REFERRALS, REFERRALS, REFERRALS 1. Child Care Referrals 2

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Transcript of REFERRALS, REFERRALS, REFERRALS 1. Child Care Referrals 2

Referral Backlog vs Working on it.

REFERRALS, REFERRALS, REFERRALS

1The Division of Child Development and Early Education is aware that there are referrals that have not been addressed or reviewed and this is something that has to be changed. 1Child Care Referrals

2In fact the first statement in the Subsidized Child Care Policy states: Both the State and the local purchasing agencies (LPA) have a responsibility to assure proper administration of state and federal funds that pay for child care services for children and to take steps to prevent and deter fraudulent misrepresentationEach LPA determines whether fraud has occurred and designates staff to handle fraud cases. All instances of fraud must be investigated by the LPA. Pursuing Child Care Fraud Referrals is required by the DCDEE. The Division of Child Development and Early Education (DCDEE) must be notified by the LPA of any investigations initiated for suspected fraud or misuse of subsidy funds. See Handout (Subsidized Child Care Provider or Recipient Fraud/ Sanction Report) A running document that will need to be updated as the case progresses. Please refer to the email sent out 4-16-15. Each update must be sent to DCDEE adding up to three submissions. When client information is included in email, please remember to use Zixmail to make sure that the information is protected. 2Financial Assistance Available 2% of Child Care Subsidy Funds can be allocated for Fraud Detection and Investigation initiatives

3This information can be found in Administrative Letter 05-13. 3

FOOD AND NUTRITION SERVICESWORK FIRSTCHILD CARE SUBSIDYMEDICAIDConnectivity Among Services4Best practice is to review all programs that a customer is participating when a report is received. Multiple programs could be inter-related with child care. An example would be: A customer receives a child care credit on her Food and Nutrition application. Is the amount correct? Did it change? Or was the customer totally ineligible for the deduction? Staff would need to determine if it is a true fraud situation or an agency error. Having to touch a case one time versus multiple times is time and cost efficient. 4

PrioritizeActive Casevs Inactive Case

5Where to start? First you need to review and separate the referrals between active and inactive cases. The active cases will be your priority since they are still receiving assistance and the ongoing eligibility corrected immediately. The second step would be to go back to the month that the referral states is the point of potential fraud and recalculate the household income and update the household composition if necessary. For your inactive cases a good tool would be to make a note in the system that there is a potential fraud case and that it must be addressed if the client reapplies. In the era of the paper case records, we would have a printout of a stop sign attached to the inside cover stating that there was either a Investigative Referral, that the client was sanctioned or even a note about noncooperation.5

Scenario

6Being proactive rather than reactive will save your county money. Let's look at a child care situation. Here is a family that applied, the mother stated the father moved out and she is unaware of his whereabouts and is not receiving any support for the children. An anonymous tip is received by your agency stating that the father is in the home, works at a major employer in the area and the family should not be eligible for assistance. If the staff acts on this right away, substantiates the allegation and has the child care staff correct the ongoing case, the amount saved by the county can be amazing. Here is a case scenario. There were 4 children in the household, two of them are infants at a cost of $600 per month, a three year old at a cost of $450 and a 5 year preschooler at a cost of $400. The original parent fee assessed to the family based on the mothers reported income is $150 per month. 6

Infant #1 $600.00Infant #2 $600.00Three Year Old $450.00Five Year Old $400.00Parent Fee - $150.00Total Monthly Amount $1900.00Child Care Assistance Received

7Your agency is paying out a total of $1900 per month for this family. 7

1 Month$1900.002 Months$1900.003 Months$1900.004 Months$1900.005 Months$1900.006 Months$1900.00

Total Paid while not Processed $11,400.00Referral Not Processed

8If this referral is set aside for 6 months, the amount that was spent on this family is $11,400. Now remember it was determined that based on the combination of the mothers and fathers income the household was not eligible to receive child care assistance.8

Subsidy Services Unit Staff For Fraud Consultation Kim Miller, Program ManagerMichele Bessette, ConsultantBelinda Thomas, Consultant dcdee.subsidy.fraud@dhhs.nc.gov

9At DCDEE we are currently working on realigning our Program Integrity practices that will be combining Regulatory and Subsidy staff to handle all Provider Fraud and Non Compliance. The Sanctioning of providers will also be a DCDEE responsibility. All counties will be notified of provider sanctions as they occur. The counties will still be responsible for all client fraud and Sanctions. All instances of fraud are required to be reported to DCDEE for tracking purposes. DCDEE staff will be available for assistance as needed. 9COMMENTS AND QUESTIONSThank you for attending this presentation today

10Open question and answer period for all programs,10