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148 5.10 Provider Fraud, Repayment, Disqualification & Appeals
When it is suspected that there has been a deliberate misrepresentation of facts in order to receive payments, the LDSS must determine whether fraud was committed. There must be clear and convincing evidence that demonstrates that the provider committed or intended to commit fraud.
Suspected instances of child care fraud must be referred to the LDSS’ fraud investigation unit, the appropriate regional child care consultant, and the VDOE. LDSS must send copies of fraud investigation final reports to their appropriate regional child care consultant and copy the VDOE (childcaresubsidy@doe.virginia.gov). If there is clear and convincing evidence that fraud has occurred, VDOE will refer the case to the attorney for the Commonwealth to determine if the case will be prosecuted.
A. Overpayment Due to Fraud
In addition to any criminal punishment, anyone who causes the Department to make an improper provider payment by withholding required information or by providing false information will be required to repay the amount of the improper payment.
Providers will be permanently disqualified from participating in the child care subsidy program upon the first finding of child care fraud.
B. Non-Fraud Overpayment
In the case of non-fraud overpayment, the provider will not be disqualified from participating in the subsidy program as long as a repayment schedule is entered into with the LDSS and payments are made according to that schedule.
Providers who fail to enter into a written repayment schedule with the LDSS for non-fraud overpayment will be disqualified from participating in the child care subsidy program until entering into a written repayment schedule.
Providers who fail to make a payment according to the written repayment schedule for non-fraud overpayments will be disqualified from participating in the child care subsidy program until all delinquent payments are made.
Upon payment of all delinquent payments according to the written repayment schedule, child care subsidy payment will resume for providers who are otherwise eligible.