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 Office of Internal Audit (OIA) investigates potential fraud and program violations. When a case crosses multiple programs, all programs including CCDF funded CCAP becomes part of that investigation. Currently OIA requests input from DHS Office of Child Care on payment information related to Criminal cases. DHS CCAP Regulations provide for penalties related to intentional program violation at both the civil and criminal level. OIA investigations result in civil penalties or criminal prosecution. Findings inform implementation and adjustment to provider monitoring processes and customer verification processes. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Unintentional program violations by a Provider resulting in an overpayment are reviewed by financial management and flagged for recoupment. Post the COVID pandemic, the lead agency has not yet implemented a recoupment process for overpayments. This was paused during the pandemic and post-pandemic recovery period and is under review to implement recoupment of UPV resulting in Provider overpayments through the Financial Management team. UPV violations by customers resulting in over issuance of benefits are reviewed and recouped by the Customer Claims and Recovery Unit. This practice was also paused during the pandemic and post- pandemic recovery period and is under review for reinstatement. Review of unintentional program violations by providers informs implementation and adjustment to requirements for provider monitoring and informs training needs for providers. Unintentional violations by customers in their application process informs case processing training updates and system enhancements as needed. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice:: Agency errors that result in an overpayment to providers are flagged for recoupment by the DHS Financial Management team. Post the COVID pandemic, the lead agency has not yet implemented a recoupment process for overpayments related to agency errors. This was paused during the pandemic and post-pandemic recovery period and is under review to re-implement. Agency errors are reviewed by financial management and program to determine root cause and course of correction: process and procedure, training for staff and/or providers, and system enhancement are addressed. Agency errors related to case processing and customer eligibility determination are shared with field ops teams for review, correction and to inform training needs for individual staff. As a result, CCAP specific training was launched in July 2024 as a mandatory course for field staff who work on CCAP eligibility. Utilization of system interfaces and inclusion of data from the interface in the CCAP case is included in this training. There is also a training specific to interfaces available to all field staff. In addition, a CCAP Payment Accuracy course was launched as a follow-up to the full CCAP training, also mandatory for field staff who work on CCAP eligibility. Agency errors related to provider payment practices are reviewed in provider management/financial management weekly touch points to determine cause, how to correct and how to adjust processes to prevent reoccurrence. 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: The Office of Child Care runs a weekly Active Provider Report that shows the number of CCAP participating children enrolled in every CCAP approved program. Tracking flags programs with high CCAP enrollments for review to ensure compliance with licensing capacity and attendance submissions related to payments. This information is used to inform provider training and communication and the Provider Monitoring process where providers are required to provide documentation supporting enrollments including parent-provider agreements and attendance documentation for children. Review of this report results in provider outreach to acquire additional information on enrollments and to flag licensing or monitoring visits where there are questionable results. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Bi-weekly payroll reports for two week batch payments are reviewed by program and financial management and Deloitte prior to payroll runs to flag any ineligible children (resolved before payment is issued) and to review co-payments, number of records and payment details prior to issuance. This information is used to ensure accurate payment including family co-payments. When this report shows a potentially ineligible child enrolled with a provider submitting for payment, the provider management team reviews the case and refers to field operations for corrections/clarification and makes a determination based on case review to pay or withhold payment for that provider, for that child, for the current pay period until eligibility can be resolved. Review of these cases informs ops training needs to ensure cases are processed completely and correctly and informs provider management team of potential system issues that require additional review, report and resolution. These follow up activities are handled in weekly systems review meetings with internal IT team and Deloitte. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Bi-weekly payroll reports for two week batch payments noted above are reviewed by program and financial management and Deloitte prior to payroll runs to flag any ineligible children (resolved before payment is issued) and to review co-payments, number of records and payment details prior to issuance. As identified through systems testing, provider report or program review, reports specific to the potential errors are run to determine if an error is case specific or is a systems issue affecting more than one provider/family and appropriate action taken to address the case or the system. For example, if case review or payment review showed a copay issue or a closure issue specific to a child/family a report to identify any additional cases with the same issue is requested from IT/Deloitte. Then appropriate action is taken to correct case specific issues with the provider and/or field operations and to address systems issues related to the error, if any.Bi-weekly payroll reports for two week batch payments noted above are reviewed by program and financial management and Deloitte prior to payroll runs to flag any ineligible children (resolved before payment is issued) and to review