Policy and Process Handbook Chapter 4 Program Integrity

Wisconsin Shares Child Care Subsidy Program

Policy and Process Handbook ? Chapter 4 Program Integrity January 3, 2019

Division of Early Care and Education

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Table of Contents

Wisconsin Shares Child Care Subsidy Program ______________________________________ 1

Acronyms ___________________________________________________________________ 7 4.1 Bureau of Program Integrity Overview _________________________________________ 9

4.1.1 Achievement of Goals and Principles ______________________________________________ 9 PART A: CLIENT PROGRAM INTEGRITY ___________________________________________ 12

4.2 Prevention ______________________________________________________________ 12 4.2.1 Front End Verification _________________________________________________________ 12

4.2.1.1 FEV Error-Prone Profile ___________________________________________________________ 13 4.2.1.2 Criteria for an Error-Prone Profile ___________________________________________________ 13 4.2.1.3 FEV Referral Steps _______________________________________________________________ 15 4.2.1.4 FEV Specialist Functions __________________________________________________________ 15 4.2.1.5 Front End Verification for Authorizations _____________________________________________ 16

4.2.2 Parents who are also Child Care Providers ________________________________________ 17 4.2.3 Local Agency Fraud Plans ______________________________________________________ 18

4.2.3.1 Subcontracting ___________________________________________________________________ 18

4.2.4 Technical Assistance __________________________________________________________ 18 4.2.5 Child Care Program Integrity Resource Library _____________________________________ 19 4.3 Detection _______________________________________________________________ 19 4.3.1 Referrals ___________________________________________________________________ 19

4.3.1.1 Screenings ______________________________________________________________________ 21

4.3.2 Data Exchanges ______________________________________________________________ 21 4.3.3 Client Red Flag Reports ________________________________________________________ 22 4.3.4 Public Assistance Reporting Information System (PARIS) Report _______________________ 22 4.3.5 Federal Improper Payment Report_______________________________________________ 23 4.3.6 Targeted Case Reviews ________________________________________________________ 23 4.3.7 Audits______________________________________________________________________ 23 4.4 Client Investigations_______________________________________________________ 24 4.4.1 Evidence and Tools ___________________________________________________________ 24 4.4.2 Information to Verify for the Investigation ________________________________________ 24

4.4.2.1 Questionable Employment _________________________________________________________ 24 4.4.2.2 Questionable Household Composition_______________________________________________ 26

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4.4.2.3 Questionable Need for Child Care __________________________________________________ 27 4.4.2.4 Fraudulent Documents ____________________________________________________________ 27

4.4.3 Data Tracking Requirements ___________________________________________________ 27

4.5 Sanctions________________________________________________________________ 27

4.5.1 Retractions _________________________________________________________________ 28

4.5.2 Overpayments _______________________________________________________________ 29

4.5.2.1 Establishing a Client Overpayment _________________________________________________ 29 4.5.2.2 Overpayment Calculations _________________________________________________________ 29

4.5.3 Entry of Client Overpayment in Benefit Recovery (BV) _______________________________ 34

4.5.3.1 Correcting a Client Overpayment ___________________________________________________ 34

4.5.4 Overpayment Classifications ___________________________________________________ 34

4.5.4.1 Administrative Error(s) ____________________________________________________________ 35 4.5.4.2 Client Error(s) ____________________________________________________________________ 39 4.5.4.3. Intentional Program Violations (IPVs) _______________________________________________ 49

4.5.5 Collusion ___________________________________________________________________ 58

4.5.5.1 Cash Refunds or "Kickbacks" ______________________________________________________ 59 4.5.5.2 Paying for Care for Children Not on the Case ________________________________________ 59 4.5.5.3 Possessing a MyWIChildCare EBT Card, Account Number, or PIN _____________________ 60 4.5.5.4 Issuing Payment for Child Care Not Provided ________________________________________ 60 4.5.5.5 Shell Company ___________________________________________________________________ 60

4.5.6 Criminal Prosecution __________________________________________________________ 61

4.5.7 Appeal Process ______________________________________________________________ 62

4.5.7.1 Fair Hearing Tracker ______________________________________________________________ 62 4.5.7.2 Overpayment Appeal Process______________________________________________________ 62 4.5.7.3 IPV Appeal Process_______________________________________________________________ 63

4.5.8 Data Tracking Requirements ___________________________________________________ 65

4.6 Collections_______________________________________________________________ 66

4.6.1 Client Overpayment Recovery Process ___________________________________________ 66

4.6.1.1 System-Generated Notice _________________________________________________________ 66 4.6.1.2 Manual Notices___________________________________________________________________ 67 4.6.1.3 Notice to Additional Liable Individuals _______________________________________________ 67 4.6.1.4 Statute of Limitations______________________________________________________________ 67 4.6.1.5 BVPA ? Client Repayment Agreement ______________________________________________ 67 4.6.1.6 Dunning Notices __________________________________________________________________ 68 4.6.1.7 Posting a Client Payment __________________________________________________________ 68

