10.2 Fraud Investigation, Payment Recovery, and Sanctions

Lead Agencies must have the necessary controls to identify fraud and other program violations to ensure program integrity. Program violations can include both intentional and unintentional client and/or provider violations, as defined by the Lead Agency. These violations and errors, identified through the error-rate review process and other review processes, may result in payment or nonpayment (administrative) errors and may or may not be the result of fraud, based on the Lead Agency definition. 10.2.1 Strategies used to identify and prevent program violations Check the activities the Lead Agency employs to ensure program integrity, and for each checked activity, identify what type of program violations the activity addresses, describe the activity and the results of these activities based on the most recent analysis. a. [ ] Share/match data from other programs (e.g., TANF program, Child and Adult Care Food Program, Food and Nutrition Service (FNS), Medicaid) or other databases (e.g., State Directory of New Hires, Social Security Administration, Public Assistance Reporting Information System (PARIS)). i. [ ] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: ii. [ ] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: iii. [ ] Agency errors. Describe the activities, the results of these activities, and how they inform better practice:: b. [ ] Run system reports that flag errors (include types). i. [ ] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: ii. [ ] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: iii. [ ] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: c. [x] Review enrollment documents and attendance or billing records. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: To ensure the policies and procedures are maintained to avoid program violations the Lead Agency Finance staff process all billing records Service Voucher Log (SVLs) submitted by providers to ensure proper billing procedures have been followed. Any errors or violations found from reviewing the SVLs are used to provide clearer policy and training to the child care providers and the child care Finance and program staff. ABC Quality staff review enrollment documents prior to a provider enrolling to ensure the provider is enrolled at the appropriate rates and level as well as set up with a valid IRS letter and Federal Identification Number or Driver's license and Social Security Number depending on how the provider is doing business. This process ensures that the provider is appropriately set up with our state Treasurer's office and with the ABC Quality level to ensure proper billing for children eligible for subsidy. During the enrollment process, ABC Quality and Child Care Scholarship Control Center staff follow the guidelines, policies and procedures outlined in the Child Care Scholarship Policy Manual to ensure provider enrollments meet the appropriate requirements. Any discrepancies found as a result of the enrollment process is used to ensure policy is clear as well as provide training for the child care program staff. See ABC Quality License Exempt Manual (https://www.scchildcare.org/media/4qdn5tgg/license-exempt-school-age- manual-6-3-2024.pdf), ABC Quality Center-Based Manual (https://www.scchildcare.org/media/2g1dfkhl/center-based-manual-june-18- 2024.pdf), and the ABC Quality Family Group Manual (https://www.scchildcare.org/media/ngbg1mjo/family-group-manual-revised- june-2024.pdf). The Lead Agency does not distinguish intentional and unintentional program violations or agency errors when adjustments are processed. During the period October 2022 to September 2023, the Lead Agency Finance staff processed 18,341 online SVL’S totaling $181,449,919 and 1,346 paper SVL’s totaling 1,836,468. During the same period there were 1,134 Adjustments for $146,692.00 (Payable Adjustments 549 for $22,205 and Receivable Adjustments 585 for $168,897. There were 47 Tax Intercepts processed for $49,977.96. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: To ensure the policies and procedures are maintained to avoid program violations the Lead Agency Finance staff process all billing records Service Voucher Log (SVLs) submitted by providers to ensure proper billing procedures have been followed. Any errors or violations found from reviewing the SVLs are used to provide clearer policy and training to the child care providers and the child care Finance and program staff. ABC Quality staff review enrollment documents prior to a provider enrolling to ensure the provider is enrolled at the appropriate rates and level as well as set up with a valid IRS letter and Federal Identification Number or Driver's license and Social Security Number depending on how the provider is doing business. This process ensures that the provider is appropriately set up with our state Treasurer's office and with the ABC Quality level to ensure proper billing for children eligible for subsidy. During the enrollment process, ABC Quality and Child Care Scholarship Control Center staff follow the guidelines, policies and procedures outlined in the Child Care Scholarship Policy Manual to ensure provider enrollments meet the appropriate requirements. Any discrepancies found as a result of the enrollment process is used to ensure policy is clear as well as provide training for the child care program staff. Lead Agency policies are the same for all enrollment documents, attendance, enrollment and billing records program violations. The Lead Agency does not distinguish intentional and unintentional program violations or agency errors when adjustments are processed. During the period October 2022 to September 2023, the Lead Agency Finance staff processed 18,341 online SVL’S totaling $181,449,919 and 1,346 paper SVL’s totaling 1,836,468. During the same period there were 1,134 Adjustments for $146,692.00 (Payable Adjustments 549 for $22,205 and Receivable Adjustments 585 for $168,897. There were 47 Tax Intercepts processed for $49,977.96. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: During the enrollment process, ABC Quality and Child Care Scholarship Control Center staff follow the guidelines, policies and procedures outlined in the Child Care Scholarship Policy Manual to ensure provider enrollments meet the appropriate requirements. Any discrepancies found as a result of the enrollment process is used to ensure policy is clear as well as provide training for the child care program staff. Red flag reports are also used or new ones created. The Lead Agency does not distinguish intentional and unintentional program violations or agency errors when adjustments are processed. During the period October 2022 to September 2023, the Lead Agency Finance staff processed 18,341 online SVL’S totaling $181,449,919 and 1,346 paper SVL’s totaling 1,836,468. During the same period there were 1,134 Adjustments for $146,692.00 (Payable Adjustments 549 for $22,205 and Receivable Adjustments 585 for $168,897. There were 47 Tax Intercepts processed for $49,977.96. During the period October 2022 to September 2023, the Lead Agency Finance staff processed 18,341 online SVL’S totaling $181,449,919 and 1,346 paper SVL’s totaling 1,836,468. During the same period there were 1,134 Adjustments for $146,692.00 (Payable Adjustments 549 for $22,205 and Receivable Adjustments 585 for $168,897. There were 47 Tax Intercepts processed for $49,977.96. 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: During case reviews, if it is determined that an individual has provided incorrect information or intentionally provided fraudulent information to obtain child care services, the case is referred to the Child Care Scholarship Program Manager for denial or termination of child care services. During the desk review process over the past year, the review team has not identified any intentional program violations. During the period of October 2022 to May 2023, 2964 cases were reviewed resulting in229 administrative errors and 35 improper payments. The Lead Agency does not track agency error based on intentional vs. unintentional errors. Errors are only tracked by administrative vs improper payments. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: As a result of the case reviews, if the violations are determined to be unintentional, the case is referred to the Child Care Scholarship Program Manager for further action to ensure policies, procedures and processes are reviewed to determine if changes or clarifications to such policies are needed. This activity is an effective method to identify errors. Any discrepancies found as a result of the enrollment process is used to ensure policy is clear as well as provide training for the child care program staff. Red flag reports are also used and new ones created as necessary. During the period of October 2022 to May 2023, 2964 cases were reviewed resulting in229 administrative errors and 35 improper payments. The Lead Agency does not track agency error based on intentional vs. unintentional errors. Errors are only tracked by administrative vs improper payments. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: This activity is an effective method by which to identify errors. The reviews are to be used to identify training needs for staff and to make recommendations regarding methods to improve the child care program, by reviewing and making changes to changes to policies and procedures. Training sessions are developed to target the causes of errors, such as incorrect income calculations. During the period October 2022 to May 2023, 2,964 cases were reviewed resulting in 229 Administrative Errors and 35 Improper Payments. The Lead Agency does not track agency errors based on intentional vs unintentional only administrative vs improper payments. 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 engagement letter is sent to the child care provider to announce the upcoming audit. The auditor calls the child care provider to discuss the information needed for the audit. The child care provider sends in information and the auditor reviews submitted documents. The supervisor reviews results determined by the auditor. A final report sent to the child care provider if there are no findings. A draft report is sent to the child care provider to report any findings. The provider is given 15 days to respond to the draft report or to send additional documentation of attendance. If adjustments are made, a revised draft report is sent to the child care provider and they are given another 15 days to respond. A final report is sent to the child care provider. The child care provider has 30 days from the date of the final report to send a request to the Office of Administrative Hearings to request an appeal of the audit findings. If audits are not notified of an appeal, after 30 days, a recoupment request is sent to Finance for recovery of funds. Finance contacts the child care provider to set-up a payment plan. This activity is an effective method by which to identify errors in the provider's records. The draft finding letter and the final letter is also sent to the child care program area. These findings are used to ensure policy is clear as well as inform training topics needed for the Town Hall webinars with child care providers, conference training sessions, and policy bulletins to child care providers. Lead Agency’s Audit Division conducted 281 audits during the period 10/1/2022- 9/30/2023 and forwarded $169,732.00 in recoupments to Lead Agency Finance based on 116 findings. These findings are currently not identified by intentional vs unintentional program violations. