Florida Administrative Code
6 - DEPARTMENT OF EDUCATION
6M - Division of Early Learning
Chapter 6M-9 - Division of Early Learning - Early Learning Coalitions
Section 6M-9.400 - Early Learning Coalitition Anti-Fraud Plans
Universal Citation: FL Admin Code R 6M-9.400
Current through Reg. 50, No. 187; September 24, 2024
(1) Definitions. As used in this rule:
(a) "Recipient" is the parent or legal
guardian whose child was determined eligible for School Readiness or Voluntary
Prekindergarten Education Program benefits.
(b) "Fraud" is an intentional deception,
omission, or misrepresentation made by a person with knowledge that the
deception, omission, or misrepresentation may result in unauthorized benefit to
that person or another person, or any aiding and abetting of the commission of
such an act. The term includes any act that constitutes fraud under applicable
federal or state law.
(2) Anti-fraud plan approval. Each early learning coalition (coalition) shall adopt an anti-fraud plan addressing the detection and prevention of overpayments, abuse, and fraud relating to the provision of and payment for School Readiness program and Voluntary Prekindergarten Education Program services and submit the plan to the office for approval. The anti-fraud plan must be approved by the coalition board prior to submission to the Office of Early Learning. The plan must be sent to the Office of Early Learning's Office of Inspector General no later than June 30 of each year. Submission may be electronic or through the mail. The Office of Early Learning will process the plan no later than September 1 of each year and shall notify the coalition in writing of approval or disapproval and the reasons for disapproval. If disapproved, a corrected plan shall be submitted no later than November 1 of each year.
(3) Criteria for approval of anti-fraud plan. Each coalition's anti-fraud plan shall include:
(a) A description or chart outlining the
organizational structure of the plan's personnel who are responsible for the
investigation and reporting of possible overpayment, abuse, or fraud. This
shall include the name and contact information of the primary coalition
position responsible for implementing the early learning coalition's anti-fraud
activities.
(b) A description of
the plan's procedures for detecting and investigating possible acts of fraud,
abuse, or overpayment. This shall include a review of data quality reports
generated from the Office of Early Learning, documented verification of child
care referrals from other organizations, a process for electronic monthly
reporting to the Office of Early Learning the recipients and providers
terminated for fraud, and a description of any fraud hotlines in place and how
this information is shared with parents, providers, employees and the
public.
(c) A description of the
plan's procedures for the mandatory reporting of possible abuse or fraud,
including the possible overpayment associated with the abuse or fraud, to the
Office of Early Learning's Office of Inspector General. This shall include the
name and contact information of the coalition position serving as the coalition
administrator for the Office of Early Learning Fraud Referral System.
(d) A description of the plan's program and
procedures for education and training personnel on how to detect and prevent
fraud, abuse, and overpayment including an annual self-assessment of the
coalition's internal controls, policies and procedures.
(e) A description of the plan's procedures,
including the appropriate due process provisions for suspending or terminating
from the School Readiness program or the Voluntary Prekindergarten Education
Program a recipient who the coalition concludes has committed fraud. Due
process provisions must include all elements set forth in subsection (4),
below.
(4) Due process requirements for recipients. The early learning coalition anti-fraud plan shall include the following elements establishing due process:
(a) A clear policy of the right of the
recipient to appeal suspension or termination of benefits based on information
that leads the coalition to conclude that School Readiness or Voluntary
Prekindergarten Education program benefits have been obtained or used
fraudulently.
(b) The coalition
shall provide written advance notice of the intended action to suspend or
terminate benefits to the recipient to be affected and it must clearly advise
of the allegations, the basis of the allegations, the intended action and the
date the action is to be imposed. The coalition shall send the written advance
notice at least fourteen (14) calendar days before the intended action. The
written advance notice should be translated into the recipient's native
language if the coalition's other communications with the recipient have been
translated. The written advance notice shall include following:
1. The procedure for the recipient to follow
to attempt to appeal the decision.
2. A statement, in bold print, that the
failure to file a timely appeal waives the right to an appeal.
3. Notice of the potential for repayment of
improper benefits if the conclusion of fraud is upheld, including any benefits
received after the receipt of the written advance notice.
4. The procedure for the recipient to obtain
a copy of his or her file.
5. The
amount of overpayment to be recovered, if applicable.
6. The length of time for which the
recipient's benefits are suspended or the date of the termination of benefits,
if applicable. This length of time shall be proportionate to the alleged
offense committed, consistent with suspensions or terminations issued to other
recipients who allegedly committed comparable offenses, and may also consider
prior offenses, as appropriate.
(c) A suspension or termination shall not be
applied against recipients with a valid at-risk referral.
(d) If the recipient believes that the
conclusion of fraud was made in error, the recipient should first seek to
resolve the matter by contacting the coalition and providing the necessary
documentation to resolve the issue. The executive director of the coalition
shall not be involved in the pre-appeal resolution of the issue.
(e) If the recipient believes that the issue
was not resolved by the coalition, the recipient may file a formal written
appeal for review by the executive director of the coalition, using the
following procedure:
1. Submit a written
appeal to the executive director or other executive staff person as designated
by the coalition board. The appeal must fully describe the nature of the error
the recipient believes has been made and shall contain any documentation which
supports the recipient's claim.
2.
The appeal shall be postmarked or emailed before the date of the intended
action. The recipient who fails to file a timely appeal waives the right of
appeal.
3. If the recipient files a
timely appeal, he or she will not be suspended or terminated from the program
until the written decision of the executive director or the original date of
the intended action, whichever is later.
4. The executive director of the coalition or
other executive staff person designated by the coalition board must respond to
the recipient, in writing, within thirty (30) days of receiving the appeal with
a decision as to whether the suspension or termination will be upheld or
modified.
5. The recipient who
wishes to appeal the decision of the executive director of the coalition or
other executive staff person designated by the coalition board may request
further review by an appeals committee in accordance with paragraph (e) of this
rule. The request for further review by an appeals committee must be submitted
to the coalition in writing within ten (10) calendar days of the date of the
executive director or other executive staff person designated by the coalition
board's written response to the recipient's formal written
appeal.
(f) The recipient
shall be given the opportunity to defend his or her position in an orderly
proceeding of the appeals committee. When the meeting of the appeals committee
is scheduled, the recipient shall be notified of the date of the appeals
committee, informed that it is a public meeting, and informed that any
information presented may be used by other state agencies.
1. The appeals committee shall be selected by
the Chairman of the Board of the coalition and a chair of the appeals committee
shall be named.
2. The appeals
committee shall be convened within forty-five (45) calendar days of receipt of
the recipient's request for an appeal.
3. The recipient shall be provided up to
thirty (30) minutes to present their position and any information they wish the
appeals committee to consider.
4.
The coalition staff, excluding the executive director or other executive staff
person designated by the coalition board, shall be available to provide any
information requested by the committee.
5. The appeals committee will consider all
statements, review all documents and may request any additional evidence or
information from the parties if an appeals committee member believes it is
necessary and relevant to the decision making. The required final determination
letter will be tolled for the length of time given to provide the additional
information.
6. The appeals
committee shall select or appoint a member of the coalition, excluding the
executive director the coalition or other executive staff person designated by
the coalition board, to memorialize the events of the appeals committee
proceeding and the final determination including the basis for the
decision.
7. The appellant shall be
notified in writing of the appeals committee's determination within ten (10)
days of the date of the meeting.
8.
The determination of the appeals committee shall be
final.
(5) The due process procedures for providers will be provided for in the contract between the coalition and the provider, pursuant to Rule 6M-4.610, F.A.C.
Rulemaking Authority 1001.213(2), 1002.91(4), (8) FS. Law Implemented 1002.91(4), (8) FS.
New 3-1-15.
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