Rule 18-17-9.10 - Improper PaymentImproper 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;vi. Failing to charge co-payments;vii. Having multiple certificates for the same child; orviii. 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 probationiii. 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.18 Miss. Code. R. 17-9.10
45 CFR 98.100(d); Miss. Code Ann. § 43-1-2(4); Miss. Code Ann. § 43-1-4 Revised: May 2023