(A)      What is a provider improper child care payment?

Improper child care payments made to a provider are payments to which the provider was not entitled. These are as a result of:

(1)      An error on the part of the provider.

(2)      An error by the county agency or the Ohio department of job and family services (ODJFS).

(B)      What is misuse of publicly funded child care or Ohio electronic child care (Ohio ECC) by a provider?

Misuse includes, but is not limited to, a provider:

(1)      Possessing or using an Ohio ECC card issued to a caretaker.

(2)      Falsifying attendance records.

(3)      Knowingly seeking and/or accepting payment for care not provided or for which the provider was not eligible, including care at an unlicensed location.

(4)      Knowingly seeking and/or accepting payment for child care provided to a child that resides in the provider's own home.

(C)     What are the repayment procedures for a provider improper child care payment or an overpayment related to misuse of Ohio ECC?

(1)      If the improper payment is the the result of a county data error, the county agency shall:

(a)      Calculate child care overpayments resulting in an improper payment.

(b)      Send a provider with a current provider agreement a notice of the determined overpayment using the JFS 01172 "County Agency Notice of Child Care Improper Payment and Repayment Requirements for Child Care Providers" (rev. 4/2015).

(c)      Complete the payment adjustment process for providers with a current provider agreement and refer all cases in which the provider does not have a current provider agreement to ODJFS.

(d)      Propose revocation of an in-home aide certification if the in-home aide fails to repay an overpayment.

(2)      If the overpayment is a result of all other improper payments or misuse of Ohio ECC:

(a)      ODJFS may recoup one hundred per cent of the overpayment via payment adjustments, if the provider is currently receiving payment.

(b)      An invoice will be issued if the provider is not currently receiving payments or for overpayments unable to be recouped through the adjustment process. The full amount due shall be submitted to ODJFS within thirty calendar days from the mailing date of the invoice.

(c)      After thirty calendar days any remaining balance will be certified to the office of the attorney general for collection.

(D)     Can a child care provider request a review of an identified overpayment?

A child care provider may request in writing to ODJFS that a reconsideration review be conducted for any identified overpayment that is subject to recoupment.

(1)      A child care provider may request in writing to ODJFS that a reconsideration review be conducted for any identified overpayment that is subject to recoupment.

(2)      The written request must be received by ODJFS no later than fifteen days after the date the provider receives the overpayment notice.

(E)      What is provider fraud?

Provider fraud is the willful withholding or falsification of information by the provider with an intent to deceive or defraud, resulting in the acceptance of or the receipt of payment for which the provider was not entitled, as determined by a court of law or the provider's admission.

(1)      Provider fraud is the willful withholding or falsification of information by the provider with an intent to deceive or defraud, resulting in the acceptance of or the receipt of payment for which the provider was not entitled, as determined by a court of law or the provider's admission.

(1)(2)  The county agency shall recommend to ODJFS the termination of the provider agreement if a provider has admitted or pleaded guilty to committing fraud or has been convicted of fraud, as determined by a court of law.

(2)      If a certified in-home aide has admitted or pleaded guilty to committing fraud or has been convicted of fraud, as determined by a court of law, the county agency shall propose revocation of the certificate according to rule 5101:2-14-35 of the Administrative Code.

Effective: 07/09/2017

Five Year Review (FYR) Dates: 08/01/2020

Certification: CERTIFIED ELECTRONICALLY

Date: 06/05/2017

Promulgated Under: 119.03

Statutory Authority: 5104.38

Rule Amplifies: 5104.32, 5104.37, 5104.38

Prior Effective Dates: 6/3/96, 10/1/97 (Emer.), 12/30/97, 1/1/02, 2/1/07, 7/1/08, 3/28/10, 8/28/11, 5/4/14, 8/10/15