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.)
25 State agencies responded to Question 14 (Appendix 14: pp. 77–86) |
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State | Steps or activities performed | What stage in the process | Frequency | Effective |
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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 |
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g. Initiate a fraud investigation if warranted | When investigation is warranted | Investigation continued until answers are determined |
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h. Conduct program integrity/quality control review | Program monitor conducts yearly sample monitoring | Yearly |
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Arizona | a. Require documentation from client | Approval, redetermination, whenever a change in the client’s circumstance changes | At least every 6 months |
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c. Access online database | Approval, redetermination, whenever a change in the client’s circumstance changes | At least every 6 months | X |
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d. Match automated computer files | Approval, redetermination, whenever a change in the client’s circumstance changes | At least every 6 months | X |
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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 |
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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 |
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g. Initiate a fraud investigation if warranted | At any point in the process if fraud is suspected. | As needed |
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i. Supervisor Case Reviews | On child care initial and review cases. | At least 12 per Child Care Specialist per year. |
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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 |
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h. Conduct program integrity/quality control review | X |
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i. Other | Require documentation of attendance in care | Every day child attends | X |
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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 |
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c. Access online database | Pre-approval/approval/re-determination | Daily |
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d. Match automated computer files | Pre-approval/approval/re-determination | Monthly/quarterly | X |
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e. Conduct telephone, fax, or e-mail contacts | Pre-approval/approval/re-determination | As needed |
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f. Conduct home visits | Varies from county to county | As needed |
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g. Initiate a fraud investigation if warranted | Pre-approval/ongoing fraud | As needed |
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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 |
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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 |
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d. Match automated computer files | Regular intervals and Variable | Variable |
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e. Conduct telephone, fax, or e-mail contacts | Application, redetermination and interim changes | Daily |
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f. Conduct home visits | Fraud Investigations (1/1/06 FRED implementation) | On request | X |
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g. Initiate a fraud investigation if warranted | Ongoing referral protocols | Daily |
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h. Conduct program integrity/quality control review | DSS – Quarterly Program – ongoing internal QC |
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District of Columbia | a. Require documentation from client | X |
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d. Match automated computer files | X |
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e. Conduct telephone, fax, or e-mail contacts | X |
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g. Initiate a fraud investigation if warranted |
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h. Conduct program integrity/quality control review |
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i. Submit Child Care Provider’s attendance reports |
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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 |
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d. Match automated computer files | Upon specific purpose/request |
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e. Conduct telephone, fax, or e-mail contacts | Approval/changes in case | 6 &12 month |
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g. Initiate a fraud investigation if warranted | As needed |
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h. Conduct program integrity/quality control review | 6 Month Review; monthly accuracy review (by sample) | 6 month | X |
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Kansas | a. Require documentation from client | pre-approval redetermination | yearly | X |
c. Access online database | pre-approval redetermination | yearly | X |
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d. Match automated computer files | on-going | if applies for other benefits | X |
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g. Initiate a fraud investigation if warranted | when fraud is suspected | as needed |
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h. Conduct program integrity/quality control review | randomly selected | random |
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Kentucky | a. Require documentation from client | Initial interview redetermination as needed | X |
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e. Conduct telephone, fax, or e-mail contacts | As needed |
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f. Conduct home visits | 12 months, as needed for STARS | License renewal |
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g. Initiate a fraud investigation if warranted | As needed | X |
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h. Conduct program integrity/quality control review | Varied | Yearly | X |
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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 |
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e. Conduct telephone, fax, or e-mail contacts | As needed |
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g. Initiate a fraud investigation if warranted | As needed |
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h. Conduct program integrity/quality control review | Can occur at any stage | At least once yearly by the agency | X |
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Massachusetts | a. Require documentation from client | Pre-approval/ redetermination every 6 mos. | Every 6 mos. | X |
c. Access online database | Approval |
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e. Conduct telephone, fax, or e-mail contacts |
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f. Conduct home visits | Approval and after | Periodically |
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g. Initiate a fraud investigation if warranted | As applicable | As needed |
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h. Conduct program integrity/quality control review | Desk reviews annually/internal control questionnaire post-approval | Updated yearly | X |
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i. On-site monitoring visits to providers | Post-approval | Within three years or as needed | X |
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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 |
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d. Match automated computer files | If fraud referral is made |
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e. Conduct telephone, fax, or e-mail contacts | County agencies may need to contact client or provider | When necessary |
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g. Initiate a fraud investigation if warranted | CCA worker makes a referral to the fraud investigator | When necessary | X |
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h. Conduct program integrity/quality control review | Under development, will be applied at regular intervals of case management review | X |
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Mississippi | a. Require documentation from client | Pre-approval & Redetermination | Every 6 months | X |
d. Match automated computer files | Approval | Monthly |
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e. Conduct telephone, fax, or e-mail contacts | Approval & Redeter. at 6 months | Daily | X |
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g. Initiate a fraud investigation if warranted | Approval & Redeter. at 6 months | Annually |
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h. Conduct program integrity/quality control review | Approval & Redeter. at 6 months | Quarterly | X |
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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 |
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c. Access online database | Approval, Re-determination | At least annually |
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d. Match automated computer files | Approval, Re-determination | At least annually | X |
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e. Conduct telephone, fax, or e-mail contacts | Approval, Re-determination | Whenever the situation warrants |
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g. Initiate a fraud investigation if warranted | As needed | As needed | X |
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Montana | a. Require documentation from client | Application & re-certification | Min. Every 6 months | X |
c. Access online database | Application | 1x/year |
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g. Initiate a fraud investigation if warranted |
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h. Conduct program integrity/quality control review | Recertification | Min. Every 6 months | X |
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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 |
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Nebraska | a. Require documentation from client | Pre approval & redetermination | At least 12 months, sometimes more frequently | X |
c. Access online database | Pre approval & redetermination |
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d. Match automated computer files | Pre approval & redetermination | X |
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e. Conduct telephone, fax, or e-mail contacts | Pre approval & redetermination | X |
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g. Initiate a fraud investigation if warranted | When potential fraud is identified |
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i. Annual audit conducted by State Auditor | Annually |
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New Hampshire | a. Require documentation from client | Six and 12 month determination and re-determination visits |
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g. Initiate a fraud investigation if warranted | At any stage, if referred |
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h. Conduct program integrity/quality control review | Once per 2 year Local Agency Agreement period (Contract Centers) |
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North Carolina | a. Require documentation from client | Pre-approval/approval; redetermination; periodic reviews | X |
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c. Access online database | Varies by county or local purchasing agency | Varies by county or local purchasing agency | X |
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d. Match automated computer files | Varies by county or local purchasing agency | Varies by county or local purchasing agency |
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e. Conduct telephone, fax, or e-mail contacts | Varies by county or local purchasing agency | Varies by county or local purchasing agency |
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f. Conduct home visits | When fraud is suspected | When fraud is suspected |
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g. Initiate a fraud investigation if warranted | When fraud is suspected by LPA staff | When fraud is suspected by LPA staff |
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h. Conduct program integrity/quality control review | Varies by county or local purchasing agency | Varies by county or local purchasing agency | X |
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Ohio | a. Require documentation from client | pre-approval & redetermination | Every 12 mos. |
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e. Conduct telephone, fax, or e-mail contacts | pre-approval, redetermination, & when conflicting information is received |
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f. Conduct home visits | when conflicting information is received |
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g. Initiate a fraud investigation if warranted | when conflicting information is received | X |
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Oklahoma | a. Require documentation from client | Approval, redetermination & change reporting. | 6 mo. & 12 mo. | X |
c. Access online database | Approval, redetermination & change reporting | X |
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d. Match automated computer files | Approval, redetermination & change reporting |
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g. Initiate a fraud investigation if warranted | Upon referral | X |
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Puerto Rico | a. Require documentation from client | Pre-approval | 3 times a year |
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c. Access online database |
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d. Match automated computer files |
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f. Conduct home visits |
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g. Initiate a fraud investigation if warranted |
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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 |
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d. Match automated computer files | Pre-payment and post-payment | Every 3 months |
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e. Conduct telephone, fax, or e-mail contacts | Pre-payment and post-payment | Every 3 months |
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f. Conduct home visits | When warranted | When warranted |
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g. Initiate a fraud investigation if warranted | When warranted | When warranted | X |
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h. Conduct program integrity/quality control review | Post-payment | 6months to a year |
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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 |
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d. Match automated computer files | Approval and Reapproval | Re-applications are due every 3 or 6 months |
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e. Conduct telephone, fax, or e-mail contacts | Approval and Reapproval | Re-applications are due every 3 or 6 months |
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g. Initiate a fraud investigation if warranted | At any time |
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h. Conduct program integrity/quality control review | At any time | X |
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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 |
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g. Initiate a fraud investigation if warranted | At any point in the case, when warranted | At any point in the case, when warranted |
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h. Conduct program integrity/quality control review | Monthly, at both the State and local level | Monthly, at both the State and local level | X |
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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 |
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d. Match automated computer files | Established cases in batch | Weekly, monthly, bi-monthly, quarterly, and annually | X |
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e. Conduct telephone, fax, or e-mail contacts | As needed. |
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g. Initiate a fraud investigation if warranted | As needed. |
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h. Conduct program integrity/quality control review | As needed. |
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Appendix 15 >>