co-payments, number of records and payment details prior to issuance. As identified through systems testing, provider report or program review, reports specific to the potential errors are run to determine if an error is case specific or is a systems issue affecting more than one provider/family and appropriate action taken to address the case or the system. For example, if case review or payment review showed a copay issue or a closure issue specific to a child/family a report to identify any additional cases with the same issue is requested from IT/Deloitte. Then appropriate action is taken to correct case specific issues with the provider and/or field operations and to address systems issues related to the error, if any. For example, when review of a specific case showed an incorrect closure prior to a recertification date, a report showing all closures prior to recertification was requested and reviewed to ensure correct case closures. One additional incorrect closure was identified and the remaining closures were reviewed and confirmed to be accurate. Field review of the incorrect closure informs training and/or system needs and are reviewed by cross functional team meeting that occur weekly and include program, operations, policy and IT input. 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: CCAP Providers submit child attendance using the Provider Portal on a defined bi-weekly schedule and payments are based on child’s attendance during the batch weeks. If a child has not been enrolled through the Provider Portal and/or attendance has not been submitted, payment is not issued. Absent notices uploaded by Providers (required for payment if a child is absent for 5 consecutive days) are reviewed by Financial Management prior to payment. Providers are required to maintain a Parent- Provider agreement detailing the hours a family is requesting care and to maintain attendance records, sign in/out sheets for each CCAP participating child for a minimum of three years. As part of Provider Monitoring initiated in February 2024, providers are required to provide proof of parent-provider agreements and attendance records that show daily sign-in/out for CCAP enrolled children If monitoring results show a lack of documentation to support the attendance as submitted and payment as issued, the Lead Agency is requesting additional documentation and scheduling further monitoring to ensure compliance. If monitoring reveals potential intentional program violations, the case would be referred to the Lead Agency fraud investigation department for evaluation. Since the monitoring program was launched in February 2024, DHS has requested enrollment and attendance documentation from 80 providers including both center-based providers and family child care providers. Technical assistance is provided to all providers around record keeping requirements in their orientation and in ongoing provider communications. Requirements and resources are shared with all programs as part of monitoring. The Lead Agency is conducting additional monitoring for programs with higher TA needs and has not yet had to refer a monitored program to the fraud unit for further investigation. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Unintentional program violations would be flagged in the same way as intentional violations noted above. In addition, Providers are required to enroll a CCAP participating child in their program through the Provider Portal before or during the first week of providing care. If they are unable to do so, they are to contact the Provider Management team for assistance within the first week of care to ensure payment. In cases where Providers have not enrolled timely, provider management will deny payment or work with the provider to submit documentation to support back billing. Unintentional program violations such as failure to enroll timely, or to complete and retain required enrollment and attendance documentation are addressed with technical assistance and continued monitoring. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: Agency errors related to accepting enrollments and/or attendance submission due to systems issues that prevent a Provider from enrolling a child timely or submitting attendance or absent forms through the portal are triaged through Provider Management, Financial Management and the IT/Deloitte team to troubleshoot, resolve the immediate payment issue and rectify related system issues. These errors inform additional reporting needs, system enhancement requirements and internal training requirements. For example, a system issue preventing providers from uploading absent notices correctly in certain circumstances was identified by financial management review of payment records and solutioned during the cross-functional weekly meeting. A minor system update and provider communication re: uploads were implemented to resolve the issue. d. [x] Conduct supervisory staff reviews or quality assurance reviews. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Monthly case reviews are conducted as part of the triennial improper payment process and continue to be implemented at the same rate of 20+ reviews a month beyond the current review period. The lead agency has formed an internal program integrity team that joined in this work to further integrate regular case reviews with the field operations department, the training department, and the program and policy teams. Results are shared with operations and program integrity leads to review and share with operations teams. The Operations team has a layered staff and QI review process that includes: Monthly leadership updates including email updates, quarterly refreshed and trainings; Daily Morning Staff Huddles, where supervisors share QI updates, identify areas for improvement and review available tools and supports; Bi-weekly supervisor One-on-ones where supervisors meet with each direct report to review cases and areas for improvement and Bi-weekly all-supervisor meetings where supervisors share QI findings, best practices and techniques to improve accuracy and reduce errors. Findings that indicate an intentional program violation would be referred to the internal fraud investigation department. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The activities related to unintentional program violations mirror those noted above for Intentional program violations. In addition, the training and operations teams have a defined and required training schedule for eligibility workers processing all program benefits, including CCDF funded programs, CCAP. CCAP training is mandatory for all new Eligibility Staff within their 6-month probationary period ￿ CCAP Training is offered every other month ￿ It encompasses both low income CCAP and Categorical CCAP and includes Policy, Systems, and Business Operation Procedure. All Eligibility Staff can enroll in the course as needed. An additional refresher course is accessible to all staff as of June 2024. When there is an update to Policy, the System Knowledge Transfers are released to supervisors and staff. Supervisory review prior to Benefit Authorization is required for new employees for at least the first 6-months of their probationary period. Supervisor reviews take place every two months for eligibility workers and are designed to review performance and identify additional learning needs. These processes are to ensure accurate case processing and reduction of common errors. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The activities related to agency errors include monthly case reviews with program, review team, operations and program integrity, Policy Transmittals outlining changes are shared with all program staff by the Policy team, knowledge transfers trainings are assigned for completion (mandatory) by eligibility teams on a monthly basis. Eligibility training tools developed by the training team are covered with operations staff through weekly operations review calls, and updates to training and office hours materials. Findings from audits and case reviews are shared with operations supervisors and staff through program team quality meetings, program office hours and training updates. The training and operations teams have a defined and required training schedule for eligibility workers processing all program benefits, including CCDF funded programs, CCAP. CCAP training is mandatory for all new Eligibility Staff within their 6-month probationary period ￿ CCAP Training is offered every other month ￿ It encompasses both low income CCAP and Categorical CCAP and includes Policy, Systems, and Business Operation Procedure. All Eligibility Staff can enroll in the course as needed. An additional refresher course is accessible to all staff as of June 2024. When there is an update to Policy, the System Knowledge Transfers are released to supervisors and staff. Supervisory review prior to Benefit Authorization is required for new employees for at least the first 6-months of their probationary period. Supervisor reviews take place every two months for eligibility workers and are designed to review performance and identify additional learning needs. Trainings, QI reviews, supervisor huddles, one-on-one meetings are all used to ensure accurate processing and reduction of unintentional case processing errors. e. [x] Audit provider records. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Beginning February 2024, the Lead Agency implemented a Provider Monitoring program to request Parent-Provider Agreements and attendance documentation from Providers on a monthly basis to ensure monitoring of all CCAP Approved providers over a three-year period. The goal of Monitoring is to ensure accurate record usage and retention, accurate reporting of attendance through the Provider Portal and accurate enrollment hours that result in accurate provider payments. If a monitoring result indicates an intentional program violation, the results would be shared with internal fraud investigation department. Since the monitoring program was launched in February 2024, DHS has requested enrollment and attendance documentation from 80 providers including both center-based providers and family child care providers. Technical assistance is provided to all providers around record keeping requirements in their orientation and in ongoing provider communications. Requirements and resources are shared with all programs as part of monitoring. The Lead Agency is conducting additional monitoring for programs with higher TA needs and has not yet had to refer a monitored program to the fraud unit for further investigation. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Unintentional program violations activities are similar to those noted above for Intentional program violations, including the introduction of a provider monitoring process where providers are required to submit documentation of enrollment and attendance. In addition, whenever a provider requests back billing or payment adjustments, these same attendance/absent records are required for provider management review of the request prior to approving payment. Unintentional program violations such as failure to enroll timely, or to retain complete and consistent enrollment and attendance documentation are addressed with technical assistance and continued monitoring to ensure Providers are aware of the requirements and how to comply. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency processes Provider Applications for providers who want to become approved to enroll and care for children receiving the CCAP subsidy. These agreements are reviewed by the provider management supervisor for completeness and accurracyaccuracy. In the event of an agency error in processing, such as missing documentation, the supervisor or assigned worker will outreach to the Provider to obtain the documentation and update the file. In the event the missing documentation, or documentation submitted is incomplete or inadequate the Provider would be denied or would be notified of the termination of their CCAP approval. 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: CCAP policy is reviewed regularly with OCC staff in bi-weekly staff meetings. Updates are formalized through Policy Transmittals shared with all program staff by the Policy team, knowledge transfers trainings (mandatory) and reviewed with OCC staff. Policy updates and associated training tools are covered with operations staff through weekly operations review calls, policy transmittals, new training tools such as TMTs (two minute tips) QRGs (quick reference guides) and updates to regular training and office hours materials. Findings from audits and case reviews are shared with operations supervisors and staff through program team quality meetings, program office hours and training updates. As a result of these combined activities, staff are trained and have access to training materials on policy updates, policy implementation at the case level and knowledge of common errors uncovered through case reviews and QI activities. