Mississippi Administrative Code › Title 18 - HUMAN SERVICES › Part 17 - Division of Early Childhood Care and Development Child Care Payment Program Policy Manual › Chapter 9 - Program Compliance › Rule 18-17-9.10 - Improper Payment

Current through June 25, 2024
Improper payments occur when MDHS makes a payment to a
				  provider on behalf of a recipient who is ineligible for the CCPP subsidy, or if
				  the payment was calculated in error. Improper payments can occur due to Agency
				  Errors (AE), Unintentional Program Violations (UPV), or Intentional Program
				  Violations (IPV). MDHS shall recover the improper payment, regardless of
				  type.
A. Threshold
:
MDHS
				shall pursue recoupment of UPV and IPV improper payments of more than $1,000.00
				and may pursue those claims of $1,000.00 or less. The threshold is applicable
				to UPV and IPV errors.
B. Types:
1) Agency Error (AE): occurs when MDHS staff
				takes an incorrect action or fails to take an action that causes an improper
				payment.
2) Unintentional Program
				Violation (UPV): occurs when a payment was paid to a child care provider, on
				behalf of the recipient, due to a misunderstanding of policy or by an
				unintentional error on the part of the parent or child care provider.
3) Intentional Program Violation (IPV):
a. Definition: an intentional act by the
				recipient or child care provider to misrepresent or mislead by providing false
				documentation or verification or intentionally omitting documentation or
				verification in an effort to wrongfully obtain eligibility for services or
				payment, which MDHS must prove by clear and convincing evidence at a
				Programmatic Administrative Disqualification Hearing. MDHS Programmatic
				Administrative Disqualification Hearing Policy is incorporated herein by
				reference (See Part 23, Chapter 2 (Definitions) and Chapter 5 (Programmatic
				Disqualification Actions) of the Administrative Hearings for MDHS Subgrant
				Manual).
b. Examples of an IPV
				include, but are not limited to:
i.
				Intentionally over-claiming payment for child care services rendered;
ii. Claiming payment for a child who no
				longer attends the child care facility;
iii. Failing to maintain sign-in/sign-out
				sheets, forging sign-in/sign-out sheets;
iv. Forging change-of-provider
				forms;
v. Forging
				signatures;
vi. Failing to charge
				co-payments;
vii. Having multiple
				certificates for the same child; or
viii. Providing manipulated, falsified or
				false documents to establish eligibility.
c. Findings: may be made by DECCD staff, the
				MDHS Office of Inspector General, by a court of competent jurisdiction, or by
				the execution of a waiver.
d.
				Penalties for Providers:
A child care provider or individual working in or for the
				  child care provider who is found to have committed an IPV shall be responsible
				  for repayment or recoupment of the improper payment amount and be ineligible to
				  participate in the program as follows:
i. First Offense: If the amount to be
				recovered is between $1,000-$9,999.99, the program/provider will be prevented
				from adding any new certificate children until the amount is repaid in full. If
				the amount to be recovered is between $10,000-$99,999.99, the program/provider
				will be suspended from CCPP participation for six months. If the amount to be
				recovered is $100,000 or more, MDHS reserves the right to permanently terminate
				a program/provider from the CCPP.
ii. Second Offense: Any amount to be
				recovered up to $10,000 will result in program/provider suspension from CCPP
				for 1 (one) year. If the amount is over $10,000 the program/provider will be
				permanently terminated from the CCPP.
iii. Third Offense: The program/provider will
				be permanently terminated from participation in the CCPP.
When an IPV is committed by an individual acting alone or in
				  concert with others for any offense and that individual or individuals are
				  permanently terminated from the CCPP, that individual or individuals shall not
				  hold an administrative position including an owner/operator, director, or
				  director designee as defined by MSDH in a facility or home in which CCPP
				  subsidies are received. Additionally, the individual or individuals shall not
				  hold a position responsible for the recording or tracking of enrollment and
				  attendance or for the completing and reporting of family/child status and/or
				  enrollment and attendance. If the individual is an owner/operator that owns or
				  operates multiple sites and is terminated from the CCPP, all sites will be
				  terminated as well.
If a child care provider is permanently terminated from the
				  CCPP, DECCD will assist CCPP certificate holders in finding an alternative
				  child care provider, unless the parent(s) chooses to keep the child(ren) at the
				  program/provider and forfeit CCPP funding.
e. Penalties for Recipients:
If the IPV is due to the actions of a recipient, MDHS shall
				  enter into a repayment agreement to recover the disputed funds from the
				  recipient or recoup them from the child care provider depending on the
				  circumstances. If MDHS finds that the documents that were used to establish
				  eligibility were false, falsified, or manipulated and all components of
				  eligibility cannot otherwise be verified, MDHS shall terminate the certificate
				  due to lack of eligibility having ever been established, and recoup the
				  improper payment from the program/provider or enter a repayment agreement with
				  the parent.
A recipient who is found to have committed an IPV shall be
				  responsible for repayment or recoupment of the improper payment amount and/or
				  be ineligible to participate in the program as follows:
i. First Offense: allowed to retain the
				certificate if eligibility can be established by valid documentation ii.Second
				Offense: 1-year probation
iii.
				Third Offense: Permanently terminated from participation in the CCPP. If a
				certificate is terminated due to wrongful action by a recipient with no
				evidence of wrongful action by the provider, MDHS will give the provider a two
				week notice of the termination.