4.6.2 Delinquency Collections Process ________________________________________________ 69

4.6.2.1 Referrals to Central Recoveries Enhanced System (CRES) ____________________________ 69

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4.6.2.2 Levy ____________________________________________________________________________ 69 4.6.2.3 Warrant/Lien _____________________________________________________________________ 70 4.6.2.4 DOR State Tax Intercept __________________________________________________________ 70 4.6.2.5 Delinquency Collections Appeal Process ____________________________________________ 70

4.6.3 Retention of Records__________________________________________________________ 72

4.7 Confidentiality and Routine Disclosure ________________________________________ 73

PART B: PROVIDER PROGRAM INTEGRITY ________________________________________ 74

4.8 Prevention ______________________________________________________________ 74

4.8.1 Local Agency Refusal to Authorize to a Child Care Provider ___________________________ 74

4.8.2 Written Payment Agreement ___________________________________________________ 75

4.8.3 Prohibited Actions by a Provider ________________________________________________ 75

4.8.4 Requirement for Providers to Notify the Local Agency _______________________________ 76

4.8.5 Provider Record Keeping System and Attendance Documentation Method ______________ 76

4.9 Detection _______________________________________________________________ 77

4.9.1 Referrals ___________________________________________________________________ 77

4.9.2 Provider Investigation Referrals _________________________________________________ 77

4.9.2.1 Tracking Referrals ________________________________________________________________ 80

4.9.3 40% Rule ___________________________________________________________________ 80

4.9.3.1 Calculation of the 40% Rule________________________________________________________ 80 4.9.3.2 Out of State Providers_____________________________________________________________ 81 4.9.3.3 Enforcement _____________________________________________________________________ 82 4.9.3.4 Repeat Violations _________________________________________________________________ 83

4.9.4.3 Red Flags__________________________________________________________________ 84

4.9.43.1 Provider Red Flag Reports _______________________________________________________ 84 4.9.43.2 Red Flags for Site Visits __________________________________________________________ 84

4.9.54 Provider Data Tracking Requirements ___________________________________________ 84

4.10 Provider Investigations ___________________________________________________ 85

4.10.1 Local Agency Provider Investigation Tools ________________________________________ 85

4.10.1.1 Unannounced Site Visit __________________________________________________________ 85 4.10.1.2 Requesting Information __________________________________________________________ 87 4.10.1.3 Surveillance ____________________________________________________________________ 87 4.10.1.4 Monitoring Visits_________________________________________________________________ 87 4.10.1.5 Parent Interviews ________________________________________________________________ 88

4.10.2 Required Documentation _____________________________________________________ 88

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4.10.2.1 Provider Explanation Letter (7m Letter) ____________________________________________ 88 4.10.2.2 Technical Assistance Letter _______________________________________________________ 89

4.10.3 YoungStar Investigation Referrals ______________________________________________ 89

4.11 Sanctions_______________________________________________________________ 90

4.11.1 Overpayments ______________________________________________________________ 91

4.11.1.1 Overpayment Calculations ________________________________________________________ 91

4.11.1.1.1.1 Correcting an Overpayment ______________________________________________ 92

4.11.1.1.1.2 Entering an Overpayment ________________________________________________ 92

4.11.1.2 Overpayment Classifications ______________________________________________________ 93

4.11.2 Stipulations ________________________________________________________________ 99

4.11.3 Permanent Suspension _______________________________________________________ 99

4.11.3.1 Permanent Suspension Meeting__________________________________________________ 100

4.11.4 Provider Appeal Process _____________________________________________________ 100

4.11.4.1 Pre-Hearing Conference Call ____________________________________________________ 100 4.11.4.2 Witness Lists___________________________________________________________________ 101 4.11.4.3 Exchange of Exhibits____________________________________________________________ 101 4.11.4.4 Hearing _______________________________________________________________________ 101 4.11.4.5 Proposed Decision _____________________________________________________________ 101 4.11.4.6 Final Decision __________________________________________________________________ 102 4.11.4.7 Dismissal ______________________________________________________________________ 102 4.11.4.8 Remand _______________________________________________________________________ 102 4.11.4.9 Stipulation _____________________________________________________________________ 102

4.12 Collections_____________________________________________________________ 102

4.12.1 Recovery of Provider Overpayments ___________________________________________ 102

4.12.1.1 Voluntary Repayment Agreement (VPA) __________________________________________ 103 4.12.1.2 Personal Liability for Overpayment _______________________________________________ 104

4.12.2 Collections Process _________________________________________________________ 104

4.12.2.1 Referring a Provider to Benefit Recovery (BV) _____________________________________ 104 4.12.2.2 BVPP ? Provider Repayment Agreement (RPA) ____________________________________ 104 4.12.2.3 Dunning Notices________________________________________________________________ 105 4.12.2.4 Provider Payments _____________________________________________________________ 105

4.12.3 Delinquency Collections Process ______________________________________________ 106

4.12.3.1 Referring a Provider for Delinquency______________________________________________ 106 4.12.3.2 Delinquency Collections Actions__________________________________________________ 106 4.12.3.23 Delinquency Collections Appeal Process _________________________________________ 107

4.12.4 Retention of Records _______________________________________________________ 108

4.13 Confidentiality and Routine Disclosure ______________________________________ 108 5

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