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: CCAP policy is reviewed regularly with OCC staff in bi-weekly staff meetings. Updates are formalized through Policy Transmittals shared with all program staff by the Policy team, knowledge transfers trainings (mandatory) and reviewed with OCC staff. Policy updates and associated training tools are covered with operations staff through weekly operations review calls, policy transmittals, new training tools such as TMTs (two minute tips) QRGs (quick reference guides) and updates to regular training and office hours materials. Findings from audits and case reviews are shared with operations supervisors and staff through program team quality meetings, program office hours and training updates. As a result of these combined activities, staff are trained and have access to training materials on policy updates, policy implementation at the case level and knowledge of common errors uncovered through case reviews and QI activities. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: CCAP policy is reviewed regularly with OCC staff in bi- weekly staff meetings. Updates are formalized through Policy Transmittals shared with all program staff by the Policy team, knowledge transfers trainings (mandatory) and reviewed with OCC staff. Policy updates and associated training tools are covered with operations staff through weekly operations review calls, policy transmittals, new training tools such as TMTs (two minute tips) QRGs (quick reference guides) and updates to regular training and office hours materials. Findings from audits and case reviews are shared with operations supervisors and staff through program team quality meetings, program office hours and training updates. As a result of these combined activities, staff are trained and have access to training materials on program policy updates, policy implementation at the case level and knowledge of common errors uncovered through case reviews and QI activities. Through the Improper Payment case reviews, agency errors related to processing eligibility and case management are identified through independent case audits. A cross-agency team that includes program, operations, training, policy and IT now reviews these findings to address errors from multiple angles including system updates, training updates and requirements and policy revisions. A program integrity administrator is part of that review team to provide additional case review and accurate audit results. g. [ ] Other. Describe the activity(ies): i. [ ] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: ii. [ ] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: iii. [ ] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: 10.2.2 Identification and recovery of misspent funds Lead Agencies must identify and recover misspent funds that are a result of fraud, and they have the option to recover any misspent funds that are a result of unintentional program violations or agency errors. a. Identify which agency is responsible for pursuing fraud and overpayments (e.g., State Office of the Inspector General, State Attorney): The Office of Internal Audit (OIA) investigates fraud and determines related overpayments. The Claims, Collections and Recover Unit is responsible for pursuing fraud overpayments. The DHS office of Financial Management is responsible for pursuing recoupment of overpayments resulting from provider or agency error. b. Check and describe all activities, including the results of such activity, that the Lead Agency uses to investigate and recover improper payments due to fraud. Consider in your response potential fraud committed by providers, clients, staff, vendors, and contractors. Include in the description how each activity assists in the investigation and recovery of improper payment due to fraud or intentional program violations. Activities can include, but are not limited to, the following: i. [ ] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: ii. [x] Coordinate with and refer to the other State/Territory agencies (e.g., State/Territory collection agency, law enforcement agency). Describe the activities and the results of these activities based on the most recent analysis: Fraudulent overpayments in excess of $10k (total for all DHS Program overpayments, not just CCDF related overpayments) is referred to the AG for criminal prosecution. Overpayments related to a fraud finding under $10k are referred to DHS CCRU for recoupment. This process has been on hold during post pandemic recovery with plans to reinstate in 2024. The Department currently has an internal process for monitoring providers that is level-based. A level 3 provider with a number of egregious errors is forwarded to CCRU for continued follow-up and communication for recoupment process. The Department works alongside any agency that we provide information to to ensure we recoup the correct amount and goes to the correct place. iii. [ ] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: For recoupment of overpaid funds, Providers have an option to pay in full with a one-time payment or to establish a repayment plan over time. Repayment plans are established and tracked by Financial Management and we have a workflow established for not only tracking payments, but documented the need for repayment plans and establishing a cadence for reduction of funds. 