of Certification to prevent both intentional and unintentional program violations. Work on recovery of funds have resulted in multiple investigations by OSIG and other auditing state bodies with a result of the recovery of funds. Pennsylvania’s subsidized child care regulations state that parents or caretakers may not be required to repay an overpayment that is the result of an administrative error with the exception of cases including current recipients of TANF benefits. Overpayments that are not the result of an administrative error are collected by arranging payment plans with parents or caretakers once a suspected fraud case has been determined by the Office of the State Inspector General. c. Does the Lead Agency investigate and recover improper payments due to unintentional program violations? [ ] No. [x] Yes. If yes, check and describe below any activities that the Lead Agency will use to investigate and recover improper payments due to unintentional program violations. Include in the description how each activity assists in the investigation and recovery of improper payments due to unintentional program violations. Include a description of the results of such activity. i. [x] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: The ELRCs recover spent funds if they identify there was an unintentional program violation. There is no minimum dollar amount for payments issued by an ELRC subgrantee. Using ELRC internal tracking mechanisms, ELRCs identify on their year-end fiscal recap to OCDEL the dollar amount of unintentional program violations which resulted in recoupment of funds. The three-year total recouped since the 2020-21 institution of the recap reporting requirement is $17,423.41. The extracted 22-23 statewide amount was $6,815.50. Once funds are returned to the Commonwealth refund memos are prepared. Then the refund memos are sent to Comptroller for processing/deposit. 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: For TANF clients the Office of Income Maintenance has a process in place for recovery of the funds. The process is maintained by the Office of Income Maintenance for the Commonwealth of Pennsylvania. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: The policy allows for payment plans with the ELRCs, a lump refund or the ELRC can take it out of future CCW payments. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: A recoupment letter is generated that details the amount of the recoupment and the percentage of recoupment from each payment. v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [ ] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: vii. [ ] Establish a unit to investigate and collect improper payments and describe the composition of the unit. Describe the activities and the results of these activities based on the most recent analysis: viii. [ ] Other. Describe the activities and the results of these activities: d. Does the Lead Agency investigate and recover improper payments due to agency errors? [ ] No. [x] Yes. If yes, check and describe all activities that the Lead Agency will use to investigate and recover improper payments due to agency errors. Include in the description how each activity assists in the investigation and recovery of improper payments due to administrative errors. Include a description of the results of such activity. i. [x] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: The ELRCs recover spent funds from providers if they identify there was an agency error. For providers, there is no minimum dollar amount for payments issued by an ELRC subgrantee. Pennsylvania subsidized child care regulations state that parents or caretakers may not be required to repay an overpayment that is the result of an administrative error, except for cases including current recipients of TANF benefits. 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: For TANF clients the Office of Income Maintenance has a process in place for recovery of the funds. This process is maintained by the Office of Income Maintenance for the Commonwealth of Pennsylvania. iii. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: The policy allows for payment plans with the ELRCs, a lump refund or the ELRC can take it out of future CCW payments. Providers that no longer have a Provider Agreement will be advised of the need to repay the amount owed and provide repayment options outside of the PELICAN CCW system. PELICAN CCW is designed to automatically recoup outstanding overpayments, regardless of the fiscal year. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: A recoupment letter is generated to the provider that details the amount of the recoupment and the percentage of recoupment from each payment. v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [ ]Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: vii. [ ] Establish a unit to investigate and collect improper payments and describe the composition of the unit. Describe the activities and the results of these activities based on the most recent analysis: viii. [ ] Other. Describe the activities and the results of these activities: e. What type of sanction will the Lead Agency place on clients and providers to help reduce improper payments due to intentional program violations or fraud? Check and describe all that apply: i. [x] Disqualify the client. Describe this process, including a description of the appeal process for clients who are disqualified. Describe the activities and the results of these activities based on the most recent analysis: : If a parent or caretaker is found guilty of committing an intentional program violation or fraud, the family is prohibited from participating in the subsidized child care program for a period of six months from the date of the first conviction, hearing decision or determination; a period of twelve months from the date of the second conviction, hearing decision or determination; and permanently from the date of the third conviction, hearing decision or determination. Pennsylvania regulations allow a parent or caretaker 30 calendar days from the date the parent or caretaker receives notice about an intentional program violation to appeal the original facts of the intentional program violation or fraud through DHS. The parent or caretaker cannot appeal the disqualification decision through DHS. The regulations state a parent or caretaker may not be granted a hearing on a court conviction or administrative disqualification hearing decision that led to the disqualification. However, the parent or caretaker can file an appeal through the Commonwealth Court of Pennsylvania. In fiscal year 2022-23 there were 10 disqualifications. All 10 were for six months. An observable outcome from this activity is the prohibiting of the fraudulent client reduces instances of improper payments in these situations. 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: Each provider participating in the subsidized child care program must sign a Provider Agreement. OCDEL may end the Provider Agreement with any provider that is convicted of fraud. OCDEL’s Bureau of Certification Services may revoke or refuse to renew the provider’s certificate to operate if the provider is convicted of fraud. The provider can appeal the decision to revoke or refuse to renew the certificate. Appeals are heard by DHS Bureau of Hearings and Appeals, and the provider may appeal to the Commonwealth Court if the Bureau of Hearing and Appeals decides against the provider. An observable outcome from this activity is OCDEL may revoke or refuse to renew the provider’s certificate to operate if the provider is convicted of fraud thus reducing instances of improper payments in these situations. iii. [x] Prosecute criminally. Describe the activities and the results of these activities based on the most recent analysis: The OSIG will review and, if appropriate, will prosecute provider and/or parent fraud overpayments. If the OSIG determines that the fraud is criminal in nature, the case is referred to the local District Attorney for criminal prosecution. The District Attorney will review and determine if the case will go to court for criminal prosecution. An observable outcome from this activity is if OSIG prosecutes fraud situations criminally this will reduce instances of improper payments in these situations. iv. [x] Other. Describe the activities and the results of these activities based on the most recent analysis: The Keystone STARS program suspends or removes the STAR rating for providers who have violated the terms of the grant agreement or non- compliance with state and federal regulations. Providers in violation are suspended from receiving grants and tiered reimbursements until the violations are corrected at which time the provider is reinstated into the Keystone STARS program. The Keystone STARS program utilizes the OSIG to report misspent funds or alleged fraud by providers. Should OSIG agree that the violation is in fact fraud, the violation is handed over to the District Attorney for further review/prosecution, if deemed appropriate. An observable outcome from this activity is this action may reduce instances of improper quality grant payments. 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: