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15. Program Integrity

15.1 Fair Hearings DSS will provide a fair hearing to any household disputing an action of DSS which affects the participation or benefit level for Child Care Assistance. If a family requests a fair hearing to dispute an action on their case, Child Care State office will be notified by the Office of Administrative Hearings (OAH). OAH will request the notice of decision from the case file. This will need to be provided promptly. OAH will schedule the administrative hearing.

A request for a hearing is defined as a clear expression, oral or written, by the household or its representative, that it wishes to appeal a decision or would like the opportunity to present its case to a higher authority. The freedom to make a request for a hearing will not be limited or interfered with in any way. If it is unclear from the household's request what action it wishes to appeal, DSS may request the household clarify its grievance. Form DSS-EA-319, Oral/Written Request for Administrative Hearing, must be completed by DSS if the request for a hearing is initiated at the local office. DSS-EA-319 must be submitted to the Office of Administrative Hearings within one working day of receipt. If the household has submitted the request for hearing in writing, the written request must be attached to the DSS-EA-319 along with the notice of action that caused the request for hearing.

Benefits Specialists must ensure copies of all hearing exhibits are sent to all parties involved no later than five day prior to the hearing. Within 60 days of receipt of a request for a fair hearing, the Office of Administrative Hearings (OAH) will assure that the hearing is: • Conducted • A decision is reached • The household and local agency is notified of the decision.

Decisions which result in an increase in household benefits will be reflected in the benefit amount within 10 days of the receipt of the hearing decision.

If a household requests a fair hearing within 10 days after the notice of adverse action is mailed and the household’s certification period has not expired, the household's participation in the program will be continued on the basis authorized immediately prior to the notice of adverse action upon request.

15.2 Intentional Program Violations

15.2.1 Identifying Potential Fraud When processing an application, the EABS should check any information provided against information known to other DSS programs, which may include SNAP, Medicaid, TANF, and LIEAP programs. If potential applicant fraud has been identified for a CCA case, a fraud tip should be sent to the Child Care State office for review. If additional investigation is needed, a fraud tip is submitted to Office of Recoveries and Fraud Investigation (ORFI) using the ORFI 889 form. An ORFI investigator will then complete an investigation and provide a report either substantiating or un-substantiating the report. If a fraud tip is substantiated by ORFI, the IPV process will begin.

An applicant who is determined to have committed an Intentional Program Violation (IPV) though an administrative hearing will be required to serve a program disqualification. While serving an IPV disqualification their case will reflect an IPV sanction preventing eligibility determination during the disqualification period. Disqualifications for IPVs are as follows: • 12-months for first offence; • 24-months for second offence;