Effective Date: 12/01/03
Revised: 12/12/19
Reference: None
Policy Statement:
All cases of suspected intentional program violations must be referred to the Illinois Department of Human Services, Bureau of Subsidy Management, Program Integrity and Quality Assurance Unit, for further investigation.
Procedure:
Refer cases of suspected intentional program violation to:
Illinois Department of Human Services
Bureau of Subsidy Management
ATTN: Program Integrity & Quality Assurance Unit
401 S. Clinton, 3rd Floor
Chicago, IL 60607
(312) 793-3610
A case of suspected intentional program violation can be brought to staff's attention through a variety of sources such as a phone call, letter, e-mail, newspaper article, television news broadcast, personal knowledge, or through state databases used during the normal eligibility determination process.
Generally, if staff are able to determine (1) what program violation occurred; (2) who committed the program violation; and (3) the period of time in question, the case does not need to be referred for investigation. Instead, determine the amount of overpayment; and direct the overpayment to the party (client or provider)according to the procedures outlined in 07.04.01.
If, however, there has been an allegation of a suspected program violation and staff are unable to determine the facts through the normal processes of checking program eligibility, a referral to the Program Integrity and Quality Assurance Unit is warranted. Staff may use the Child Care Program Referral Information for Investigation form found in Section 10 of this manual, or a written description of the suspected program violation may be submitted. In either case, the referral must include the following information:
- The client's name, case number, social security number (if available), and address;
- The provider's name, social security number or FEIN, and address;
- The name, birth date, and social security number (if available) of each child;
- The source of the information, i.e. anonymous caller, newspaper article, a concerned citizen who chooses to be named. If the caller chooses to be named, obtain the caller's name, address, and phone number;
- A detailed narrative description of how/what alleged fraudulent activity occurred;
- The name, agency, address, and telephone number of the person making the referral; and
- A copy of the entire case record including certificates for the period of time in question.
Staff in the Program Integrity and Quality Assurance Unit will review the information and determine if a referral for investigation is warranted. Suspected intentional program violations involving certificate providers are referred to the Illinois Department of Public Aid (IDPA), Bureau of Investigations. Suspected intentional program violations involving Site Administered contracted providers, the CCR&Rs, employees of the CCR&Rs, and State employees are referred to IDPA, Bureau of Internal Affairs. Additional information such as payment and eligibility information from the Child Care Management System, CARS, and KIDS, AWVS, PASDX... is often requested by these bureaus and will be provided by the Bureau of Subsidy Management.
All cases referred for investigation do not go through the investigation process. The Bureau of Investigations accepts cases based upon available information, the potential recoupment amount, and the availability of investigation staff. If a case is not accepted, it is returned to the Bureau of Subsidy Management. If the case is still active, a determination will be made as to whether an overpayment assessment is appropriate based upon any additional information that has been obtained. If an overpayment is warranted, the overpayment process will be initiated by Bureau of Subsidy Management staff according to the procedures outlined in 07.04.01. If a response is not received from the client/provider in a timely manner, the case will be turned over to the Bureau of Collections.