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: An engagement letter is sent to the child care provider to announce the upcoming audit. The auditor calls the child care provider to discuss the information needed for the audit. The child care provider sends in information and the auditor reviews submitted documents. The supervisor reviews results determined by the auditor. A final report sent to the child care provider if there are no findings. A draft report is sent to the child care provider to report any findings. The provider is given 15 days to respond to the draft report or to send additional documentation of attendance. If adjustments are made, a revised draft report is sent to the child care provider and they are given another 15 days to respond. A final report is sent to the child care provider. The child care provider has 30 days from the date of the final report to send a request to the Office of Administrative Hearings to request an appeal of the audit findings. If audits are not notified of an appeal, after 30 days, a recoupment request is sent to Finance for recovery of funds. Finance contacts the child care provider to set-up a payment plan. This activity is an effective method by which to identify errors in the provider's records. The draft finding letter and the final letter is also sent to the child care program area. These findings are used to ensure policy is clear as well as inform training topics needed for the Town Hall webinars with child care providers, conference training sessions, and policy bulletins to child care providers. Lead Agency’s Audit Division conducted 281 audits during the period 10/1/2022- 9/30/2023 and forwarded $169,732.00 in recoupments to Lead Agency Finance based on 116 findings. These findings are currently not identified by intentional vs unintentional program violations. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: This activity is an effective method by which to identify errors in the provider's records. The draft finding letter and the final letter is also sent to the child care program area. These findings are used to ensure policy is clear and being interpreted appropriately by child care staff. These topics also inform training topics for child care staff. Lead Agency’s Audit Division conducted 281 audits during the period 10/1/2022- 9/30/2023 and forwarded $169,732.00 in recoupments to Lead Agency Finance based on 116 findings. These findings are currently not identified by intentional vs unintentional program violations. 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: Lead Agency eligibility staff are provided one-on-one training by members of the Review Team as a part of the on- boarding process. Child Care Scholarship Program policies and procedures are taught and reviewed to ensure that new staff know the eligibility criteria and can correctly process applications for the child care scholarship. This is a significant part of orientation to the Program. At regular intervals ongoing Training Curriculum sessions are presented in small group settings providing time for staff to review the information and ask questions. Eligibility staff have an opportunity to clarify policy which will then allow them to make accurate decisions. The goal of the Lead Agency is to provide all eligibility workers with tools to decrease errors and improve our error rate therefore avoiding the possibility of program violations leading to misuse of funds. This activity is an effective method by which to train staff on policy. Results of this activity can be seen in lower errors and improper payment findings. The goal of the Lead Agency is to provide all eligibility workers with tools to decrease error and improve our error rate therefore avoiding the possibility of program violations leading to misuse of funds. ABC Quality provides an orientation for new employees, which includes a review of all program manuals. The program manuals outline the requirements to participate, which includes the CCDF requirements as well as the definition of fraud, the investigation process, and consequences for committing fraud. ABC Quality provides updates and changes to program requirements or procedures at regular staff meetings. ABC Quality staff is trained on reporting potential fraud cases to the appropriate entities who will investigate the claim. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: Lead Agency eligibility staff are provided one-on-one training by members of the Review Team as a part of the on- boarding process. Child Care Scholarship Program policies and procedures are taught and reviewed to ensure that new staff know the eligibility criteria and can correctly process applications for the child care scholarship. This is a significant part of orientation to the Program. At regular intervals ongoing Training Curriculum sessions are presented in small group settings providing time for staff to review the information and ask questions. Eligibility staff have an opportunity to clarify policy which will then allow them to make accurate decisions. The goal of the Lead Agency is to provide all eligibility workers with tools to decrease errors and improve our error rate therefore avoiding the possibility of program violations leading to misuse of funds. This activity is an effective method by which to train staff on policy. Results of this activity can be seen in lower errors and improper payment findings. The goal of the Lead Agency is to provide all eligibility workers with tools to decrease error and improve our error rate therefore avoiding the possibility of program violations leading to misuse of funds. Child Care Scholarship staff and Quality Review Team utilized the same process and policies for all program violations. ABC Quality utilizes the same staff training strategies for all types of program violations. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: As a result of the bi-weekly case reviews performed by the Quality Review Team the risk of errors in eligibility determination is kept at a minimum. The Team reviews an average of 247 cases per month. Eligibility workers and Control Center staff are provided one-on-one training through the Quality Review process to address redundant errors. They are also trained based on findings from audit reviews and supervisory reviews. The Quality Review Team has a process in place to review errors with supervisors and new processes are also being developed as a result of the Improper Payments Reviews. Additionally, there is a yearly training conducted with staff by the Program Manager and team to review changes to policy and provide policy clarifications to ensure compliance. As new policy guidance is available, all staff are sent an email with the new policy updates to include any changes to existing policy, the new policy language, and the effective date of any policies or changes. This activity is an effective method by which to train staff on policy. Results of this activity can be seen in lower errors and improper payment findings. The goal of the Lead Agency is to provide all eligibility workers with tools to decrease error and improve our error rate therefore avoiding the possibility of program violations leading to misuse of funds. g. [x] Other. Describe the activity(ies): The Lead Agency refers to the Office of Inspector General (OIG) to investigate issues related to fraud. The Lead Agency staff upon identifying the potential for fraud or misrepresentation refers documentation to the OIG for extensive research and investigation to determine findings. As a result of this process with OIG, policies and procedures are reviewed to ensure that no changes are needed based on findings. i. [x] Intentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency refers to the Office of Inspector General (OIG) within SCDSS to investigate issues related to fraud. The Lead Agency staff upon identifying the potential for fraud or misrepresentation refers documentation to the OIG for extensive research and investigation to determine findings. As a result of this process with OIG, policies and procedures are reviewed to ensure that no changes are needed based on findings. During the period October 2022 to September 2023 OIG received and investigated 17 complaints of which 12 were Provider related and 5 were client related. The Office of Inspector General OIG utilizes a Case Management and Tracking System to maintain records of open complaints and investigations. Annual updates are requested from OIG to determine the number of cases prosecuted. As a result of this activity, we review policies and procedures to ensure they are effective. ii. [x] Unintentional program violations. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency refers to the Office of Inspector General (OIG) within SCDSS to investigate issues related to fraud. The Lead Agency staff upon identifying the potential for fraud or misrepresentation refers documentation to the OIG for extensive research and investigation to determine findings. As a result of this process with OIG, policies and procedures are reviewed to ensure that no changes are needed based on findings. During the period October 2022 to September 2023 OIG received and investigated 17 complaints of which 12 were Provider related and 5 were client related. The Office of Inspector General OIG utilizes a Case Management and Tracking System to maintain records of open complaints and investigations. Annual updates are requested from OIG to determine the number of cases prosecuted. As a result of this activity, we review policies and procedures to ensure they are effective. iii. [x] Agency errors. Describe the activities, the results of these activities, and how they inform better practice: The Lead Agency refers to the Office of Inspector General (OIG) within SCDSS to investigate issues related to fraud. The Lead Agency staff upon identifying the potential for fraud or misrepresentation refers documentation to the OIG for extensive research and investigation to determine findings. As a result of this process with OIG, policies and procedures are reviewed to ensure that no changes are needed based on findings. During the period October 2022 to September 2023 OIG received and investigated 17 complaints of which 12 were Provider related and 5 were client related. The Office of Inspector General OIG utilizes a Case Management and Tracking System to maintain records of open complaints and investigations. Annual updates are requested from OIG to determine the number of cases prosecuted. As a result of this activity, we review policies and procedures to ensure they are effective. 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): South Carolina Department of Social Services and Office of Inspector General, when applicable. 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. [ ] 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: When it is determined that a provider has unintentionally violated the program policies, a recoupment of monies paid to the provider is processed. The provider is allowed to set up a repayment plan through the Lead Agency Finance Division. A repayment letter is sent to the provider describing the monies owed. The provider is given an option to pay the amount in full by a specific date, or the option of requesting a payment plan and making regular payments. A report will be created to give a total amount of funds recovered through repayment plans. The results of allowing a repayment plan allows the provider to budget for the recoupment of funds over a period of time determined by finance and the provide depending on the amount owed. During the October 2022 through September 2024 there were 133 repayment plans generated for a total of $167,488 to be repaid. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: If the provider who has unintentionally violated program policy is allowed to continue to serve child care scholarship children, recoupments will be recovered from future payment requests submitted by the provider. The Lead Agency has processes in place to recover misspent funds from providers that are the results of these errors. These processes include an automated adjustment system in which both payable and receivable adjustments can be entered in the Child Care Scholarship Program database. Once the adjustments are entered, the future payments for the child care provider will be either increased, if a payable adjustment was entered and additional monies are due, or decreased, if a receivable adjustment was entered and monies are due back. The adjustments are reflected on the Service Voucher Log (SVL) for the child care provider and will affect all future payments until the amount of the adjustment has been paid or received. The results of the recoupment from subsequent moths ensures a faster recover of funds owed. By reducing the child care scholarship funds from future payments, the providers are more likely to review their future payments more closely to avoid future recoupments of funds. During the period October 2022 to September 2023, the Lead Agency Finance staff processed 585 Receivable Adjustments for $168,897. v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: The Lead Agency’s Accounts Receivable Division handles the process of submitting State tax intercept requests which are processed through the SC Department of Revenue. Tax intercepts are not processed for clients. During October 2022 - September 2024, there were 47 Tax Intercepts processed for $49,977.96. vi. [ ] Recover through other means. Describe the activities and the results of these activities based on the most recent analysis: vii. [ ] Establish a unit to investigate and collect improper payments and describe the composition of the unit. Describe the activities and the results of these activities based on the most recent analysis: viii. [ ] Other. Describe the activities and the results of these activities: c. Does the Lead Agency investigate and recover improper payments due to unintentional program violations? [ ] No. [x] Yes. If yes, check and describe below any activities that the Lead Agency will use to investigate and recover improper payments due to unintentional program violations. Include in the description how each activity assists in the investigation and recovery of improper payments due to unintentional program violations. Include a description of the results of such activity. i. [ ] 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. [x] Recover through repayment plans. Describe the activities and the results of these activities based on the most recent analysis: When it is determined that a provider has unintentionally violated the program policies, a recoupment of monies paid to the provider is processed. The provider is allowed to set up a repayment plan through the Lead Agency Finance Division. A repayment letter is sent to the provider describing the monies owed. The provider is given an option to pay the amount in full by a specific date, or the option of requesting a payment plan and making regular payments. A report will be created to give a total amount of funds recovered through repayment plans. During the October 2022 through September 2024 there were 133 repayment plans generated for a total of $167,488 to be repaid. iv. [x] Reduce payments in subsequent months. Describe the activities and the results of these activities based on the most recent analysis: If the provider who has unintentionally violated program policy is allowed to continue to serve child care scholarship children, recoupments will be recovered from future payment requests submitted by the provider. The Lead Agency has processes in place to recover misspent funds from providers that are the results of these errors. These processes include an automated adjustment system in which both payable and receivable adjustments can be entered in the Child Care Scholarship Program database. Once the adjustments are entered, the future payments for the child care provider will be either increased, if a payable adjustment was entered and additional monies are due, or decreased, if a receivable adjustment was entered and monies are due back. The adjustments are reflected on the Service Voucher Log (SVL) for the child care provider and will affect all future payments until the amount of the adjustment has been paid or received. During the period October 2022 to September 2023, the Lead Agency Finance staff processed 585 Receivable Adjustments for $168,897. v. [x] Recover through State/Territory tax intercepts. Describe the activities and the results of these activities based on the most recent analysis: The Lead Agency’s Accounts Receivable Division handles the process of submitting State tax intercept requests which are processed through the SC Department of Revenue. Tax intercepts are not processed for clients. During October 2022 - September 2024, there were 47 Tax Intercepts processed for $49,977.96. 