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. [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 Rhode Island Department of Administration's Office of Internal Audits, when necessary, will conduct fraud investigations on the Lead Agency's behalf for DHS families using a tip line. They will follow up on any information they received and alert the Department to their findings, which will then result in one of the other activities. viii. [x] Other. Describe the activities and the results of these activities: Rhode Island investigates and recovers payments of potential fraud by contractors and partner staff using subrecipient monitoring for all contracts utilizing federal funding. Contractors are required to complete a risk assessment and provide us with annual audited financial statements. In addition, programming services staff audit invoicing and meet with contractors a minimum of monthly to go over expenses to deliverables. Any questionable invoices are reviewed and asked for follow up information, and not paid if appropriate. c. Does the Lead Agency investigate and recover improper payments due to unintentional program violations? [x] No. [ ] Yes. If yes, check and describe below any activities that the Lead Agency will use to investigate and recover improper payments due to unintentional program violations. Include in the description how each activity assists in the investigation and recovery of improper payments due to unintentional program violations. Include a description of the results of such activity. i. [ ] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: ii. [ ] 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. [ ] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: iv. [ ] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [ ] 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? [x] No. [ ] Yes. If yes, check and describe all activities that the Lead Agency will use to investigate and recover improper payments due to agency errors. Include in the description how each activity assists in the investigation and recovery of improper payments due to administrative errors. Include a description of the results of such activity. i. [ ] Require recovery after a minimum dollar amount of an improper payment and identify the minimum dollar amount. Describe the activities and the results of these activities based on the most recent analysis: ii. [ ] 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. [ ] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: iv. [ ] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: v. [ ] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: vi. [ ]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: DHS CCAP Regulations define administrative penalties for clients who commit an intentional program violation and/or fraud. These sanctions include: First offense ￿ disqualification from the CCAP program for 3 months. Second offense ￿ disqualification from the CCAP program for 6 months. Third offense ￿ disqualification form the CCAP program for 12 months. If a benefit recipient chooses to appeal or contest the determination, they are entitled to a hearing as outlined Title 218 section 10-00-1.6. Upon completion of the investigation, the fraud unit determines whether an overpayment has occurred and if so, whether it is classified as fraud, agency error or household error. If such claim is determined to be fraud, the fraud unit shall pursue administrative penalties set forth by the Federal and State Regulations. A recipient has the right to an administrative disqualification hearing. If such recipient waives the hearing and chooses to sign the waiver agreement, the waiver shall be returned to the fraud unit within ten (10) days. At its discretion the fraud unit may refer any case that is determined to be of a criminal nature to the Rhode Island State Police or the Office of the Attorney General. In the past year, the Lead Agency has not made any referrals to the fraud unit related to client fraud. 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: DHS CCAP Regulations define administrative penalties for Providers who commit an intentional program violation and/or Fraud. These sanctions include: First offense ￿ disqualification from the CCAP program for 3 months. Second offense ￿ disqualification from the CCAP program for 6 months. Third offense ￿ disqualification form the CCAP program for 12 months. If a provider chooses to appeal or contest the determination, they are entitled to a hearing as outlined Title 218 section 10-00-1.6. Upon completion of the investigation, the fraud unit determines whether an overpayment has occurred and if so, whether it is classified as fraud, agency error or provider error. If determined to be fraud, the fraud unit shall pursue administrative penalties set forth by the Federal and State Regulations. A provider has the right to an administrative disqualification hearing. If such provider waives the hearing and chooses to sign the waiver agreement, the waiver shall be returned to the fraud unit within ten (10) days. At its discretion the fraud unit may refer any case that is determined to be of a criminal nature to the Rhode Island State Police or the Office of the Attorney General. In the past year, the Lead Agency has not made any referrals to the fraud unit related to provider fraud. iii. [x] Prosecute criminally. Describe the activities and the results of these activities based on the most recent analysis: When the Office of Internal Audit determines an Intentional Program Violation committed by a benefit recipient or a CCAP Provider meets the criteria for a criminal investigation, the case is referred to the State police and/or to the Office of the Attorney General of Rhode Island. The results would vary based on the facts and circumstances of each case. In the past year, the Lead Agency has not made any referrals to the fraud unit related to criminal prosecution. iv. [ ] Other. Describe the activities and the results of these activities based on the most recent analysis: Appendix 1: Lead Agency Implementation Plan The Appendix will be available for Lead Agencies to use in CARS after the Plan approval letter is issued. For each non-compliance, Lead Agencies must describe the following: • Action Steps: List the action steps needed to correct the finding (e.g., update policy manual, legislative approval, IT system changes, etc.). For each action step list the: o Responsible Entity: Indicate the entity (e.g., agency, team, etc.) responsible for completing the action step. o Expected Completion Date: List the expected completion date for the action step. • Overall Target Date for Compliance: List date Lead Agency anticipates completing implementation, achieving full compliance with all aspects of the findings. (Note: Compliance will not be determined until the FFY 2025-2027 CCDF Plan is amended and approved). Appendix 1: Form [Plan question with non-compliance and associated provision will pre-populate based on preliminary notice of non-compliance] A. Action Steps for Implementation B. Responsible Entity(ies) C. Expected Completion Date Step 1: Step 2 (as necessary): [Additional steps added as necessary] Overall Target Date for Compliance: