Child Care Bureau: Improper Payments: State Survey Analysis Report: Appendix 14

State Survey Analysis Report

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APPENDIX 14. ACTIVITIES PERFORMED AND CONSIDERED MOST EFFECTIVE TO VERIFY ACCURACY OF INFORMATION

14. For each activity listed below, indicate whether or not your State performs it to verify the accuracy of information needed to determine eligibility for and/or proper amount of a program payment. If yes, indicate, when in the process the step or activity is performed, and how often it is performed. (States were also asked to indicate the 3 steps or activities considered the most effective.)

State	Steps or activities performed	What stage in the process	Frequency	Effective
25 State agencies responded to Question 14 (Appendix 14: pp. 77–86)
Alabama	a. Require documentation from client	Pre-approval	Depends on client activity	X
	e. Conduct telephone, fax, or e-mail contacts	Pre-approval & continuing	As needed
	g. Initiate a fraud investigation if warranted	When investigation is warranted	Investigation continued until answers are determined
	h. Conduct program integrity/quality control review	Program monitor conducts yearly sample monitoring	Yearly
Arizona	a. Require documentation from client	Approval, redetermination, whenever a change in the client’s circumstance changes	At least every 6 months
	c. Access online database	Approval, redetermination, whenever a change in the client’s circumstance changes	At least every 6 months	X
	d. Match automated computer files	Approval, redetermination, whenever a change in the client’s circumstance changes	At least every 6 months	X
	e. Conduct telephone, fax, or e-mail contacts	Approval, redetermination, whenever a change in the client’s circumstance changes	At least every 6 months	X
	f. Conduct home visits	Not conducted on clients. Conducted at initial certification and regularly throughout the year. Conducted only for Certified Home Providers (caring for 4 or less children for compensation), as the Arizona Department of Health Services regulates other providers such as Licensed Centers, and Group Homes. Relative providers are not regulated, so therefore are not subject to home visits.	At least 2 times per year
	g. Initiate a fraud investigation if warranted	At any point in the process if fraud is suspected.	As needed
	i. Supervisor Case Reviews	On child care initial and review cases.	At least 12 per Child Care Specialist per year.
California (DE)	a. Require documentation from client	Initially, and at re-determination.	Annually or more often, if appropriate	X
	g. Initiate a fraud investigation if warranted	Refer to local fraud investigators
	h. Conduct program integrity/quality control review			X
	i. Other	Require documentation of attendance in care	Every day child attends	X
California (DSS)	a. Require documentation from client	Pre-approval and at redetermination at 3 months	Quarterly	X
	b. Fingerprint clients	Pre-approval and re-determination	At intake	X
	c. Access online database	Pre-approval/approval/re-determination	Daily
	d. Match automated computer files	Pre-approval/approval/re-determination	Monthly/quarterly	X
	e. Conduct telephone, fax, or e-mail contacts	Pre-approval/approval/re-determination	As needed
	f. Conduct home visits	Varies from county to county	As needed
	g. Initiate a fraud investigation if warranted	Pre-approval/ongoing fraud	As needed
	h. Conduct program integrity/quality control review	CDSS conducts reviews of local agencies as a whole. Additionally, counties may conduct QC reviews a their option.	Large counties – 1 per year Medium counties- every other year Small counties- every 3 years
Connecticut	a. Require documentation from client	Application, redetermination and interim changes	6 month review cycles	X
	c. Access online database	Application, redetermination	6 months	X
	d. Match automated computer files	Regular intervals and Variable	Variable
	e. Conduct telephone, fax, or e-mail contacts	Application, redetermination and interim changes	Daily
	f. Conduct home visits	Fraud Investigations (1/1/06 FRED implementation)	On request	X
	g. Initiate a fraud investigation if warranted	Ongoing referral protocols	Daily
	h. Conduct program integrity/quality control review	DSS – Quarterly Program – ongoing internal QC
District of Columbia	a. Require documentation from client			X
	d. Match automated computer files			X
	e. Conduct telephone, fax, or e-mail contacts			X
	g. Initiate a fraud investigation if warranted
	h. Conduct program integrity/quality control review
	i. Submit Child Care Provider’s attendance reports
Georgia	a. Require documentation from client	Approval/6 month review/redetermination at 12 months.	6 &12 month	X
	c. Access online database	6 month review/ 12 month redetermination	6 &12 month	X
	d. Match automated computer files	Upon specific purpose/request
	e. Conduct telephone, fax, or e-mail contacts	Approval/changes in case	6 &12 month
	g. Initiate a fraud investigation if warranted	As needed
	h. Conduct program integrity/quality control review	6 Month Review; monthly accuracy review (by sample)	6 month	X
Kansas	a. Require documentation from client	pre-approval redetermination	yearly	X
	c. Access online database	pre-approval redetermination	yearly	X
	d. Match automated computer files	on-going	if applies for other benefits	X
	g. Initiate a fraud investigation if warranted	when fraud is suspected	as needed
	h. Conduct program integrity/quality control review	randomly selected	random
Kentucky	a. Require documentation from client	Initial interview redetermination as needed		X
	e. Conduct telephone, fax, or e-mail contacts		As needed
	f. Conduct home visits	12 months, as needed for STARS	License renewal
	g. Initiate a fraud investigation if warranted		As needed	X
	h. Conduct program integrity/quality control review	Varied	Yearly	X
Maryland	a. Require documentation from client	Application and reconsideration	At least once every 12 months	X
	c. Access online database	Application and reconsideration	At least once every 12 months	X
	e. Conduct telephone, fax, or e-mail contacts		As needed
	g. Initiate a fraud investigation if warranted		As needed
	h. Conduct program integrity/quality control review	Can occur at any stage	At least once yearly by the agency	X
Massachusetts	a. Require documentation from client	Pre-approval/ redetermination every 6 mos.	Every 6 mos.	X
	c. Access online database	Approval
	e. Conduct telephone, fax, or e-mail contacts
	f. Conduct home visits	Approval and after	Periodically
	g. Initiate a fraud investigation if warranted	As applicable	As needed
	h. Conduct program integrity/quality control review	Desk reviews annually/internal control questionnaire post-approval	Updated yearly	X
	i. On-site monitoring visits to providers	Post-approval	Within three years or as needed	X
Minnesota	a. Require documentation from client	Initial approval, redetermination at 6 mos, and when the family reports a change	At least 6 months, could be more often	X
	c. Access online database	During fraud investigation
	d. Match automated computer files	If fraud referral is made
	e. Conduct telephone, fax, or e-mail contacts	County agencies may need to contact client or provider	When necessary
	g. Initiate a fraud investigation if warranted	CCA worker makes a referral to the fraud investigator	When necessary	X
	h. Conduct program integrity/quality control review	Under development, will be applied at regular intervals of case management review		X
Mississippi	a. Require documentation from client	Pre-approval & Redetermination	Every 6 months	X
	d. Match automated computer files	Approval	Monthly
	e. Conduct telephone, fax, or e-mail contacts	Approval & Redeter. at 6 months	Daily	X
	g. Initiate a fraud investigation if warranted	Approval & Redeter. at 6 months	Annually
	h. Conduct program integrity/quality control review	Approval & Redeter. at 6 months	Quarterly	X
Missouri	a. Require documentation from client	Approval, Re-determination	At least annually	X
	b. Fingerprint clients	Approval (Providers only)	One time and name checks on an annual basis thereafter
	c. Access online database	Approval, Re-determination	At least annually
	d. Match automated computer files	Approval, Re-determination	At least annually	X
	e. Conduct telephone, fax, or e-mail contacts	Approval, Re-determination	Whenever the situation warrants
	g. Initiate a fraud investigation if warranted	As needed	As needed	X
Montana	a. Require documentation from client	Application & re-certification	Min. Every 6 months	X
	c. Access online database	Application	1x/year
	g. Initiate a fraud investigation if warranted
	h. Conduct program integrity/quality control review	Recertification	Min. Every 6 months	X
	i. Parents required to turn in Work Verification Forms, School Schedules, and any other documentation that can be used to determine the need for child care	Recertification (During the recertification process, the parent is requested to review an Explanation of Benefits from the previous month and sign it if they agree with the billing of the provider.)	Min. Every 6 months	X
Nebraska	a. Require documentation from client	Pre approval & redetermination	At least 12 months, sometimes more frequently	X
	c. Access online database	Pre approval & redetermination
	d. Match automated computer files	Pre approval & redetermination		X
	e. Conduct telephone, fax, or e-mail contacts	Pre approval & redetermination		X
	g. Initiate a fraud investigation if warranted	When potential fraud is identified
	i. Annual audit conducted by State Auditor		Annually
New Hampshire	a. Require documentation from client	Six and 12 month determination and re-determination visits
	g. Initiate a fraud investigation if warranted	At any stage, if referred
	h. Conduct program integrity/quality control review	Once per 2 year Local Agency Agreement period (Contract Centers)
North Carolina	a. Require documentation from client	Pre-approval/approval; redetermination; periodic reviews		X
	c. Access online database	Varies by county or local purchasing agency	Varies by county or local purchasing agency	X
	d. Match automated computer files	Varies by county or local purchasing agency	Varies by county or local purchasing agency
	e. Conduct telephone, fax, or e-mail contacts	Varies by county or local purchasing agency	Varies by county or local purchasing agency
	f. Conduct home visits	When fraud is suspected	When fraud is suspected
	g. Initiate a fraud investigation if warranted	When fraud is suspected by LPA staff	When fraud is suspected by LPA staff
	h. Conduct program integrity/quality control review	Varies by county or local purchasing agency	Varies by county or local purchasing agency	X
Ohio	a. Require documentation from client	pre-approval & redetermination	Every 12 mos.
	e. Conduct telephone, fax, or e-mail contacts	pre-approval, redetermination, & when conflicting information is received
	f. Conduct home visits	when conflicting information is received
	g. Initiate a fraud investigation if warranted	when conflicting information is received		X
Oklahoma	a. Require documentation from client	Approval, redetermination & change reporting.	6 mo. & 12 mo.	X
	c. Access online database	Approval, redetermination & change reporting		X
	d. Match automated computer files	Approval, redetermination & change reporting
	g. Initiate a fraud investigation if warranted	Upon referral		X
Puerto Rico	a. Require documentation from client	Pre-approval	3 times a year
	c. Access online database
	d. Match automated computer files
	f. Conduct home visits
	g. Initiate a fraud investigation if warranted
Utah	a. Require documentation from client	Pre-payment and post-payment	Every 3 months	X
	c. Access online database	Pre-payment and post-payment	Every 3 months	X
	d. Match automated computer files	Pre-payment and post-payment	Every 3 months
	e. Conduct telephone, fax, or e-mail contacts	Pre-payment and post-payment	Every 3 months
	f. Conduct home visits	When warranted	When warranted
	g. Initiate a fraud investigation if warranted	When warranted	When warranted	X
	h. Conduct program integrity/quality control review	Post-payment	6months to a year
Washington	a. Require documentation from client	Approval and Reapproval	Re-applications are due every 3 or 6 months	X
	c. Access online database	Approval and Reapproval	Re-applications are due every 3 or 6 months	X
	d. Match automated computer files	Approval and Reapproval	Re-applications are due every 3 or 6 months
	e. Conduct telephone, fax, or e-mail contacts	Approval and Reapproval	Re-applications are due every 3 or 6 months
	g. Initiate a fraud investigation if warranted	At any time
	h. Conduct program integrity/quality control review	At any time		X
West Virginia	a. Require documentation from client	Pre-approval at 6 mos redetermination, and for any change in the case	Pre-approval at 6 mos redetermination, and for any change in the case	X
	e. Conduct telephone, fax, or e-mail contacts	Pre-approval at 6 mos redetermination, and for any change in the case	Pre-approval at 6 mos redetermination, and for any change in the case	X
	g. Initiate a fraud investigation if warranted	At any point in the case, when warranted	At any point in the case, when warranted
	h. Conduct program integrity/quality control review	Monthly, at both the State and local level	Monthly, at both the State and local level	X
Wisconsin	a. Require documentation from client	Application/prior to approval, 12 month review, 6 month mail in report	Application/prior to approval, 12 month review, 6 month mail in report	X
	c. Access online database	Application, 12 month review, on request	Quarterly and On Request	X
	d. Match automated computer files	Established cases in batch	Weekly, monthly, bi-monthly, quarterly, and annually	X
	e. Conduct telephone, fax, or e-mail contacts	As needed.
	g. Initiate a fraud investigation if warranted	As needed.
	h. Conduct program integrity/quality control review	As needed.

Appendix 15 >>

State Survey Analysis Report

APPENDIX 14. ACTIVITIES PERFORMED AND CONSIDERED MOST EFFECTIVE TO VERIFY ACCURACY OF INFORMATION

25 State agencies responded to Question 14 (Appendix 14: pp. 77–86)