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: The Lead Agency has a Quality Review Process that conducts monthly random reviews to check the accuracy of determinations of child care eligibility. The results of these reviews are then discussed with the eligibility supervisors to assist with one-on-one sessions with child care eligibility workers to ensure correct interpretation of policy and procedures. If it is determined that there is potential fraud case it is directed to the Child Care Scholarship Program Manager for review and referral to the Office of Inspector General. If it is determined that the client misrepresented themselves by providing forged or fraudulent eligibility documentation, then the client is disqualified for life. A designation code is added to the client's record in the Child Care Scholarship system to indicate this action. The applicant/client is given an opportunity to request a fair hearing in compliance with the Civil Rights Act of 1964. They may appeal any decision that results in the denial or termination of services. A fair hearing must be requested in writing and must be made within 30 days from the date of the negative action. The request may be made by the applicant/client or a person acting on their behalf, such as legal representative, relative, or friend. Staff must not impede, limit, or interfere in any way with the client's right to request a fair hearing. During the appeal process the client is responsible for paying for their own child care arrangements. After the fair hearing is conducted, if the denial or termination of services for deliberate misrepresentation is upheld, the client will be disqualified from receiving child care services for life. During the period October 2022 to September 2023, there were no findings for misrepresentation by the client. 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: Providers who are determined to have intentionally violated the program or to have committed fraud will be terminated from participation in the ABC Quality program. The ABC Quality Program Manuals states that a child care program may appeal adverse actions such as termination or de-enrollment of an age group pursuant to SCDSS’s regulations [Reg. 126150, et seq.]. A certified letter will be sent to the child care provider notifying them of any adverse action along with instructions of how to request an appeal. To appeal the decision, a request must be made by the child care provider, in writing, within 30 days from receipt of the letter notifying the child care provider of the negative action. Once a representative has been appointed by the child care provider, all communications regarding the hearing and appeal are required to be made with that representative. If the request for appeal is not submitted to SCDSS within the 30-day period, the right to challenge the termination will be lost and the decision will become final. Once the Department of Individual and Provider Rights (DIPR) receives a written appeal request from the child care program, they will notify the child care provider, in writing, of the date and time for the hearing. The decision is made after reviewing the testimony and evidence provided by the child care provider and the representing program staff. If the decision rendered is not agreeable to the child care provider, the child care provider may appeal further to the Administrative Law Court, which is outside of DSS, for judicial review of their case. Any costs associated with this are the responsibility of the child care provider. During the appeal process, the child care provider is not eligible for the following opportunities: grants, promotions or recognitions of the child care program or any special projects offered by the Lead Agency. Additionally, during the appeal process, no new child care scholarship children will be allowed to connect to the child care provider during the appeal. The child care provider may continue serving children who are currently connected and have current eligibility until the end of the child’s 12-month eligibility period as long as there is not a break in service or their 12 months ends and the client renews their eligibility. If there is a break in service of a week or more or the family’s original 12 months of care has ended and they are renewing services, the family will not be allowed to connect to the child care provider that is under the appeal and must find alternative child care arrangements. Currently, ABC Quality policy states that child care providers who have committed fraud are ineligible to enroll or reenroll. The Lead Agency requested a reevaluation of the current policy to ensure that the enrollment process is equitable. ABC Quality plans to develop a scoring rubric to review potential child care provider enrollments and the incidents that have occurred within the program that would possibly deny their participation. This rubric will include reviewing the incident based on intentionality, severity, negligence, and the actions that the program took to maintain compliance. During the period October 2022 to September 2023, there was 1 provider that had to be terminated from the program and disqualified from the program. iii. [x] Prosecute criminally. Describe the activities and the results of these activities based on the most recent analysis: The Office of Inspector General is staffed with certified law enforcement personnel skilled in specialized administrative and criminal investigative techniques with the responsibility for the detection and prevention of fraud, waste, and abuse in South Carolina Department of Social Services' (SCDSS) programs and operations. Specifically, allegations of ABC Program Fraud investigated by the OIG and upon the establishment of probable cause, are referred to the appropriate prosecutorial authority for adjudication. During the period October 2022 to September 2023 OIG received and investigated 17 complaints of which 12 were Provider related and 5 were client related. During this period there were no providers criminally prosecuted. The Office of Inspector General OIG utilizes a Case Management and Tracking System to maintain records of open complaints and investigations. Annual updates are requested from OIG to determine the number of cases prosecuted. 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: