Current through Register Vol. 24-18, September 15, 2024
Eligible child care providers described in WAC 170-290-0125
must comply with all provider responsibilities listed in WAC
170-290-0034. Failure to comply
causing a provider overpayment will result in a program violation finding and
may cause the agency to impose sanctions.
(1) Administrative errors are payment
discrepancies which result from a departmental mistake. Provider overpayments
caused by administrative error still require repayment of ineligible amounts.
Administrative errors will not result in a finding of a program
violation.
(2) An unintentional
program violation is an overpayment resulting from a provider's error and not
caused with willful knowledge.
(a) An
unintentional program violation can include a provider's unfamiliarity with
program rules and requirements.
(b) Any unintentional provider error
resulting in an overpayment will result in department consultation with the
provider.
(c) The department tracks
all unintentional program violations in order to identify program improvement
areas.
(d) Unintentional program
violations require provider repayment of ineligible funds.
(3) An intentional program violation is an
overpayment caused by a provider's willful failure to comply with program
rules.
(a) Any repeated misrepresentation of
invoices or other information submitted to the department or failure to submit
documentation upon request is an intentional program violation.
(b) If a provider has been consulted by the
department for billing concerns and overpayment but then continues to have
overpayment findings, then the department will impose sanctions as listed in
WAC 170-290-0279.
(c) Overpayments caused by intentional
program violations require provider repayment of ineligible funds.
(d) Beginning March 1, 2018, all intentional
program violations will be cited by the department, and providers with more
than three instances of intentional program violations will be subject to
review for program ineligibility.
(i) The
department has discretion to impose additional sanctions if a provider has more
than three instances of intentional program violations.
(ii) As per WAC 170-290-0280 and
170-290-0285, a provider can
dispute the department's finding of program ineligibility.
(4) Suspected fraud is a
departmental determination resulting in referral to the office of fraud and
accountability (OFA) at the department of social and health services (DSHS).
(a) Program fraud is defined in
RCW
74.04.004. Program staff at the department of
early learning and DSHS do not criminally investigate fraud. OFA conducts
criminal investigations and pursues prosecution of program fraud.
(b) Departmental program staff will identify
instances of suspected fraud when facts available to the department indicate
the provider willfully violated program rules. This includes repeated instances
of misrepresentation.
(c) Program
staff will not inform the provider when suspected fraud is referred to
OFA.
(d) Providers convicted for
program fraud are permanently barred from future participation in the program
as a child care provider or consumer.
Statutory Authority:
RCW
43.215.060,
43.215.070 and 2017 3rd sp.s. c 1
§ 615. WSR 17-23-033, §
170-290-0277, filed 11/7/17,
effective 12/8/17.
